SARS-CoV-2 has kept health care organizations busy over the last three years, but it has some company. Formerly prevalent pathogens are reemerging, with poliovirus surfacing in wastewater and measles cropping up around the world. Now more than ever, physicians are seeing new infections show up in places they have never been seen before or haven’t been seen in a long time, so how can they stay prepared to safely respond?
Abigail Carlson, MD, MPH, is a physician with the Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion and has seen data showing an uptick in tuberculosis and Candida auris cases. Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections have also risen during the pandemic, following a period of steady and sustained decline in health care-associated MRSA.
Two fundamental principles should guide infection prevention and control strategies, said Dr. Carlson, who joined Erica Kaufman West, MD, the AMA’s director of infectious diseases, for a virtual town hall discussion on the latest reemerging pathogens.
“Use syndromes to guide your response—including your epidemiologic risk factors to identify and manage your possible cases. And then return to your basics and reinforce your baseline IPC [infection prevention and control] practices in your clinic,” Dr. Carlson advised her physician audience during the town-hall discussion, which was part of Project Firstline, the CDC's national training collaborative for health care infection control.
Why certain pathogens are reemerging
Several reasons may explain why some pathogens are gearing up for a comeback.
Changes in vaccination or immunity status of the population may be driving reemerging diseases like measles or polio.
Climate change could be a catalyst for certain vector-borne diseases. The warming of certain regions of the world are igniting fears about the reemergence of certain mosquito-borne diseases, for example, particularly in the southern U.S.
Migration, travel and the speed with which people interact with each other, in addition to the movement of animals and products, can also lead to the reemergence of pathogens, said Dr. Carlson. “Often, these interact together, so it's not just one thing that leads to a reemergence, but multiple aspects coming together.”
Applying diagnostic reasoning
Responding to reemerging pathogens on a practice or institutional level calls for a syndromic approach, said Dr. Carlson.
Physicians don't necessarily need “to have testing capacity to recognize and respond to the risks from a reemerging pathogen," she said. "You can rely on your diagnostic reasoning and use the components of diagnosis to help build your IPC practices.”
For example, if measles is the pathogen of concern, doctors should focus on the syndrome that a patient may present with in this case. Physicians should ask themselves:
- What am I going to do with people who present with cough, nasal congestion, runny nose and conjunctivitis?
- How do I teach my staff to recognize that and respond to that appropriately?
Physicians should consider what infection-control measures to take if they suspect a patient is infected with one of these reemerging pathogens. Key questions might include:
- Do staff have the appropriate personal protective equipment? Do we have N95 respirators or masks?
- Do we know what the hourly air changes are in our space?
- Do we have the right cleaning and disinfection products?
- What are the protocols for getting the patient safely in and out of the medical building and contacting public health authorities?
A baseline toolkit
Having strong baseline infection prevention and control practices helps set you up for success, Dr. Carlson continued.
This means storing PPE in a specific area, making sure all staff has been fit-tested for their N95s, and establishing solid relationships with equipment suppliers. There also should be a plan for cataloging, stocking and ordering materials. It also means going back to the basics of hand hygiene before and after every patient and disinfecting with Environmental Protection Agency-registered cleaning products.
Having these protective steps in place means avoiding the worst-case scenario: trying to accomplish all these tasks in the middle of an emergency, she emphasized.
Resources for physicians
Dr. Carlson directed physicians to a comprehensive CDC tool to help assess IPC practices in acute, long-term and outpatient care settings. Additionally, Project Firstline materials highlight core infection control practices that are relevant for both re-emerging pathogens and everyday infection concerns. Resources include posters, infographics, handouts, training toolkits with 20-min session plans, and even social media materials that may also be relevant for patients and visitors.
The National Healthcare Safety Network is another CDC resource physicians can explore to learn more about tracking health care-associated infections and adherence to infection-control measures. She also recommended that doctors stay in touch with city, county and state health departments to track local developments with pathogens.
Physician practices should be aware that there are other facilities they can partner with to share information and get patients better health care, Dr. Kaufman West noted.
