Anjali Bisht, MPH, CIC

As the health care setting progresses from focusing primarily on COVID-19 toward living with the disease, infection preventionists (IPs) are also grappling with how to continue a new era of infection prevention. Basic infection prevention principles, which may have been placed on the back burner for 2 or more years, are reemerging. Staff members are now coming to IPs for recommendations in areas where IPs previously may not have had as much oversight.

One subject IPs may start to see as being ideal for more feedback and collaboration involves environmental infection prevention. The role the area around us plays in infection prevention has become more evident throughout the pandemic. As health care systems restart projects that may have been put on hold, these opportunities may now be revisited. Some common environmental areas where IPs can provide valuable input include construction projects, water safety, and ventilation.

Construction projects in the health care setting greatly increase the possibility of pathogens such as mold and fungus being present in the environment. Organisms such as 

 can be found in environments where construction was or is occurring if proper infection prevention practices are not followed. In healthy individuals, this organism may not cause any harm or even be detected. However, in patients who are immunocompromised, this organism can cause respiratory illness that can be difficult to treat.

The Facility Guidelines Institute (FGI) is an organization that provides guidance around the planning, design, and construction of health care facilities.

 FGI requires that a tool, the infection control risk assessment (ICRA), be completed before all construction projects begin.

An ICRA organizes a construction project by classifying the type of work that will be occurring along with the level of risk involved should a project not be performed correctly. Depending on how the type of work and risk align, different expectations are listed for how the project should be carried out.

The ICRA document is to be filled out by the project manager of the construction site who will be providing oversight on compliance. Once a draft of the scope of work has been completed, it should be sent to the other key stakeholders such as those in safety and infection prevention. If there are questions on the scope of the project, IPs should feel comfortable asking for a job site walk-through.

Once the project is under way, and especially if there is high risk to surrounding patient care areas, IPs should go around the site weekly to ensure that the ICRA is being followed. Any concerns should be brought to the project manager for immediate rectification.

A water management program in a health care facility is key in mitigating the spread of infections. Common practices in health care systems, from providing oral care to patients to the reprocessing of medical devices, require use of water. If microbial growth is allowed to occur in any of these areas, it can pose a serious risk to patients. Among other organisms, a water management plan aims to mitigate 

 a genus of bacteria that can be transmitted to immunocompromised patients if they inhale contaminated water.

The CDC provides resources for better understanding of a facility’s current state regarding water safety. The agency’s guide, “Developing a Water Management Program to Reduce 

 helps explain the steps that should be taken in creating a water management plan.

IPs who may not know much about their facility’s water management plan should reach out to their facilities team to discuss and partner in the creation of a plan. One of the first priorities is to create a diagram of how water enters and leaves the facility. This allows potential hazards such as fountains, stagnant water, and high-risk units to be better identified. With these risks recognized, mitigation strategies can be put in place.

As has been emphasized during the pandemic, proper ventilation can lead to decreased risk of infection. The concept of ventilation as a means of reducing infection transmission risk has been a part of health care expectations since well before COVID-19.

The American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE), along with FGI, helps to provide best practice expectations for health care facilities relating to heating, ventilation, and air conditioning (HVAC) systems.

 Because air circulation is critical to reducing airborne transmission of communicable diseases, ensuring areas are regularly meeting the minimum air exchanges (MAC) for outdoor air is crucial.

In addition to MAC, the use of high efficiency particulate air (HEPA) filters is an added way of trapping particulates that may be present in the air. When deciding what type of HEPA filter to use, it is important to determine whether it has met HEPA classification and to know how often it needs to be replaced.

Because air is circulated through facilities throughout the year, the changing temperature and humidity of the outdoors can affect the HVAC system indoors. To curb the potential for microbial growth, it is important to review temperature and humidity standards as provided by ASHRAE and FGI for each area, to monitor regularly, and to know what to do if levels get out of range.

The risk of infection transmission in construction projects, water safety, and ventilation all reflect how these projects require multidisciplinary oversight. Professionals from environmental health and safety, facilities, infection prevention, and more must work to ensure that when changes are made to a facility, patient safety is kept at the forefront. Similarly, even during periods of stagnation, it is also important to review current workflows to ensure no additional changes need to be made.

