Infection Prevention & Control Specialist
In this step, Emilio Hornsey (PHE & UK-PHRST) explains the role of infection prevention and control professionals and how they are involved in outbreak response, including the expertise they bring to the different levels of the health system.
1) Who are IPC professionals?
Infection Prevention & Control Professionals (IPCPs) have specific expertise in the investigation, prevention and control of infectious diseases. Most IPCPs have a clinical background (doctors, nurses or paramedics) and work in a variety of healthcare settings, in hugely diverse roles. Their remit extends from training and education, to audit, surveillance and the provision of expert advice at all levels of the health system. In many health systems an IPC practitioner will need to provide technical support across the whole spectrum of health care activity.
2) How are IPC professionals involved in outbreak preparedness and response?
IPCPs use a range of measures to support infectious disease outbreak preparedness. Standard and transmission based precautions are important tools used by IPCPs. Robust surveillance and adherence to standard and transmission based precautions form the corner stone of outbreak preparedness.
Standard precautions include a suite of evidence-based measures which are applicable with all patients at all times1. They include all precautions taken to avoid contact with body fluids and include detailed methods for sharps safety, decontamination of medical equipment, healthcare waste management, environmental cleaning, personal protective equipment (PPE), cough etiquette and hand hygiene, among others. While these were developed initially to halt nosocomial transmission of blood borne viruses, standard precautions, when correctly and consistently applied, can reduce the risk of a multitude of healthcare acquired infections.
Transmission based precautions are employed in addition to standard precautions when alternative modes of transmission are known or suspected. These include close contact, droplet and airborne/aerosol precautions2. They can include measures such as special separation of patients (isolation or cohorting), ventilation systems, more extensive use of PPE, and more frequent and extensive environmental cleaning, in order to reduce the transmission of a specific pathogen which is known or suspected.
Infections may be transmitted by more than one route so more than one type of precaution may need to be in place. Healthcare activity may also change the mode of transmission (e.g. organisms aerosolising during procedures).
3) What expertise do IPC professionals bring to an outbreak response?
In outbreak response, IPCPs identify where improvements are required to halt transmission of the disease. Once these have been identified through a comprehensive assessment, they develop plans to rectify failings using as many approaches as possible. These may include physical infrastructure, training, promotional materials, regular monitoring, feedback and visible engagement from influencers3.
In the early stages of an outbreak response, the IPC priority will be undertaking a risk assessment; reinforcing standard and transmission based precautions; assessing patient flow; and ways to provide surge capacity. Efficient patient flow and a clear triage procedure are often immediate measures that need prompt implementation in an outbreak response to prevent healthcare facilities becoming compromised4. The protection of health workers is a priority as they will allow the rest of the health system to function and speed up recovery after the outbreak is controlled. Provision of all health services will be compromised if these considerations are not prioritised early on.
© London School of Hygiene and Tropical Medicine 2019