During a recent webinar I presented with Ann Geier, chief nursing officer for Surgical Information Systems, I covered the myriad areas of consideration for returning to normal ASC operations from an infection prevention perspective. As I was preparing for the webinar, I came across a quote from legendary NC State coach Jim Valvano: You need to have a dream, a goal, and you must be willing to work hard.
Needless to say, you are working hard right now as you begin to come back online following the COVID-19 slowdown or shutdown, depending on your situation. But have you thought about your dreams and goals to ensure that your hard work pays off?
Goals for Consideration
- Provide the cleanest, safest, and most sanitary space possible.
- Do a thorough environmental cleaning before re-opening. Make sure you've addressed every nook and cranny in your center, not just clinically, but everywhere when it comes to your environmental cleaning. Go inside your cabinets, drawers, baskets, linen carts – basically anything that contains supplies and sterile instruments. Don’t forget your refrigerators. Chances are someone left their lunch way back in March.
- Make sure your HVAC system is in compliance with ASHRAE 170 ventilation requirements in critical areas, such as operating rooms.
- Establish a cleaning schedule for your clinical areas and your reception area. You may never have cleaned your reception area before other than fixing magazines and picking up trash. But now you should consider how often to wipe down furniture and make sure you have hand sanitizer available.
- For terminal cleaning, decide if you will just clean at the end of the day or after every case. Or perhaps, you will choose to clean after aerosol-generating cases and at the end of the day.
- Plan for isolation. If you need to isolate somebody that has COVID-19 symptoms, how are you going to handle that situation? Are you going to walk them out the door? Are you going to create an isolation area behind a curtain until you can test them, assuming you are doing test? It is up to you to decide what is best for your center but be sure to have a written plan and educate all staff so they will know what to do if the situation arises.
- Review products such as cleaning supplies and disinfectants to be sure you have what you need based on the manufacturer’s instruction for use. Also check to be sure all products are within the expiration dates. If you haven't been using them, they might be out of date now.
- Update your medication list.You may have had to change medications due to shortages, so be sure to write down or update your medication list in your software.
- Have a training plan. Make sure that you have trained your staff, your providers, and anyone coming into your center, on your infection control policies and procedures. Everyone is responsible for complying with rules, regulations, and your policies, including vendors. Eventually ASCs will reopen to invited guests, so they will need to be trained on your infection control plan and be held accountable for compliance. We have to be diligent at all times.
- Take a look at your emergency kit to be sure it includes items you now need such as hand sanitizer, masks, and PPE that you likely never had in your emergency kit before. Whoever is responsible for your emergency preparedness should talk with your infection preventionist to determine what should be in it and where it should be located.
- Review your infection control plan and use this as an opportunity to take your plan to the next level. Get your team together to work on the plan – everyone plays a role in infection prevention. Someone in the front office who hasn’t had a hand in the infection control plan in the past may have good ideas about what to do for infection control in the lobby area, for example. So, get all team members involved. Also keep track of all changes that are implemented. Document any policy additions, revisions, and addendums. You don’t have to change your policy for COVID-19, you can just have a written addendum.
Compliance
There’s a lot to think about with infection control, but all the planning, policies and procedures don’t mean a thing without compliance. So, how do we get compliance? First, you will need to perform a lot more surveillance than you've had to in the past. You want to make sure that people are doing what they're supposed to be doing, what you've trained them to do. If we standardize all our processes, then it's a lot easier to do it right every time. So, try to standardize procedures for things like donning and duffing PPE.
I’m a big proponent of praising in public and criticizing in private. If people are doing a good job with infection control, give them a shout out in front of their peers. If you need to address an issue with a staff member, do it in your office with the door closed, and put it on you. “Did I not train you appropriately? Here, let's try this.”
Finally, you want to stress the benefits and the rationale of why you are implementing or pushing change, or simply showing how infection control is supposed to be done, whichever the case may be.
Leadership’s Role
Your governing board, your medical director, your clinical leaders, your infection preventionist. These are your leaders who you can lean on to support training and compliance. You want them to lead by example so be sure they are properly trained so they can do things appropriately all the time. As the saying goes: Follow my lead.
Your leaders are also there to support your policies and procedures. If as an infection preventionist or administrator, you think that A is better than B, you need your leaders to support “A.” To be sure they support your policy or procedure, you will need to educate them on your rationale.
Infection prevention is ongoing. You and your leaders are always educating on policies and procedures that will help you reach the ultimate dream of infection control: to keep all staff, providers, and patients safe and well.
If you are interested in learning more about how to move forward with infection prevention during these times, you can watch a replay of the full webinar here.