infection prevention
By Phenelle Segal , RN , CIC , FAPIC
COVID-19 Lessons Learned at Nine Months
November 2020 signifies an unprecedented nine months into the COVID-19 pandemic that took the nation by surprise and resulted in a tragedy on many levels . The intensity and speed with which this virus entered the United States turned healthcare facilities upside down across the continuum of care . Acute-care hospitals were unprepared with inadequate supplies of personal protective equipment ( PPE ), disinfectants and equipment , thereby creating challenges of unprecedented proportions . Hospital beds were filling at alarming rates and several hospitals were turning non-clinical areas into wards or units . Makeshift hospitals were being erected in some cities and staff shortages were extreme .
Long-term care and outpatient facilities , including doctor ’ s offices and clinics , were unable to obtain supplies due to demand outweighing supply and this resulted in a state of chaos . Nursing homes and other long-term care settings in many regions were hit very hard with facility outbreaks and many elderly residents died . Lack of preparation was not necessarily the fault of the individual facilities or offices and practices , but rather , akin to the “ big earthquake .” Unpredictable until it happens and particularly with such intensity .
Well into the pandemic , due to the diligence of the healthcare industry , Food and Drug Administration ( FDA ), Environmental Protection Agency ( EPA ) the Occupational Safety and Health Administration ( OSHA ) and private organizations as well as supply companies , obstacles have been approached aggressively . Depending on the location of facilities and the number of COVID-19 cases , supplies including personal protective equipment or PPE have become more available , albeit an ongoing shortage of N95 masks for some acute-care and non-acute care settings . Many facilities have been able to revert to conventional
Surge Capacity
capacity as per the Centers for Disease Control and Prevention ( CDC ) guidance developed earlier in the pandemic for optimizing PPE .
A critical component of the ability to respond to large-scale disasters is surge capacity . Surge capacity is defined as “ a healthcare system ’ s ability to expand quickly beyond normal services to meet an increased demand for medical care ” or “ the ability to expand care capabilities in response to sudden or more prolonged demand .”
Emergency preparedness and planning in response to the terrorist attack on 9 / 11 was ramped up and beginning in 2003 , the Joint Commission required all acute-care hospitals to develop a written plan based on facility hazard vulnerability assessments . In 2004 , the Agency for Healthcare Research and Quality ( AHRQ ) expanded its Bioterrorism Planning and Response research and focused on ways to expand bed capacity in hospitals and develop surge requirements . In addition , in 2008 the U . S . Department of Health and Human Services ( HHS ) and the CDC were included in the emphasis on emergency preparedness and planning , with
the Department of Homeland Security funding initiatives .
Effective emergency preparedness in healthcare requires planning for large-scale situations that affect many people . These events include terrorist attacks resulting in multi-casualty trauma , chemical , biological and radioactive events . Infectious disease epidemics and pandemics between 2003 and prior to COVID-19 included severe acute respiratory syndrome ( SARS ), Middle Eastern Respiratory Syndrome ( MERS ), H1N1 flu and Ebola virus . Each event includes subtle differences in the type of capacity needed , but general principles apply .
For at least two decades , hospitals have provided a written plan evaluating their hazard risks , resources , and an idea of their general ability to handle a surge including highly transmissible infectious agents . Prior to COVID-19 , long-term care facilities ( LTCFs ) which includes nursing homes , assisted living facilities , and rehabilitation centers , were expected to address surge capacity for the purpose of being available either for acute-care patients or for patients who were discharged early from traditional acute-care facilities to make beds available for additional acute-care victims needing hospitalization .
Nursing homes had plans in place for some public health emergencies , but many had not done planning specific to pandemics such as COVID-19 . Natural disaster plans were available such as those for wildfires and earthquakes . Planning was also depended on facility location and State requirements .
In planning for emergencies , concerns in nursing homes included caring for special patient populations during an emergency . Concerns about staffing in an emergency were seen across the board and staff were reluctant to leave their families . Lack of adequate amounts of medications and medical supplies as well as storage space for such were of concern too . Many nursing homes were willing to accept residents from area hospitals but concerns regarding the patient acuity levels and subsequent staffing and building capacity issues were of concern .
Key Components of Surge Capacity The key components of surge capacity are known as “ 4 S ’ s ” and include Staff , Stuff , Structure and Systems .
Staff
Key personnel include clinical staff such as physicians , nurses , respiratory therapists , pharmacists and technicians . Support staff such as environmental services , physical plant services , security services and clerical workers are indispensable during a pandemic . Intensive care units and emergency departments are two areas that require a tremendous number of staff . Repurposing of staff may be required including retired clinical personnel or those with expired professional licenses . Staff shortages due to long shifts and physical exhaustion , PPE burnout due to mandatory use , emotional burnout , resignations , inability to work due to childcare or elder care needs and ill personnel with several deaths are expected . Stuff