Lessons learned from the COVID-19 pandemic through the JHI and IPIP (2022)

Author: Prescott et al.

The SARS-CoV-2 was a new novel virus when it emerged resulting in the Covid-19 Pandemic with catastrophic effects globally leading to high morbidity, mortality and financial costs. Although there had been a certain amount of pandemic preparedness the planning had been around influenza pandemic therefore leaving us ill-prepared for this novel respiratory virus with no effective antiviral treatments or vaccine. The last two years have been an enormous challenge for those working in infection prevention and control.

This article provides some key learning points taken from a number of other published studies:

• A survey showed that healthcare workers (HCW) felt reasonably confident in their knowledge about Covid-19, and the infection prevention measures required but wanted support on personal protective equipment earlier than they received it
• 50% of survey respondents did not feel confident around diagnostics for the virus
• Sampling of environmental surfaces in eight English hospitals detected SARS-CoV-2 on 8.9% of surfaces, leading to recommendations that frequently touched surfaces needed to be cleaned regularly
• Early reports during the first wave of the pandemic may have overstated the clinical importance of environmental contamination.
• A joint working party concluded that transmission most often occurs following close contact without PPE. Droplet transmission was considered probable, but transmission via fomites only possible, and transmission via non-respiratory body fluids unlikely
• There is continuing debate around the view that larger respiratory droplets are most important in the spread of SARS-CoV-2
• There are suggestions that there needs to be more focus on direct evidence of the risk of infection associated with activities, rather than between droplets and aerosols.
• A systematic review of the evidence found that a range of procedures of concern in relation to generation of infectious aerosols (including nasogastric tube insertion, pulmonary function tests, and upper airway suction) were not associated with an increased risk of transmission of viral respiratory infections
• There was a delay in information of the effectiveness of which disinfectants were effective resulting in some unfamiliar products coming to the market
• A systematic review concluded they were unable to draw conclusions on the most efficacious and safe methods for decontaminating surgical masks but suggest that hydrogen peroxide vapour may provide an option
• The reprocessing of PPE needs to be further explored and developed to establish effective decontamination methods, if required, and part of operational plans addressing matters such as user acceptance, traceability and stock management
• The use of rapid PCR-based testing is costly with limited testing capacity with the use of rapid antigen tests been useful in screening HCW and patients for the need for PCR testing
• SARS CoV-2 antibody testing among HCW may have resulted in some HCW to be less compliant with IPC precautions
• The use of non-CE-marked PPE found 68% of respirators did not meet the standards whereas 58% of date-expired surgical face masks were found of were fully compliant
• There was evidence of cross transmission of nosocomial infections between patients with an increase in Gram-negative bacteraemias
• There was a shift in PPE use to protect HCW moving the focus away from the infection prevention and control basics to prevent nosocomial infections