Krista Marquis at TGH
Krista Marquis, an infection control practitioner with UHN's IPAC team, outside the Emergency Department at Toronto General Hospital, one of the three clinical units where she works. (Photo: UHN)

Before joining the Infection Prevention and Control (IPAC) team at UHN, Krista Marquis worked in clinical microbiology, spending a decade as a medical laboratory technologist at Mount Sinai Hospital.

"I miss the bacteria sometimes; I'm not going to lie," Krista quips about her lab days.

While she may no longer be cultivating bacteria in the lab, her transition to UHN's IPAC team sees her play an essential role in preventing and controlling the spread of not just bacterial infections, but all infections, including COVID-19.

"Wherever you find a patient at UHN, you will find evidence of IPAC's presence," says Krista, an infection control practitioner (ICP), who works across three units at Toronto General Hospital (TGH): the Emergency Department (ED), Medical-Surgical Intensive Care Unit (MSICU) and an inpatient psychiatry unit.

"Our goal is to make sure that everyone in the hospital is well educated in good IPAC practices, and that is what helps keep everyone safe here."

Kelsey Houston, a fellow ICP at Princess Margaret Cancer Centre, adds that through the pandemic more people are understanding IPAC's work is "not just about policing and pointing out incorrect practice."

"There's more of an appreciation for the fact that, fundamentally, it is in the best interest of patient safety – and of course their safety, and as an extension the safety of their family members at home," she says. "We're here to offer support if there are lapses but also celebrate good practices."

IPAC 'part of pretty much everything' happening inside our hospitals

Oct. 19 to 23 is National Infection Control Week in Canada, an opportunity to highlight infection control efforts in Canadian hospitals, long-term care facilities and the community. This year's theme is "Beyond the Horizon," celebrating the extra mile that ICPs and other IPAC professionals go for their organizations and patients.

At UHN, the IPAC team is made up of about 30 members. Among them, infectious disease physicians, epidemiologists who track infections, and ICPs such as Krista and Kelsey, who come from a wide variety of backgrounds including microbiology and biochemistry, nursing and public health, and work directly with clinical teams across all medical programs and at all sites. 

In addition to the clinical collaboration, IPAC's role of ensuring UHN patients and staff have the best resources available to prevent and control the spread of infections, also includes on-going educational support in a range of areas from hand hygiene to COVID-19. The IPAC team also provides its expertise on hospital construction projects, laboratory operations and, during the pandemic, long-term care homes. 

"We are part of pretty much everything that happens operationally and clinically within the hospitals," says Dr. Susy Hota, Medical Director of IPAC at UHN.

"There's still that misconception that it's our job to police the entire hospital. It's not. 

"It's everyone's responsibility and it's important that message gets out there. We're here to advise and support and show people how it can be done differently when it's being done in a way that's not safe." 

Kelsey Houston in front of PM
Kelsey Houston, an infection control practitioner at Princess Margaret Cancer Centre, says far from making her question her decision to pursue a career at a big city hospital, "the past few months have shown me how lucky we are to have the team and leadership we do here at UHN." (Photo: UHN)

Regardless of where in the hospital an ICP is working, their days follow a similar pattern. Practitioners start by pulling a census of isolated patients on their units and assessing if they need to continue on isolation. They attend safety huddles, consult with clinical staff and share messaging related to IPAC concerns. Afternoons are taken up with further tracking, case investigations and contact tracing, reporting, surveillance and quality improvement work.

For Krista, her days start early with assessing isolations in the ED at TGH, where currently, there can be up to 20 patients in isolation on any given morning.

As the screening criteria for COVID-19 is very broad, most ED patients become persons under investigation for the coronavirus, meaning they will be isolated on contact at droplet precautions.

"The priority these days is to keep patients flowing through the hospital," says Krista, "and to do that, we have to act quickly and decisively, removing those isolations when they are not needed anymore."

By 9 a.m. Krista is on the floor of MSICU for the safety huddle after having assessed existing patients and reviewed any new admissions, including any new COVID-19 positive patients, to ensure each case is reported and included in daily hospital counts.

Not surprisingly, the workload of IPAC at UHN increased dramatically with COVID-19, beginning well before the global pandemic was declared in March. One of the biggest challenges has been the multi-layered response required, from working directly with clinical teams as safety protocols changed on an almost-daily basis, helping design and implement guidelines on patient screening, visitors and sanitation practices, and providing expertise when UHN began managing about 15 long-term care homes.

At the same time, the IPAC team still has to work to stay on top of their usual roster of hospital acquired infections, including C. difficile and MRSA as well as surgical site infections and central line infections. 

"The team has been amazingly dedicated and resilient," says Carly Rebelo, Manager of IPAC at UHN. "People don't complain, they're just doing what they can to help, despite long hours and intense days." 

'This is what we prepare for and…what we are here for'

Dr. Alon Vaisman, an infectious diseases physician with IPAC at UHN, says many people "have worked extremely hard and put in lots of extra hours" helping ensure patient and staff safety in the pandemic. 

"A lot of infection control work happens on off-hours, on weekends, on holidays," he says. "It doesn't seem like a 24-hour-a-day job but for ICPs and many others, it is. Things can happen at any time." 

While on one hand IPAC team members say the past few months have highlighted the importance of the need for infection prevention and control, there's also more to do so people better understand the key role they play, something highlighted by the fact ICPs were not included in provincial pandemic pay. 

"We don't play the same role as front-line healthcare workers who are caring for patients, that's true," Dr. Hota says. "But we play a very important complementary role in pandemic response." 

Despite the challenges that the pandemic has posed, ICPs Krista and Kelsey remain committed to their roles and to their team.

"As an ICP, I have been asked if COVID has made me question my decision to pursue a career in infection control in a major city like Toronto," says Kelsey. "My response is the opposite. The past few months have shown me how lucky we are to have the team and leadership we do here at UHN.

"Of course, it has been undeniably stressful, but to be supported the way we have been and to see how much everyone is willing to assist and help out has made us feel more committed and confident in our positions here."

"We choose this role because we want to help," adds Krista. Of the pandemic itself, she says, "this is what we prepare for, and really this is what we are here for, so now is the time to jump into it to keep our staff and patients safe and protected."

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