Infectious Disease Response Initiative Reduced COVID-19–Related Staff Burnout, Prevented Rise in HAIs

An infectious disease response initiative implemented at Veterans Affairs North Texas Health Care System (VANTHCS) during the COVID-19 pandemic reduced staff burnout and prevented increases in health care–associated infections (HAIs), new research shows.

Findings were published in American Journal of Infection Control, and they indicate the program was an essential service during the pandemic.¹ Results also suggest preemptive investments in preparedness initiatives can help facilities routine prevention efforts and improve patient safety during outbreaks of infectious diseases.

Following the Veterans Health Administration’s mandate of ongoing preparation for emerging pathogens following the last Ebola outbreak in South Africa, VANTHCS created the serious infectious threat response initiative (SITRI). The group comprised multidisciplinary staff “who worked to develop an all-encompassing algorithm that would enable an effective process for communication, safe handling, assessment, and care of a patient who might present with Ebola or another emerging pathogen,” the authors wrote.

However, in the wake of COVID-19, SITRI evolved into a 24/7 service that included infection prevention and control (IPC) staff, along with a hospital epidemiologist. Infection preventionists within the group also carried out COVID-19 surveillance, data abstraction, and public health reporting.

To better understand and quantify the workload and utility of SITRI post implementation, and to measure IPC burnout and HAI incidence while the program was in effect, researchers correlated the number of weekly phone calls with inpatient COVID-19 census and assessed types of calls and staff feedback.

Analyses revealed:

• Between January 2020 to March 2021, SITRI received 3816 calls from hospital staff
• There was significant correlation between SITRI calls and the weekly average COVID-19 census (P = .00026)
• IPC burnout evaluation indicated improvement in scores for exhaustion and reduced achievement and worsening in the score for depersonalization
• Rates of 4 common HAIs (central line–associated blood stream infections [CLABSI], catheter-associated urinary tract infections [CAUTI], methicillin resistant Staphylococcus aureus [MRSA], and Clostridioides difficile) did not rise in VANTHCS acute care and long-term care centers during the implementation period

The total cost of SITRI was $360,000 based on overtime paid to staff covering the SITRI line.

“During the early months of the COVID-19 pandemic, health care facilities lacked essential infection prevention resources and information, and staff anxiety was incredibly high,” said lead study author Madhuri Sopirala, MD, in a statement.“Our evaluation shows that the VANTHCS’ SITRI provided support and services that contributed meaningfully to patient safety and staff well-being during this time.”²

Authors suggest the stable HAI rates seen throughout the study period could be attributed to the program enabling the IPC team to retain routine functions like HAI surveillance and audits throughout the pandemic.

VANTHCS is the second largest health care system in the Department of Veterans Affairs and serves veterans from 38 counties in Texas and 2 counties in Oklahoma. Because the program was implemented at a veterans health care system, results may not be generalizable, marking a limitation to the study. In addition, not all COVID-19–related issues were directed to the SITRI phone line.

Overall, “SITRI's active management of issues related to personal protective equipment [PPE] and isolation may have prevented any outbreaks from multidrug-resistant gram-negative organisms that were experienced by multiple other institutions while at the same time conserving PPE for COVID-19 outbreak,” the authors concluded.

“SITRI's deliberate attempt to help maintain routine prevention focused efforts by IPC may have contributed to our favorable outcomes with HAI during the pandemic, which were in contrast with widely reported increases in HAI in COVID-19 literature,” they wrote.

Reference

1. Sopirala M, Hartless K, Reid S, et al. 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. Am J Infect Control. Published online April 26, 2023. doi:10.1016/j.ajic.2023.02.007

2. Infectious-diseases response initiative reduced staff burnout and helped prevent HAI increases at VA health care system during covid-19 pandemic. News release. EurekAlert. April 27, 2023. Accessed April 27, 2023. https://www.eurekalert.org/news-releases/987264