Sylvia Garcia-Houchins
Infection Prevention and Control Director, The Joint Commission
As the COVID-19 pandemic continues to disrupt society and claim lives, one segment of the population is paying a tremendous price: front-line healthcare workers. The International Council of Nurses (ICN) estimates that over 90,000 healthcare workers have been infected, and 260 nurses have died as a result of the disease, giving rise to questions about how we can better protect them.
“A huge challenge is inequity across the continuum of care,” says Sylvia Garcia-Houchins, infection prevention and control director at The Joint Commission, a nonprofit healthcare accreditation organization. “There’s such a vast spectrum of healthcare that the challenge differs for every organization.”
A trio of challenges
For Garcia-Houchins, the challenges coming in the wake of the COVID-19 pandemic are familiar. “I’ve been in infection prevention (IP) since 1985 — that’s a long time. I’ve seen anthrax, I’ve seen MERS and SARS, H1N1, and Ebola.”
The challenge facing healthcare workers worldwide is threefold. First, it’s simply getting the personal protective equipment (PPE) they need. “If you’re working at a large academic teaching hospital, you are supported by a robust infection control program,” she notes. “Compare that to the small nursing care center taking take care of elderly patients. Not a lot of resources, not a lot of money, no big contracts. How do they get their PPE? And then you have the behavioral health professionals seeing patients in their offices who really don’t think about PPE because they don’t see those whom people would classically consider ‛sick.’”
Feeding into PPE supply-chain shortages is how many healthcare organizations think about budgeting. Sylvia Garcia-Houchins notes that many administrators rely on ‛just-in-time-delivery’ to get PPE supplies when needed, but that this only works for large facilities. “There are just a few main distributors of healthcare products — I call them ‘The Big Three,’” she says. “If you have a contract with them, you’re going to get first priority for that PPE.”
But even when organizations can acquire the PPE they need, there is often a lack of proper training. “Everybody takes it for granted that if you’re a healthcare professional you know how to put on gowns, and you know how to take them off,” notes Garcia-Houchins. “But studies show that a large proportion of healthcare providers do not know how to safely take off personal protective equipment.”
The third challenge in terms of protecting our healthcare workers is information. “It’s happening so fast, there’s no time to peer review everything,” Garcia-Houchins observes. “And social media allows for the transmission of both good data and information that helps to make people safe, but also personal opinions that are unsafe.”
Solutions
Garcia-Houchins knows exactly what needs to happen: standardization. “I think we need to get everyone on the same page as far as methods of protection,” she says. “What caused a lot of distrust was how COVID-19 guidance changed every day. The Joint Commission heard that loud and clear from healthcare providers. In general, healthcare providers were unaware of a plan for de-escalating PPE and then targeting PPE.” Garcia-Houchins also wants to see standardization in how PPE is put on and taken off. “And not only standardize it,” she says, “but also train healthcare workers consistently — and prove competency.”
Garcia-Houchins stresses that we have to stop thinking about these issues separately and start thinking about a holistic program. “Just providing PPE is not going to be enough. Only telling healthcare workers to wash their hands is not going to be enough. We have to establish multiple preventative systems that truly work, that truly look at how we stop that first case from entering a facility and exposing a healthcare worker. One prevention method is not enough. We need to follow the hierarchy of controls.”