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Leadership: Linda Greene, Director of Hospital Infection Prevention at the University of Rochester Highland Hospital

Posted: October 19, 2021
Author: Linda Greene, RN, MPS, CIC, FAPIC 

“…The greatest outbreak and infection prevention and control challenges I have witnessed were related to COVID-19.”

Linda Greene

As a front-line infection preventionist and Director of Infection Prevention in a healthcare organization, preventing healthcare-associated infections and addressing antimicrobial resistance are both high priorities of mine. Prior to the COVID-19 pandemic, my work with outbreaks included surgical site infections and an outbreak of healthcare-associated influenza. The influenza outbreak investigation and response were remarkably successful and stemmed from our ability to identify an initial source of the outbreak and implement several recommended infection prevention measures. Response actions included closing the unit to new admissions, carefully screening staff, and administering pre- and post-exposure prophylaxis. However, in my experience, the greatest outbreak and infection prevention and control challenges I have witnessed were related to COVID-19.  

Our hospital’s COVID-19 clusters were associated with myriad issues including staff-to-staff transmission, patient-to-staff transmission, and staff-to-patient transmission. In addition, patient and visitor non-compliance with masking, risk from aerosol generating procedures, patients who initially test negative and incubate on admission, as well as contamination during donning and doffing personal protective equipment were the main difficulties we navigated. Another challenge was the shortage of private rooms and medical supply delays, especially at the height of the pandemic, which exacerbated our containment efforts. These matters have highlighted areas and opportunities for improvement in practices, testing, and hardwiring processes. Looking to the future of outbreak investigation, we need access at the local level to important tools such as whole genome sequencing. Once these and other tools become more readily available, we will be able to identify, attribute, and mitigate outbreaks in a more comprehensive and timely manner.  

I have gained many insights from my involvement in CORHA. Most notably, I have a greater appreciation for and recognition of the link between hospital infection prevention and public health. This is an important and essential relationship, as I have acquired invaluable knowledge from both my public health colleagues in my state and in COHRA. Recently, I worked with CORHA to develop the CORHA/CSTE Proposed Investigation/Reporting Thresholds and Outbreak Definitions for COVID-19 in Healthcare Settings, and more broadly to review CORHA’s Principles and Practices for Outbreak Response. 

As a former APIC president, my perceptions and experiences have granted me the ability to contribute to CORHA in a distinctive way. APIC’s competencies for Infection Preventionists are critical during the COVID-19 pandemic, in particular the leadership competencies: communication, collaboration, critical thinking, behavioral science, program management, and mentorship. My hope for the future of CORHA is to expand its strategy and awareness to other emerging pathogens and continue development of principles and practices for addressing product and device associated infections, as well as important healthcare-associated infection outbreaks. The diverse organizations who contribute to COHRA represent an abundance of knowledge and expertise and embody the essential link between patient safety, infection prevention, and public health.  


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