The key to reinvigorating infection control? Getting back to basics, says Mount Sinai's Dr. Aaron Glatt

After three long pandemic years, the time is now for hospital clinicians to refocus efforts on infection control and prevention, said Aaron E. Glatt, MD, chair of medicine, chief of infectious disease and epidemiologist at Mount Sinai South Nassau in Oceanside, N.Y.

Research shows incidences of healthcare-associated infection increased significantly in 2020 after years of steady decline. The number of HAIs also increased with 2021's COVID-19 surges. 

"Many areas received less attention with regard to infection prevention than ideal during the pandemic, but renewed focus on them will improve overall healthcare," Dr. Glatt said.

As an example of reprioritizing infection prevention, Dr. Glatt suggested hospitals review "acceptable, proper care for central lines and foleys."

"Maybe it's time to move away from using central lines all the time and instead use peripheral lines or switch to oral therapies faster," he said. "You can't get a central line infection if you don't have a central line."

Becker's caught up with Dr. Glatt to discuss the future of virus seasons, the FDA's proposed annual COVID-19 vaccine and how hospitals can place renewed emphasis on best practices to prevent HAIs.

Further, Dr. Glatt, also a spokesperson for the Infectious Diseases Society of America, said he anticipates an RSV vaccine could be ready to roll out to high-risk populations before the next virus season begins.

Editor's note: Responses have been lightly edited for length and clarity.

Question: COVID-19 has been with us for three years now, and this is the first season we've endured a "tripledemic" — COVID-19, respiratory syncytial virus and the flu. Will future respiratory virus seasons look the same?

Dr. Aaron Glatt: You can count on it. This year is the first year we have all three coinciding. Masking and distancing over the past two years kept us from seeing them all at the same time. Masking and distancing prevented COVID, but it also prevented RSV and flu. When we are not masking and social distancing, we will probably have to deal with this every year.

Q: Do you think the pandemic reversed years of progress in the area of infection prevention?

AG: I do think COVID disrupted many of the routines people had relating to preventing these infections. In fact, I think we are seeing the issue across the country. Healthcare professionals have spent, and continue to spend, an unbelievable amount of time taking care of COVID patients. It's not that anyone was trying to neglect HAI prevention. 

Sometimes there were just so many patients that our routines were broken. We had problems accessing those patients because of isolation. Some of the routine things we would normally do may not have been carried out. When you are caring for so many patients, under difficult conditions, sometimes things will not be done as rigorously as ideally we would like.

Q. What can hospitals do to get back on track in terms of getting refocused on infection prevention?

AG: It's time to get back to the basics. We need to focus on providing good medical care at the bedside. 

There needs to be renewed focus on preventing readmissions, preventing pressure injuries, preventing the spread of resistant organisms and promoting preventative health care measures. 

We need to make sure every intravenous line is checked and be focused on removing those lines as soon as possible, as well as taking Foley catheters out as soon as possible. Additionally, we need to look at providing therapies that can be given without a central line. I think we tend to underutilize oral therapies, thinking intravenous is always better, but that's not always the case. 

Also, we need to do more training with younger nurses. Some older, more seasoned nurses unfortunately retired because of the epidemic and others left clinical medicine.

Q: Are you in favor of an annual COVID-19 vaccine?

AG: In higher-risk groups, the elderly, people with underlying comorbidities and certainly people who are not vaccinated, I believe an annual COVID vaccine will play an important role in preventing people from getting very sick, getting hospitalized and, heaven forbid, dying. 

The data isn't there to say it will be essential for a younger, healthier person to get an annual vaccine, but nobody even wants to get moderately sick. If we have more virulent strains, it will be different; if morbidity and mortality are high, we might want to consider it for everyone. I think we just need more data in the younger groups.

Q: Do you think we will have a viable vaccine for RSV before the next season of respiratory viruses?

AG: I would expect so; it would be my hope. RSV rates are coming down throughout the U.S. and I don't think we have a pressing need to put anything out right now. Over the next few months, I'd like to see follow-up data that gets published so we can really analyze it before our next RSV season. I see the possibility of an emergency use authorization or even a full vaccine approval in selected populations before the next season.

I want to point out, however, that we did have a vaccine for RSV in the late 1960s/early 1970s, but it was an abject failure. It actually caused more RSV than it prevented. There were flaws in the type of technology available that prevented it from being a good vaccine, and work in that area suddenly came to a halt. That was state-of-the-art for 30 years. 

Between 2005 and 2010, there was technology that bypassed the problems encountered years before. The new technology allowed the beginning, and hopefully the realization, of a good RSV vaccine. In fact, there are several products in preliminary phase 3 trials that are actually quite good. 

My hope, my expectation, is that we will have RSV vaccines available for babies, for pregnant women and for older people. When younger and middle-aged people get RSV, it can be a nuisance, but people recover within several days. Therefore, if we have an RSV vaccine, we will target a rollout on very high-risk populations first.

Q: What's your view of how hospitals handled the pandemic?

AG: While the outcomes were not always what everyone would have liked to have had, people have to understand that even with the horrible loss of life, the tremendous morbidity rate associated with the pandemic, U.S. hospitals were phenomenal. 

Of course, if we had the technology and the vaccines earlier, we could have saved more lives. But no one had the whole picture. They had to guess what would be the best treatments and the best approach. In that respect, obviously mistakes were made due to lack of knowledge of science but not because of lack of effort or failure to attempt to deal with the situation. That can't be forgotten. Our hospitals rose to the occasion.

Science was rapid. Maybe it was nowhere near as quick as people would have liked it to be. But that's the reality. You can't press a button and say: "This is the right answer." It doesn't work like that. It's all trial and error in science. Some of the things that we did at the beginning ultimately turned out to be wrong or even possibly dangerous. But we were grasping at straws to save lives right in front of us. 

People like to focus on the errors and lack of information or contrary information we had to work with. What came out in January changed in March and then again in April. Why? Because scientific information changes.

Q: What do you see as the most significant long-term effects the pandemic has left on healthcare?

AG: We've learned so many things. Technology has allowed us to consider different forms of vaccinations, rapid testing — there are so many technological advancements. COVID showed us that we have to look at isolation procedures and how we keep our patients safe from each other to make sure we are providing the best possible care under extremely difficult situations. 

This will help in preparing for other pandemics. It will prepare us to handle the Ebola concerns, the bird flu concerns — concerns that come up on a regular basis. 

COVID-19 provided us with a difficult, but very useful, test of our system. We learned we had certain deficiencies in terms of equipment and PPE acquisition, as examples. These challenges will hopefully allow us to be better prepared for the next pandemic. 

And it's only a question of when it will come and what it will be — rather than if it will come.



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