We hear a lot these days about infection control. But shouldn’t we really be talking about infection prevention?
To me, infection control, assumes that infection exists and that our job is to control its spread. Infection prevention however implies that we want to avoid the infection in the first place. It may be semantics but, in my mind, these are important differences, particularly during a pandemic.
The real prevention tool for the current pandemic is an effective immunization. Once available, the vaccine needs to be distributed quickly and widely. Right now, we are at the least, months away from an approved immunization and yet additional months before the immunization will be produced in adequate supplies to address a global infection.
At Juniper, we have learned much in the last four months. Many of our communities have been in hot spot areas. The New York and Denver metropolitan areas were hit early and hard at a time when the country’s knowledge about COVID-19 disease transmission and control was in its infancy. At the time, the virus was thought to be transmitted by an individual with active symptoms. At the time, this made sense as COVID-19 was another SARS virus and the original SARS virus was transmitted that way. Our precautions therefore included screening for symptoms, use of Personal Protective Equipment (PPE), and good hand-washing.
Juniper and many other practitioners on the front line however soon learned that there was silent or “community” spread going on, https://www.nytimes.com/2020/06/27/world/europe/coronavirus-spread-asymptomatic.html. Juniper learned this during its first round of testing, which began on April 1. Testing in two communities which were in hot-spots identified significant transmission of the virus, but the vast majority of the positive results were in individuals who were asymptomatic (72% and 94% respectively for residents and associates) . This data made clear to us that while screening, hand-washing and PPE were necessary, they were not sufficient. And in the absence of an effective immunization, regular rapid testing was needed to best keep the virus out of our communities.
The testing results also provided us with the ammunition to better fight the virus. With a knowledge of how and to whom the virus spread, we could effectively cohort residents and staff to protect those without infection and provide the necessary care and service to those who were. We were able to allocate PPE appropriately as well.
Today, all but one of our communities are free of active COVID-19 cases among our residents and associates. Even the one community with active cases has benefited from our learning and has contained the positive cases to just two. Via weekly testing, we are better able to identify those who may acquire the virus in the wider community. It is not perfect but the combination of regular testing, social distancing, hand-washing, enhanced disinfection protocols, screening, and proper use of PPE is making a difference in PREVENTING the spread.
So, as you might have guessed we have elected to call our effort “infection prevention” and urge others to both use the words and adopt similar protocols to limit infection.