Guidelines for Design and Construction of Hospitals

. Facility Guidelines Institute. 2018. Accessed February 10, 2022. 

https://fgiguidelines.org/guidelines/2018-fgi-guidelines/

Developing a water management program to reduce 

 growth & spread in buildings: a practical guide to implementing industry standards. CDC. June 24, 2021. Accessed February 10, 2022. 

https://www.cdc.gov/legionella/downloads/toolkit.pdf

ASHRAE offers course on the role of HVAC systems on infection control. News release. American Society of Heating, Refrigerating and Air-Conditioning Engineers. March 23, 2020. Accessed February 10, 2022.  

https://www.ashrae.org/about/news/2020/ashrae-offers-course-on-the-role-of-hvac-systems-on-infection-control

Articles

IPs can provide valuable input on construction projects, water safety, and ventilation.


Pandemic Places Importance of Preventing Environmental Infection at Center Stage

The approval of the Pfizer and Moderna coronavirus disease 2019 (COVID-19) vaccines for emergency use authorization in the United States has brought much attention and focus to the vaccination process. Because of the high demand for and low initial supply of the vaccines, the government has sought to prioritize them for individuals at highest risk for complications from COVID-19, and those who hold essential service roles that are vital to a functioning economy and health care system.

By all accounts, the rollout is still a work in progress. On January 12, Alex Azar, former head of the Department of Health and Human Services, said that focusing on health care workers and long-term care facilities has led to a vaccine distribution bottleneck. Azar issued a directive saying that people aged 65 years and older and those 16 years and older with a comorbidity should be considered priorities for vaccination. That, in effect, pushed about 163 million more people—about half the population—to the front of the vaccine line.

But back to health care systems. What many people outside the health care realm do not realize is that vaccination logistics and planning is in the yearly wheelhouse of hospital systems. Vaccinations to combat a variety of diseases are given every day, from the first-dose hepatitis B vaccine given to a newborn, to the tetanus, diphtheria, and acellular pertussis (Tdap) booster given after one scrapes against a rusty nail, to the yearly influenza vaccination.

The role of an infection preventionist (IP) in vaccination efforts is important, both to patients and providers, regardless of whether the setting is a large hospital system or a small provider’s office. IPs can help to provide best practice recommendations on immunization, from explaining sterilization techniques, to educating health care staff on the importance of vaccination, to working with occupational health in tracking rates of vaccination.

Not all IPs can administer the vaccine directly as some lack a health care degree, but they can be subject matter experts in the logistics of large-scale vaccinations. As such, it is important they participate in multidisciplinary projects involving vaccination efforts.

Proper infection control practices in vaccine administration are critical to ensuring safety and efficacy. Vaccine vials must be disinfected with sterile alcohol prep pads prior to each withdrawal and a new, sterile needle and syringe used for each injection.

Vaccines should be drawn up in clean medication preparation areas that are not next to any dirty items, and doses should be administered as soon as they have been drawn up to avoid any potential for spoilage. For vaccines that have been prepared for administration, the date and time should be marked on the syringe to alert the administrator to when the vaccine can no longer be given.

A common misconception about vaccine administration is that gloves must be worn. Per Occupational Safety and Health Administration regulations, gloves are not required when administering vaccines unless the individual administering the vaccine has open lesions on their hands or is likely to come in contact with a patient’s body fluids.

 If gloves are worn during vaccine administration, they must be removed between each patient and hand hygiene must be performed before donning a new pair of gloves.

If gloves are not worn, hand hygiene should be performed between each new patient administration.

Vaccine hesitancy is another area in which IPs can aid departments in helping alleviate fears and answering questions. Whether it be the influenza or the COVID-19 vaccine, the misconceptions surrounding them or fear of what may occur post vaccination are just 2 reasons that individuals may choose to not receive the vaccine.

IPs can help to engage health care employees and answer questions while also directing them to primary resources for further information. These include the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). IPs can also coordinate with physicians and other subject matter experts on common areas of vaccine hesitancy among staff, and work with key stakeholders to address them.

