The very nature of healthcare work puts critical care nurses, doctors, therapists, and others in direct contact with infected individuals. The COVID-19 pandemic has placed significant strain on critical care workers, and estimates from the Centers for Disease Control and Prevention1 show that 6 percent of individuals hospitalized with COVID-19 were healthcare workers. Additionally, the BMJ2 reports that healthcare workers may be up to seven times more likely to develop severe symptoms of COVID-19 compared with workers in other occupations.
Improved, aggressive infection control measures in ICUs are critical to reducing COVID-19 deaths. As nurse managers continue to work with other healthcare providers to mitigate risk, lessons from the past year can be implemented to help keep workers and patients safe. And not just from COVID-19 — new and better infection control procedures can be used to help mitigate risk from all infectious diseases, now and in the future.
Effectively blocking the transmission of infectious diseases in ICU settings requires merging several pre- and peri-pandemic infection control strategies.
Modifying Personal Protective Equipment
At the beginning of the pandemic, critical care nurses at the bedside quickly identified the need for better personal protective equipment (PPE). Advanced protections were already commonplace during routine intensive care, but these protective measures were largely supplemented with additional PPE designed for single-use only.
Examples of additional PPE use vary according to policies in each healthcare center. A study in Critical Care3 describes how some management requires staff to wear disposable masks over N95 respirators. In other cases, face shields must be worn in addition to goggles to help prevent contact with airborne droplets containing COVID-19. In hospitals where these extra PPE precautions were implemented, rates of COVID-19 infection among healthcare workers declined sharply. These lessons could also be used in other viral outbreaks, depending on the nature of the virus.
When determining whether these procedures are appropriate, nurse leaders must also gauge the need for additional staff training for donning and doffing all equipment. Developing new PPE donning and doffing sequences for critical care staff members may be necessary to help prevent adverse events resulting from improper wear and use.
Decontamination of Disposable PPE
In the earlier days of the pandemic, the U.S. Food and Drug Administration4 (FDA) recommended crisis capacity strategies5 that included the decontamination of disposable respirators to help counter supply chain issues. Multiple systems for decontamination have been developed to provide healthcare workers with N95 respirators, and a study in PLOS ONE6 shows that most types of decontamination procedures, such as autoclaving, totally eliminate viable virus samples from masks. But these procedures may also diminish the respirator's structural integrity after several rounds of decontamination and interfere with the mask's ability to form a proper seal against the face of the wearer.
Fortunately, companies have ramped up production of respirators for use in ICU settings. The FDA7 now recommends that decontaminated respirators only be used in a limited capacity when there are no other filtering facepiece respirators (FFRs) available.
Buffer Zones and Isolation Rooms
The same study in Critical Care describes the creation and use of specific buffer zones intended to isolate COVID-19 contamination. Before entering any patient care areas, staff members donned all protective equipment in designated clean areas. After performing intensive care, staff removed PPE in a buffer area located near the patient care area. A second buffer zone provided a transition between this and the clean zone, allowing staff to first remove all remaining PPE and perform personal hygiene measures before re-entering normal work areas. These isolation zones helped to mitigate COVID-19 transmission among nursing staff members and could be used as a precaution against highly infectious viruses in the future.
Some evidence suggests COVID-19 may be found not only in respiratory specimens but also in serum, saliva, urine, and stool specimens, according to The Centre for Evidence-Based Medicine8. As such, it is necessary to handle and process specimens using advanced infection control practices.
The Indian Journal of Critical Care Medicine9 notes that specimen collection and preservation procedures may be modified to improve protection for healthcare workers and patients. After collection of any specimen from a COVID-19 patient, staff should place viral transport mediums in triple packaging and deliver the sample to the laboratory immediately. Additional PPE should be worn during specimen collection and transport to prevent exposure to the virus. Even though this study focuses on COVID-19, these methods could also be used for any specimen sample containing large amounts of infectious viruses or bacteria.
It is likely that infection control measures in the ICU will continue to evolve as doctors learn more about contagious diseases like COVID-19. However, it is important that nurse leaders and others continue to review current evidence to determine best practices for infection prevention among healthcare workers.