• Innovation in Action

Apr 15, 2020

From the Frontlines: Challenges, Best Practices and Lessons Learned During COVID-19


The novel Coronavirus (COVID-19) has upended every aspect of our lives and is stretching the limits of our health care system beyond what we ever thought possible. In an interview with the Health Quality Innovation Network (HQIN), Betsy Allbee, RN, BS, CIC, FAPIC, Manager of Infection Prevention at Carilion New River Valley Medical Center in Christiansburg, Va., shared her perspective on COVID-19 and how her hospital is overcoming the challenges of responding to this unprecedented pandemic.

What has been your biggest challenge during this crisis?

When the outbreak began, there wasn’t clear guidance on how to address this novel virus. Even now, recommendations continue to change and that’s having an impact on our frontline workers – what they are doing today may not be what they will be doing tomorrow. We have been adhering to the Centers for Disease Control and Prevention (CDC) guidelines, communicating the changes and explaining the rationale behind those recommendations. When our staff understand why they have been asked to change processes they are less reluctant to change. For compliance, we must have everyone’s buy-in because if some staff aren’t implementing the changes, others question which guideline is the correct one to follow.

What lessons have you learned?

  1. Be familiar with recommendations from the CDC.
  2. As soon as possible, set up new processes for tracking COVID-19 data, such as patient test results, and share the data with leadership.
  3. Be available to talk with the staff. This is especially important for non-clinical staff and volunteers who may not be as informed about the virus and may be feeling uneasy. Allow them to voice their concerns and then share information that is reassuring.

What are three key tools you are using to navigate this crisis?

  1. I created an infection prevention and control quick reference chart based on CDC recommendations for patients with suspected or confirmed Coronavirus. In addition to outlining each Standard and Transmission-Based Precaution and recommendation, it provides the rationale behind each recommendation, which helps our staff better understand why a precaution/recommendation is suggested.
  2. We created a Microsoft Excel-based tool called a Line List, which captures a patient’s symptoms, where they live, their age group, any hospital rooms they have occupied, whether they have been tested for COVID-19, and their testing turnaround time. A Line List is a common epidemiological tool that provides valuable information not only for tracking purposes, but to help our administration manage capacity and resources. It also provides data related to our specific facility and patient population, which is the best way to promote staff compliance with personal protective equipment (PPE) recommendations.
  3. Another tool we are using, the “Official Notice – COVID-19 Test Results,” documents a patient’s COVID-19 test results (negative or positive) and includes the time of transfer between locations. The notice is shared with the Emergency Department, admitting nursing unit, hospitalist liaison, radiology, laboratory, and others who may have been involved in the care of the patient. The tool serves as additional method of notifying staff who do not document in a patient’s electronic medical record – for example, environmental service techs, dietary staff, transporters, registration personnel, radiology and laboratory techs – or those who inadvertently missed signing the contact list before it was sent to Infection Control.

How are you addressing the personal protective equipment (PPE) shortage?

We evaluate our PPE stock using the CDC’s PPE Burn Rate Calculator. We also recently developed a process for disinfecting more than 100 of our N95 masks at a time. To prevent cross contamination, our staff write their name on the side of the mask, place it in a brown paper bag and send it to a conference room we’ve converted into a decontamination space. Staff receive their sterilized mask back in a white paper bag. We also plan to implement a vaporous hydrogen peroxide decontamination process that will provide staff with their sterilized mask in a peel pack. Both methods are designed to make everyone feel confident that their mask has been sterilized.

How are you supporting your community and working with other health care settings?

There are four hospitals within a 30-mile radius in the New River Valley where we are located. If we see a patient who lives in a community closer to another hospital in the Valley, we share that information with the infection preventionist at that hospital. We have also established an expedited testing process for residents of long-term care (LTC) facilities who are brought to our hospital which provides two important benefits: 1) it promptly provides tests results to the Emergency Medical Services crew so they are not furloughed due to potential exposure; and 2) often times, LTC facilities are reluctant to take a resident back without a test result. If hospitals are unable to return a patient back to his/her facility, that patient will be occupying a hospital bed which may unnecessarily cause patient flow issues. Another benefit of expedited testing is it allows the Virginia Department of Health to initiate a contact investigation and prevent additional cases in a facility.

Every day on my way to and from work I pass a neighbor who, several weeks ago, hung a homemade sign in the yard that says, “We’re all in this together.” That’s my philosophy about sharing knowledge and resources with fellow infection preventionists.

Betsy Allbee is a certified Infection Preventionist, an Association for Professionals in Infection Prevention (APIC) fellow, and an active member of the APIC board having held many leadership roles including president. She chairs the New River Valley Cross Setting Council, a collaborative of hospital infection preventionists, long-term care leaders, the Virginia Department of Health (VDH) and Health Quality Innovators (HQI) and is a member of the Virginia HAI Advisory Council.

Additional Infection Control Resources