As vaccine rollouts begin, IPs can also partner with occupational health teams to track and trend adherence with vaccination. Regarding annual influenza vaccination of health care staff, hospitals must report adherence rates to the National Healthcare Safety Network.

Often, IPs may be the only individuals who have access to this website, so it is vital they work with occupational health to obtain accurate counts of adherent and nonadherent staff. Trending health care vaccination rates by department or role type can also be valuable indicators for how to focus education efforts during the following years to increase adherence.

Although we do not yet know if the COVID-19 vaccine will be recommended yearly or whether it will offer longer immunity against severe acute respiratory syndrome coronavirus 2, health care facilities will continue to provide the influenza vaccine yearly to employees. They will also be prepared to modify their processes to help increase adherence rates, and IPs can collaborate in these efforts as well.

ANJALI BISHT, MPH, CIC, is the lead infection preventionist at an academic medical center that comprises a number of hospitals and an extensive primary care network in the Los Angeles region in California.

Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. 

Surveillance for healthcare personnel vaccination. CDC. Updated December 2, 2020. 

https://www.cdc.gov/nhsn/acute-care-hospital/hcp-vaccination/index.html

Infection preventionists can coordinate with physicians and other subject matter experts on common areas of vaccine hesitancy among staff, and work with key stakeholders to address them.

How Infection Preventionists Will Handle COVID-19 Vaccinations

Creating vaccines for coronavirus disease 2019 (COVID-19) and getting them approved by the US Food and Drug Administration (FDA) proved to be an arduous task fraught with scientific and logistical hurdles. Now comes the hard part: Getting those vaccines widely distributed to the right people. Where do infection preventionists (IPs) fit into this part of the pandemic response?

There are 2 overarching levels of vaccine implementation: regional public health mass vaccination planning and local, targeted efforts for specific populations. In both areas, IPs need to be involved in planning and implementation. IPs have both education and training in public health and outbreak response as part of their core concepts to become an IP. Also, many IPs work closely with local, regional, and state public health partners on a regular basis, so the relationships are already built.

The first wave of vaccination is focused on large-scale public health-driven efforts. These are being implemented at the state level for distribution to focus on healthcare workers and residents of long- term care facilities. These efforts clearly must be multi-disciplinary in order to have effective planning and viewpoints that can bring creativity to solve the problem of how to effectively distribute millions of doses of a vaccine that require very specific handling and storage parameters.

For example, the Pfizer-BioNTech vaccine requires ultra-cold storage and will be allocated in large dosage counts, requiring vaccination of large groups over a short time period. The teams need to include providers, pharmacists, public health, healthcare facility leadership, emergency management, and other local leaders. It is likely that members of these groups have not worked closely together before on such a large-scale task. It will be crucial to function with a hospital incident command system to keep the group moving forward with the same objectives and bring obstacles to the forefront quickly for rapid problem solving.

IPs have been working scenarios of mass vaccination for years, in preparation for pandemic flu primarily, but also with potential biological threats (anthrax, smallpox) and other outbreaks such as measles and pertussis. These skills and insights make IPs and their public health colleagues subject matter experts on the nuances of mass vaccination. For example, some hospital systems would take the opportunity to turn annual employee flu vaccination into a drill and treat it as if it were a mass vaccination event in collaboration with emergency management colleagues. These events would teach valuable lessons in the best way to reach all staff, including having multiple vaccination administration locations and the best way to handle the data collection necessary to track large scale vaccination efforts.

Infection prevention needs to be a partner in the large-scale planning that is occurring currently in most states and local healthcare facilities. These efforts are largely being led by public health on state or regional levels, but the local hospitals will also need to plan when vaccine is distributed in future tiers for local administration. Not only to help with logistics of vaccine storage, administration, documentation, and data collection and reporting, but also to focus on safety of the workers and vaccine recipients of the vaccine clinics. Staff use of personal protective equipment (PPE), workflow to ensure social distancing and decrease crowding, and cleaning and disinfection practices of the clinic site are all logistical concerns that should be addressed in the planning stage to avoid potential exposures or contamination concerns.

Another area for concern is the cold storage and transport of the vaccine. Specialized freezers and transport companies that can safely move vaccine shipments from distribution sites to clinics are necessary to maintain that cold chain delivery system. Specialized transport companies that have experience in this type of system will be in high demand and IPs can help evaluate the processes of these third-party vendors to ensure they will be able to accommodate the level of transport needed and maintain the storage parameters of the vaccines.

