The Pulse | Wednesday, February 10, 2021

Best Practices on Infection Prevention

An Interview With the Joint Commission’s Director of Infection Prevention and Control

Sylvia Garcia-Houchins, MBA RN CIC, director of infection prevention and control of the Joint Commission, has made a name for herself in the healthcare community. Garcia-Houchins demonstrates what true dedication and love of one’s practice can accomplish.

The Inside Tract spoke to Garcia-Houchins on how she got to where she is today, best practices for infection prevention (IP) that organizations should be implementing, how IP expectations and processes have shifted in light of the COVID-19 pandemic and much more.

The Journey to Infection Prevention

Garcia-Houchins began her more than 30-year career at a young age in a microbiology lab, working on outbreak investigations. From the moment she partook in programs focused on group A Streptococcus (group A Strep) and Legionella outbreaks, she knew this was her calling.

Garcia-Houchins worked tirelessly around the clock to educate herself, taking every nursing course available and observing nurses during their night shifts. After the birth of her daughter, however, Garcia-Houchins put her goal of completing nursing school on hold — but she didn’t lose sight of the importance of infection prevention basics, like hand hygiene. Years later, she decided it was time to go back.

To her surprise, the first class wasn’t on hand hygiene, and then a year passed without covering the essential topic. “The focus on infection control had changed. It really shifted my view on how we look at hand hygiene and infection control,” she explains. 

When Garcia-Houchins interviewed for her current position at the Joint Commission, she recalls thinking that it was somewhere she wanted to be. In fact, her role as director of infection prevention and control didn’t even exist.

“When I interviewed, they didn’t have this position and I made a good case for it,” she says, noting that the Joint Commission’s willingness to hear her proposal made joining the organization all the more compelling. Today, part of the reason Garcia-Houchins loves her job so much is the true commitment the Joint Commission has to ensure “we’re moving forward and focusing on the level of care [necessary].”

Regulations, Requirements and Manufacturing Instructions: Follow the Hierarchy

According to Garcia-Houchins, the first thing to do when discussing best practices is to take a step back and look at what the law and regulatory bodies require.

“We need to focus on those regulations to protect our patients and staff. With COVID-19, there are many that don’t even know about the bloodborne pathogens standard and what the penalties are if they’re not following it. Many of our healthcare members are not even aware of certain regulations.” According to Garcia-Houchins, regulations are the most basic level of implementation of best practices.

While implementing best practices, it’s important to remember that different organizations and states may use different standards. “For example, there are states that require by law the use of SGNA. New Jersey requires that hospitals use endoscopes under SGNA standards. Illinois uses CDC,” she explains.

So, what defines a recommendation and what’s a requirement? The Centers for Medicare & Medicaid Services (CMS) have taken a step back and asked this important question, she says. “We’re seeing that play out with the pandemic,” Garcia-Houchins says. “CMS has come out with some long-term care and we’re now working off a worksheet, based on the minimum level of protection of patients required.” For example, Garcia-Houchins notes it’s a CMS requirement that organizations follow the Spaulding Classification for levels of disinfection.

While there are a lot of documents in the public sphere that Garcia-Houchins notes are incredibly well-written, there is also documentation available that can lead people down the wrong path. She reiterates how important it is for healthcare workers to follow IP best practices.

Infection Prevention Expectations and Processes: Shifting in Light of COVID-19

When asked what kind of shift she has seen in infection prevention expectations and processes in light of the COVID-19 pandemic, Garcia-Houchins responds immediately: “Huge!”

“When has a nurse ever been asked to reuse a mask? My whole career we have told people, ‘Don’t reuse a mask, you’ll contaminate yourself. Get it laundered or throw it out.’ And now we’re seeing guidelines that say you can reuse a cover gown.”

“What have we seen with COVID-19?” Garcia-Houchins asks aloud. “A disconnect. Do organizations have a leadership team that’s willing to listen? One that is knowledgeable?” Because of the immediate and severe response to COVID-19, Garcia-Houchins says it can be difficult to juggle, manage and follow constantly changing guidelines, regulations and standards.

Protection for Patients and Healthcare Providers

COVID-19 has had a big impact on healthcare, including The Joint Commission. Originally, Garcia-Houchins remembers getting complaints from staff saying they were being disciplined because they wanted to wear a mask at work. Soon after, a position statement was created, stating that employees were allowed to wear a mask.

“It ruffled a lot of feathers, but it was done to help our healthcare providers based on guidelines from the CDC,” she explains. Early on in the pandemic, some didn’t want their employees wearing masks because it scared patients. Then suddenly, she says, there weren’t even enough masks for the staff to wear at all.

This took Garcia-Houchins back to the importance of bloodborne pathogens tests she learned about early in her career while handling her unit’s first HIV patient. “Nurses cried when they got that patient,” she says, out of fear and lack of understanding of what this disease was and how it was spread. Although the illnesses themselves are not comparable, COVID-19 is a new and unfamiliar virus, much like HIV was for Garcia-Houchins and others at that time. Then and now, healthcare providers are put in positions of exposure and risk.

But now, expectations have definitely shifted. “We’re not only focusing on the risk to patients, but healthcare providers as well,” she says. “We are seeing evidence that face coverings do make a difference and can help. I’m happy we’re realizing a shift in focus to protect healthcare providers.”