Healthcare workers may be vigilant with personal protective equipment (PPE) around COVID-19 patients, but inadvertently expose colleagues when they take breaks, socialize, and eat, said Connie Steed, MSN, RN, CIC, FAPIC, director of infection prevention and control at Prisma Health in Greenville, SC.

“When we have seen clustering, our drill-down investigations have identified that, typically, our healthcare providers are not being exposed by patients infected with COVID-19,” she said at the IDWeek 2020 conference, held Oct. 21-25, 2020. “When they are with patients, they follow protocol. What we have found is that our healthcare providers will relax a little bit when they’re in the breakroom, even though the guidelines say they need to socially distance and keep their masks on unless they are eating or drinking. That, many times, does not occur. Therefore, they expose each other to a provider who is asymptomatic.”

Part of the problem is healthcare workers are experiencing PPE fatigue and may be tempted to remove gear for brief respites when possible.

“Our providers are tired,” said Steed, president of the Association for Professionals in Infection Control and Epidemiology. “In organizations across the country, there have been reports of significant outbreaks related to providers laxing off on PPE. Not necessarily on COVID-19 wards, but on the regular units where they take care of patients they don’t suspect have [the virus]. We need to really pay attention to what our providers are doing, not only when they are in the room caring for the patient, but also outside of that environment when they take their mask down when they are talking to someone because their voices are muffled.”

Steed’s hospital has adopted a “200% accountability” campaign encouraging healthcare providers to be role models.

“COVID-19 is a pandemic and it is still here,” she said. “We have flu coming, and we need to clean our hands and wear our masks. We are going to be communicating in different ways — nonverbally — when we observe providers not following a rule. Hopefully, this will help mitigate some of their risk.”

Collaboration between employee health and infection prevention is critical. “Make sure that your occupational health department and team have updated guidance,” Steed said. “Make sure that when they see clustering of healthcare provider infections that they contact infection prevention and control, so you can undertake an investigation and figure out what is going on. Assess your organization’s exposure management process and continue to alter it and change it as need arises.”

PPE lapses in breakrooms and during meals have been an ongoing issue, but leaders are using several tactics to address the problem.

“What we have done that has probably had the biggest impact is actually go to the area and talk to the providers who are using the space,” Steed said. “If they are not using it properly, help them change it. We have brought engineering in and removed chairs and moved things to socially distance them. Some of our facilities and departments have posted the maximum number of individuals who can take a break in that space, based on the size. That seems to have worked.”

Intervention and observations must occur during all shifts if exposures are to be prevented. “We have found that, after hours, we need to have someone who goes around and observes,” she explained. “We have also set up some locations where providers have a huge community room space. There are hand hygiene rubs on every table, and the limit is two people per table. We also have changed some of our waiting rooms throughout the organization, where they are closer to the unit, so they can eat and drink. They are more apt to use those because it is closer to where the patients are. We have also set up areas outside. People enjoy going out to eat, and it gets them out in the fresh air and the risk is less.”

With PPE fatigue and other issues undermining worker protections, facilities need to restore the sense of urgency that hit the healthcare system with the pandemic’s emergence. “From what I hear as I talk to people around the [United States], we have to ensure access to PPE and training,” Steed said. “We need to make sure that the PPE denial or laxity we are seeing now is turned around.”