Data collection for the large-scale clinics will likely be mediated through health departments, but the details of tracking, knowing which employees did receive the vaccine, and communicating that to the local healthcare facilities will need to be addressed. Each state will likely have to determine the best way to communicate vaccine administration, but it will also be the responsibility of each employee to report their vaccination status back to the healthcare facility.

Hospital vaccine programs are historically a collaborative effort between infection prevention and employee health programs. As COVID-19 vaccine efforts continue, there will need to be consideration of how that will be managed within the context of the current hospital-based vaccination programs. How will a COVID-19 vaccine be handled at each facility? Will it be mandatory? Will it be given annually? Will it be a condition of employment? These are all questions that will need to be addressed. There are some unknowns at this point, including the need for annual boosters, required storage needs, and data reporting.

Infection prevention is also a key partner with employee health programs to promote vaccine uptake and educate on the mechanism of how the vaccine works and potential side effects. As these new vaccines are approved for distribution, it will be key for IPs to learn about the studies completed to date to have an understanding of these key points to help with staff education. Reviewing the articles published during the trials, as well as the recommendations from the federal programs will help IPs become knowledgeable about the vaccines. Also, key information that IPs will likely need to address will be side effects, efficacy, and recommendations of priority risk groups (such as healthcare workers, elderly, essential workers, etc). IPs can help address these questions through rounding and education opportunities, published newsletters and new employee orientation.

Planning for the logistics of how vaccine will be distributed locally will take much effort. Some items to consider are the timing of when staff will receive their dose and when they work their next shift. As virtually all healthcare facilities are screening for COVID-19 symptoms, the reactions to a vaccine may potentially meet some of those criteria, such as low-grade fever or malaise. It will be important to plan for this as an organization, to consider that with screening or plan for staff to have 24-48 hours after their dose before their next shift. The calculations will also need to include the fact that the vaccines are given in 2 doses.

Planning for this process should already be starting. As many healthcare facilities are operating under the hospital incident command system, the vaccine administration can be brought under that structure and would already have all the key departments at the table to help coordinate.

Data reporting for COVID-19 vaccination will likely be extensive. Many employee health programs may not have the reporting capabilities to handle the level of data collection and tracking that will be necessary for this initial wave of vaccination. Often employee health programs do not have electronic systems that integrate with other reporting programs or link to state health departments, therefore much of the work will be manual. Infection prevention needs to advocate for improved data systems for employee health tracking, which will not only be beneficial in the COVID-19 vaccine process but, going forward, for all other employee health activities.

One thing that IPs must remember: Vaccination is not the end of this pandemic. Most likely, the vaccination rate needed to provide sufficient population immunity to control spread is around 80%.1 It will take years to achieve that level of vaccination, if at all. So, the vigilance of basic infection control measures will need to be maintained in some fashion until such a point. This is part of the IP toolkit.

Having worked with vaccine preventable diseases for decades, IPs understand that vaccination is not the only way to prevent disease transmission.

Behavior modification, engineering controls, such as modifying traffic patterns and increasing ventilation air exchanges, and other active processes are key to a multi-focal prevention plan. Universal masking will continue in healthcare facilities and hopefully on a community level for some time, until population immunity is of a sufficient level or community spread is low to minimal.

REBECCA LEACH, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a member of Infection Control Today®’s Editorial Advisory Board, currently works at a healthcare system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

1. Bartsch SM, MPH, O’Shea KJ, Ferguson MC, et al. Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention. Am J Prev Med. 2020;59(4): 493–503. doi: https://doi.org/10.1016/j.ajic.2020.10.018

Infection preventionists can coordinate with physicians and other subject matter experts on common areas of vaccine hesitancy among staff, and work with key stakeholders to address them. As vaccine rollouts begin, IPs can also partner with occupational health teams to track and trend compliance with vaccination.

