Infection Prevention Resources to Respond to the Initial Coronavirus Disease Pandemic at an Academic Medical Center

BACKGROUND: Infection prevention specialists (IPS) are relied on as subject matter experts, providing guidance and support within healthcare facilities. During the coronavirus disease (COVID-19) pandemic, infection prevention (IP) department resources were heavily taxed, creating an increased IP staffing need. The objective of this study is to quantify the additional IP resources needed to support pandemic response at a large, academic medical center. METHODS: Pre-pandemic, our IP department included 12 full-time IPS, providing support to a 1315-bed hospital, 138 outpatient clinics, and 2 ambulatory surgery centers. The increased level of organizational support needed for the COVID-19 pandemic response required more full-time employees (FTE) to assist in managing additional duties. Duties included: conducting employee cluster investigations and contact tracing; reviewing positive COVID-19 lab specimens reported each shift to ensure appropriate isolation and bed placement; developing and reviewing COVID-19 related protocols across multiple hospital areas; and instituting a clinical case review process with infectious disease (ID) physicians to respond to call questions about testing, isolation requirements, and discontinuation criteria in complex patients. RESULTS: The first known COVID-19 positive patient was admitted on 3/17/2020. Department call volumes peaked between May 2020 and end of June 2020. Calls during that time frame totaled 2,825 with an average of 202 calls daily. In response our IP department added 6 additional FTE. These FTE consisted of 2 reassigned bedside nurses and 4 contract nurses, supporting the 24/7 on-call service from 3/31/2020- 4/6/2021. Physician support increased to 2 dedicated epidemiologists managing COVID-19 guidance and IPS escalation needs, and a 24/7 on-call clinical review team, involving 16 ID physicians was implemented. CONCLUSIONS: A pandemic response effort can have a major impact on infection prevention staffing resources. Repurposing and/or onboarding non-IP staff and training them to support concrete IP processes can be an effective strategy to reduce strain on department resources.