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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

When HCPs Expose Colleagues to COVID-19

By Gary Evans, Medical Writer

Healthcare workers may be vigilant with personnel protective equipment around COVID-19 patients, but inadvertently expose themselves to 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 recently at the IDWeek 2020 conference. “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 break room 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, so therefore they expose each other to a provider who is asymptomatic."

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

“Our providers are tired,” says 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 — non-verbally — when we observe providers not following a rule. Hopefully, this useful help will mitigate some of their risk.”

Collaboration between employee health and infection prevention is critical, Steed added.

"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.”

Lapses in PPE use in break rooms and meals has been an ongoing issue, but several strategies are being brought to bear on the problem.

“What we have done that has probably had the biggest impact is actually go to the area and talk to the providers that are using the space,” Steed says. “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. And that seems to have worked.”

For more on this story, see the January issue of Hospital Employee Health.