Infection Preventionists Play Crucial Role in Vaccine Efforts

When many hear the words “frontline healthcare worker,” roles of physicians, nurses, or other healthcare professions are usually what come to mind first. Many ancillary roles within healthcare also hold essential positions, and one such area that is often overlooked by both the public and by staff is that of the environmental services (EVS) team. The EVS department is an indispensable team that is often left unnoticed when things are going well. However, if patterns of hospital-acquired infections (HAIs) emerge, the role of the environment is an area that is quickly emphasized to review.

The arrival of coronavirus disease 2019 (COVID-19) has brought a focus on how the environment plays a part in the potential transmission of infections. Although just how much contact surfaces contribute to the transmission of SARS-CoV-2, the virus that causes COVID-19, is unknown, routine disinfection is still one prevention strategy that is important to stop the spread of COVID-19.

As the hospital room and its surroundings are so critical to the wellbeing of patients and staff and the prevention of the transmission of infections, it is vital that infection preventionists (IPs) work closely with the EVS department to ensure that both teams are on the same page with best practices.

The partnership between IP and EVS is multifaceted. Many hospitals have moved away from hiring their own EVS employees and instead contract out to larger EVS companies. When this is done, the contracting company usually puts together a cleaning and disinfection plan for the hospital based off of a standard for their company. Although there are many positives to this process, as many of the methods used have been tried and improved at other facilities, it is still important for IPs to be involved in ensuring the standards that the EVS team is using are appropriate for the facility.

If the EVS department is not contracted, the IP relationship may have to be closer to help to provide recommendations and options for common disinfection processes. Regardless of whether your EVS department is contracted, the following items are important for every IP department to be aware of as it relates to a facility’s EVS program.

There is a large variety of disinfectants that are available in the hospital setting and the disinfectant wipes that may be routinely found on the units are often not the same disinfectants that the EVS team will use for daily and terminal cleaning of rooms and areas throughout a facility. The IP department should be aware of the disinfectants the EVS department uses for different surfaces as well as the contact wet time for each chemical. The EVS department should always have a bleach or sporicidal disinfectant at minimum to ensure disinfection against organisms such as Clostridioides difficile and Candida auris. Oftentimes at least 2 main disinfection chemicals will be used so as not to degrade equipment if using only bleach.

IPs spend a large amount of time educating healthcare providers on how important the prevention of the transmission of infections is in the healthcare environment and encouraging everyone to follow best practices and be comfortable in the work that they are performing. When providing this education, it is also essential to also target EVS staff and to do so on a routine basis. Explaining the different isolation signs and the personal protective equipment (PPE) that is associated with each isolation is critical to ensuring that the EVS team not only ensures its safety, but also minimizes the risk of transmitting infections to another room as further rooms are cleaned each day.

When educating EVS staff, IP staff should be cognizant of the methods used. As EVS practices are manual, providing more visual education through in-services is often more helpful to staff than providing handouts or writing emails. Additionally, when providing education on PPE donning and doffing, it is helpful to provide practice sessions so that staff feel comfortable with wearing PPE. Stressing the role PPE plays to EVS staff is important to help alleviate any fears in entering patient rooms as well.

When disinfecting a room, one should work from the area that is most to least dirty. Many contracted EVS companies have their own standard approach to room disinfection so that each employee follows the same order when disinfecting a room to limit variation and also allow staff to remember the process. IPs should review this process as well and offer feedback on any opportunities for improvement they may notice.

Apart from daily room disinfection, it is important that a system is in place for EVS teams to be aware of patient discharges so that terminal cleaning of rooms can be completed as soon as possible. In doing so, a system should be in place for notification upon discharge to EVS, and also so that the EVS team is aware if the room being disinfected is an isolation room. Depending on whether or not the room housed a patient who was on isolation, PPE may need to be worn during the disinfection process. Some ways to ensure this transparency is to allow the EVS team to connect with a hospital electronic medical record system so that they can view whether or not a patient was on isolation or, if isolation signs are used throughout the facility, to keep the sign on the door after a patient has been discharged so that the EVS team is aware of the isolation when it arrives to perform a terminal disinfection.

