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What did COVID-19 teach us about infection prevention and control?

There is no such thing as a once-in-a-century pandemic that reveals a rift in infection prevention and control (IPC) strategies. In parts of the world, the COVID-19 crisis was no exception.

Regulations such as the two-week hotel quarantine program were key to reducing community infections, but positive cases involving new foreign variants continue to break through.

Australia, one of the most stringent IPC systems, experienced 16 hotel quarantine leaks during the five months from November 2020 to April 2021.1

Meanwhile, a review of the Victorian Quarantine Program found that 90% of state cases were genomically associated with families who completed mandatory stays.2

In the field of elderly care as well, efforts to contain the outbreak are inadequate, with more than three-quarters of domestic COVID-19 deaths occurring in elderly care facilities.3

The healthcare sector wasn’t lacking in strong pre-pandemic IPC guidelines, but what did you learn about best practices?

Get ahead of the worst scenarios as soon as possible

One of the key observations about the IPC protocol surrounding COVID-19 worldwide was that it underestimated the potential for airborne propagation. Instead, measures such as hand hygiene, wearing surgical masks, and social distance focused primarily on the belief that surface droplets and parameters were the main causes of diffusion.

More than a year after these measures were introduced, evidence of airborne transmission has evolved and scientists are calling for public health guidance and a review of indoor ventilation systems. For example, the outbreak of COVID-19 in South Korea is believed to have been caused by a fecal aerosol caused by flushing the toilet.Four

But late discoveries cost us, and early IPC strategies didn’t anticipate this result — at least to the extent they should. World leaders, including Professor Paul Kelly, Australia’s Chief Medical Officer, have not denied the role of aerial transmission, but many claim it is minimal.

Appropriate PPE and training

Meanwhile, other experts argue that many of the existing IPC programs designed for medical-related infectious diseases (HAIs) such as norovirus lack the rigor required for a respiratory pandemic.

In most parts of the world, early supply of personal protective equipment (PPE) is inadequate, government-procured gear is unsuitable and reflects the modest role of airborne transmission.

Studies have shown that surgical masks and cloth masks have no effect on aerosols.Five Unlike respiratory particles, these droplets are less than 5 micrometers in diameter, travel up to 10 meters, and can stay in the air for hours. A P2 / N95 mask (a breathing PPE that fits snugly on the face) is more suitable for combating aerosols.6

Many early pandemic programs around the world also did not consider the importance of coordinated training to ensure proper use of PPE. This approach has proven costly in the field of elderly care, where the use of the IPC protocol and PPE is not functioning as prominently as in the acute care environment.

Training on other aspects of IPC, on the other hand, was inadequate within elderly housing with care, and many were uncertain about their responsibilities.

Strict IPC compliance from the beginning

The broader healthcare sector is no wonder about strict IPC measures, but it seemed that there was a delay in changing our collective self-satisfaction.

Cathy Dempsey of the New South Wales Clinical Excellence Commission said: ..

“Yes, the staff are aware of the obligations surrounding IPC, but at the same time there is a contradictory story that you have to continue when you feel a little sick, otherwise it will be difficult for your colleagues to live if you take a break. Thankfully, COVID-19 has taught me that this approach is unacceptable. “

COVID-19 clarified the focus on IPC measures, but otherwise the delay in creating leakholes in the watertight strategy could have led to broader behavioral compliance later.

In extreme cases, non-compliance is also an issue in some settings. In May 2021, the general manager of a Victorian hotel quarantine facility was allegedly stuck after visiting the facility for violating the IPC protocol and refusing to undergo COVID-19 testing.

Stamina is everything

The virus may have exploited a technical loophole in IPC strategies around the world, but one of the obvious wins is Australia’s lasting resilience, the glue that holds it all together.

Over time, behavioral compliance with IPC measures includes concentration, sacrifice, and stamina. For clinicians tasked with implementing the IPC protocol (restricting patient visitors, delaying treatment, reduced support), the journey was just as difficult as patients and their families often frustrated staff. ..

Nevertheless, Australia’s approach has not been abandoned, with a strong IPC and far lower death toll than other Western nations.

References

  1. https://theconversation.com/more-than-a-dozen-covid-leaks-in-6-months-to-protect-australians-its-time-to-move-quarantine-out-of-city-hotels- 159808.
  2. https://www.theguardian.com/australia-news/2020/aug/18/hotel-quarantine-linked-to-99-of-victorias-covid-cases-inquiry-told.
  3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (20) 32206-6 / fulltext.
  4. https://pubmed.ncbi.nlm.nih.gov/33346125/.
  5. https://www1.racgp.org.au/newsgp/clinical/guidelines-called-into-question-as-research-highli.
  6. https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article.

Image credit: © stock.adobe.com / au / tuastockphoto

What did COVID-19 teach us about infection prevention and control?

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