The serious infectious threat response initiative service was essential for the efficient management of COVID-19

In a recent study published in the American Journal for Infection Control, researchers described the serious infectious threat response initiative (SITRI) service provided by the Infection Prevention and Control (IPC) Program.

This initiative is implemented for improved care of the United States (US) population at high risk of coronavirus disease 2019 (COVID-19) severity outcomes.

Study: Effect of serious infectious threat response initiative (SITRI) during the coronavirus disease 2019 (COVID-19) pandemic at the Veterans Affairs North Texas Health Care System. Image Credit: Cryptographer/Shutterstock.com

Background

Healthcare-associated infections (HAIs) increased globally as healthcare facilities struggled through the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Previous efforts at healthcare preparedness for future pandemics fell considerably short of mitigating COVID-19.

The limited availability of testing resources, personal protective equipment (PPE), and guidance from governmental health agencies and national programs encouraged SITRI development to support healthcare professionals and provide improved care during the COVID-19 pandemic.

About the study

In the present study, researchers evaluated the utility of SITRI in assisting healthcare professionals in the efficient COVID-19 management of US veterans.

SITRI was conceptualized to support staff with triaging and patient management, facilitate daily COVID-19-associated clinical operations, manage staff queries, and shield IPC personnel from excessive pandemic-associated burdens to maintain efforts to prevent SARS-CoV-2 transmission.

Process maps were created for triaging patients based on symptoms and diagnostic/laboratory studies in the initial COVID-19 period when SARS-CoV-2 testing was unavailable.

SITRI appointed infection preventionists (IPs) and registered nurses working 12.0-hour rotational shifts to provide 24/7 assistance to staff and added teleworking flexibility in January 2020.

Call schedules were created in March 2020, with six IPs dedicated to the SITRI call lines. IPs responded to questions and health concerns and conducted SARS-CoV-2 surveillance, abstracted data, managed SARS-CoV-2 exposure and patient isolation, and reported public health and administrative data.

Being a critical part of emergency operations services, SITRI helped staff devise protocols associated with isolation, testing, safety, and the mortuary. SARS-CoV-2 testing was outsourced to the county health department.

Cross-sectional-type data of call records over 30 days, including call types in the initial pandemic period between March and April 2020, were obtained. In addition, electronic surveys were distributed to frontline workers to obtain feedback on SITRI’s utility.

Further, IPC staff burnout was evaluated concerning exhaustion, depersonalization, and decreased achievement during the financial years (FY) 2019, 2020, and 2021 using the annual All Employee Survey. SITRI program cost, including overtime payments for the staff, was estimated.

The team investigated the incidence of several HAIs in the pre-COVID-19 period (between January 2017 and December 2019) and the COVID-19 period (between January 2020 and June 2021): healthcare-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) for every 10,000.0 bed days of care; central line-associated bloodstream infections (CLABSI) for every 1,000.0 central line days; catheter-associated urinary tract infections (CAUTI) for every 1,000.0 days of using indwelling urinary catheters; and healthcare-onset Clostridioides difficile infections (HO-CDI) for every 10,000.0 bed care days at acute care hospitals and long-term care facilities.

In addition, the rates of surgical site infections for every 100.0 procedures for colonic surgery and coronary artery bypass grafting using knee and hip prostheses.

Results

SITRI was conceptualized to support healthcare personnel during the pandemic and support staff during day-to-day clinical operations related to COVID-19. The IPC program was able to retain routine prevention-focused efforts due to SITRI.

While SITRI was operational, HAIs during the COVID-19 pandemic did not increase. A significant correlation was observed between SITRI calls and the weekly mean COVID-19 census. Staff responses to the survey indicate that SITRI was an essential service during the pandemic, validating the value offered by SITRI.

IPC burnout evaluation indicated improvement in scores for exhaustion, reduced achievement, and worsening scores for depersonalization. COVID-19 was initially reported to SITRI on 28 March 2020, two months following SARS-CoV-2 detection among United States (US) residents and three weeks following the coronavirus disease 2019 pandemic declaration by the World Health Organization (WHO).

Hospital staff contacted SITRI 3,816.0 times on call between 1 January 2020 and 27 March 2021, weekly ranging between 0 and 278 calls, indicating staff anxiety related to COVID-19.

A significant correlation was observed between weekly phone calls and the COVID-19-associated hospitalization census. Between March and April 2020, SITRI staff received 420.0 calls, of which 78% (n=328) were associated with COVID-19 screening and SARS-CoV-2 testing.

Survey responses provided by staff members indicated that SITRI was an essential service during the pandemic, validating the value offered by SITRI. The evaluation of IPC burnout showed improvements in the reduced achievement and exhaustion scales during 2020 and the following year compared to 2019.

The findings could result from compensating for overtime and providing time off after working overnight. In addition, hybrid models were implemented, allowing employees to work from home while facilitating regular hospital rounds.

Further, protocols were created even before the availability of the Centres for Disease Control and Prevention (CDC)’s protocols, and the IPs were available 24/7 to support staff. SITRI’s cost, including overtime payments, was $360,000 between March 2020 and May 2021. However, the depersonalization component increased annually, indicating compassion fatigue among healthcare workers.

Conclusion

Overall, the study findings showed that the staff solicited SITRI’s support with the COVID-19 burden, indicating that SITRI served its purpose. Healthcare facilities must invest in IPC programs such as SITRI and train IPs to prevent adverse outcomes among geriatric COVID-19 patients.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.