As the importance of the role the environment plays in the prevention of hospital-acquired infections has continued to stay relevant, additional disinfection methods to pair with manual terminal cleaning have been explored. Two such common methods to reduce surface contamination after manual cleaning are ultraviolet (UV) light devices and hydrogen peroxide systems. Multiple studies have demonstrated the benefits regarding using one of these methods in addition to already established disinfection practices. These methods will not remove soil from items but can disinfect and inactivate organisms that may still reside on surfaces. Although these devices can be beneficial, they do come at a large cost. When providing a business case to your facility on the utility of using an additional device, a plan must be developed for how to staff the machine to get the most use out of it. If one of these machines lays idle, it brings into question the utility of its purchase, and so it’s helpful to provide this information as a part of the business case for its purchase. Validating the compliance of following the disinfection expectations is a way to provide education to the EVS team of potential opportunities for improvement. IPs can work with EVS leadership to implement a routine practice for quality assurance checks that EVS leadership can follow. These metrics can then be reviewed as an aggregate with the IP department to target whether further education may be beneficial. Two such ways to perform a review of disinfection practices are through blacklight inspections and Adenosine triphosphate (ATP) monitors.

Blacklight inspections are the process of an individual marking different surfaces with a fluorescent gel or powder prior to disinfection of a room. After the room has been disinfected, the marked areas can be checked using a blacklight. If the area that was marked was disinfected properly, the fluorescence will no longer be present. If, however, the area was missed, the area will light up.

ATP monitors work by using bioluminescence to detect residual bioburden on swabbed surfaces. ATP devices can be found through a variety of healthcare vendors and give off a number to identify the amount of bioburden on a surface in relative light units. EVS teams can use this method to swab high-touch surfaces such as bedrails, doorknobs, call lights, and tray tables, to identify whether or not bioburden had been removed from these surfaces. Higher numbers through these swabs can signify the need for re-education and feedback to staff.

As we learn more about COVID-19 and its role in the environment, keeping your EVS team informed is critical to maintaining their trust in IP and in the work that they do. COVID-19 has not limited the work that the EVS team does but rather has increased its workload and so it is vital to always make sure the team is aware of the positive impact it has each and every day.

ANJALI BISHT, MPH, CIC, is the lead infection preventionist at an academic medical center that comprises a number of hospitals and an extensive primary care network in the Los Angeles region.

Infection preventionists can work with environmental services (EVS) leadership to implement a routine practice for quality assurance checks that EVS leadership can follow. These metrics can then be reviewed as an aggregate with the IP department to target whether further education may be beneficial.

How to Train Environmental Services Teams

Along with it brought the generosity of many to help others in a variety of ways. As hospitals and healthcare facilities quickly began to run out of regular supplies such as personal protective equipment (PPE) and hand sanitizer, numerous companies and individuals quickly offered their support in the form of donations of supplies or production of much-needed items. However, with the abundance of donations and new products that have come to market, it is important to still validate the effectiveness and authenticity prior to use in the healthcare setting.

As COVID-19 spread through the United States, inventory of PPE rapidly declined and, as respiratory season continues, the potential for PPE shortages remains. When purchasing or accepting PPE or other medical supplies from new manufacturers, the following criteria are important to consider.

Obtaining Samples Prior to Purchase or Donation

COVID-19 has offered the opportunity for new manufacturers and inventors to come to the market, especially when it comes to healthcare supplies. If it is possible to obtain samples of products that are available for purchase or donation before they are bought or delivered, multidisciplinary teams can have the opportunity to review items to determine whether the items will be useful and where they can be best used. For inventors who are hoping to donate products, this can also be a way to offer feedback so that changes can be made before products are donated.

Gowns, gloves, facemasks, and eye protection worn in clinical settings all have standards to prove compliance in how products are made and used. Common standards organizations are ASTM Inter- national (indicated by the symbol ASTM on products, formerly the abbreviation for the American Society for Testing and Materials)

, American National Standards Institute (ANSI)

, the National Institute for Occupational Safety and Health (NIOSH)

, and the US Food and Drug Administration (FDA)

. Many of these standards have been made readily available during the pandemic. Supplies which do not meet these standards, should be carefully assessed on whether clinical use is appropriate.

Although proof of standards on packaging and PPE are often good indicators that products have been validated, throughout the pandemic, many have seen the use of counterfeit products which are falsely marketed and sold. One of the most common imitated PPE items hospitals have seen have been respirators. NIOSH regularly updates its website

 to show non-NIOSH- approved respirators and common signs to indicate that respirators may be counterfeit.

Lastly, when evaluating new PPE, consideration in how the PPE may affect donning and doffing should be reviewed. When new PPE is brought into a facility, additional training may also need to be feedback so that changes can be made before products are donated.

Two items which many infection preventionists (IPs) are infamous for always having with them are hand sanitizer and disinfectant wipes. These products have not only vanished from stores and hospital shelves, but have significantly increased in price. As many common brands of hand sanitizer and disinfectant wipes ran out of stock, manufacturers of other products have come to the market with their own versions of these highly sought after items. When accepting or purchasing hand sanitizer, the US Centers for Disease Control Prevention (CDC) recommends the use of an alcohol-based hand sanitizer that contains at least 60% alcohol.

 Hand sanitizer that contains higher amounts of alcohol is not necessarily better as it can lead to skin drying or adverse reactions. In addition to the amount of alcohol, scent should also be considered, as fragrances in the healthcare setting can affect both patients and healthcare staff.

Prior to purchasing new wipes to use in facilities, it is important to make sure that they are not only effective, but that the con- tact wet time to be effective is a reasonable time. Because SARS-CoV-2 is a novel virus, the US Environmental Protection Agency (EPA), developed a database, known as List N

, which is updated frequently to document products which are effective against SARS-CoV-2 along with the contact time required. After ensuring wipes are appropriate for use, it is also vital to check that they are compatible with equipment that will need to be disinfected.

Generosity during the pandemic has not only been seen with medical supplies. Many businesses, including restaurants, have wanted to show support to frontline providers through the donation of food. In accepting food donations on units, requesting individually packaged meals over buffet trays is preferred. If food is brought to a unit, remembering to place it in the refrigerator if it is not consumed in a timely manner is also important to avoid spoilage. When eating, remembering to stagger meals in common spaces is also a priority to reduce the number of individuals to maintain physical distancing.

As time goes on, the hope is that the supply chain for much needed products will be restored. In the interim, it is important to maintain standards in bringing in new items and donations to protect not only healthcare providers, but anyone who enters the health system as well.

If you are an IP and are not currently involved in product review, now may be a great time to reach out to your supply chain team to explain the perspective you can bring to the table and ask to be involved. Multidisciplinary teams can be formed to provide guidelines for what to look for when supply chain teams have to purchase products with a quick turnaround and samples cannot be obtained utilizing the guidelines provided above. If products can be reviewed in person, further comments can be provided as each product is analyzed to further document the importance of an evaluation. In all sectors of how COVID-19 has impacted us, it has also shown us the many ways in which working together as a team benefits everyone.

ANJALI BISHT, MPH, CIC, is the lead infection preventionist at an academic medical center that comprises a number of hospitals and an extensive primary care network in the Los Angeles region.

ASTM Standards & COVID. ASTM International website. Accessed October 1, 2020. 

Coronavirus: European standards for medical supplies made freely available to facilitate increase of production. European Commission website. Updated March 20, 2020. Accessed October 1, 2020. 

https://ec.europa.eu/commission/presscorner/detail/en/ip_20_502

Association for the Advancement of Medical Instrumentation (AAMI). 

ANSI/AAMI PB70:2012 Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities.

Approved Particulate Filtering Facepiece Respirators. CDC website. Updated April 9, 2020. Accessed October 1, 2020. 

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html

Coronavirus Disease 2019 (COVID-19). FDA website. Last Updated 10/1/2020. Accessed October 1, 2020. 

https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19#products

Counterfeit Respirators/Misrepresentation of NIOSH-Approval. CDC website. Updated September 29, 2020. Accessed October 1, 2020. 

https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html

Hand Sanitizer Use Out & About. CDC website. Updated September 10, 2020. Accessed October 1, 2020.

List N Disinfectants for Coronavirus (COVID-19). EPA website. Updated October 1, 2020. Accessed October 1, 2020. 

https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19

If you are an infection preventionist and are not currently involved in product review, now may be a great time to reach out to your supply chain team to explain the perspective you can bring to the table and ask to be involved.