COVID-19 Forced US Healthcare to "Clean Up" in Two Ways: Infection Control and Burnout

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Unless you actually work in the area of healthcare quality, it is not obvious how the twin problems of "clinician burnout" and "hospital-acquired infections (HAIs)" are related. There is a particular HAI I study a lot, called catheter-associated urinary tract infection (CAUTI). CAUTI happens when there is an issue at the time the clinician is inserting the catheter into the patient's urinary tract. I used to teach an undergraduate nursing class, and one of my students explained that regardless of whether you are putting a catheter into a man or woman, it's like threading a needle. You need to concentrate, and have the mental space to concentrate.

Example: Connection Between CAUTI and Burnout

When you are inserting the catheter, you also need to have a steady hand, and you cannot touch the catheter to the contaminated skin next to where you are inserting it. Of course, if you do touch the skin, you have to start all over with a sterile catheter - which takes time. And if you are understaffed and overworked, you don't have that time. You insert it anyway. This is how burnout leads to CAUTI.

Now let's look at the patient's point-of-view. The patient is probably being catheterized because they are unconscious. Maybe they are recovering from surgery in the intensive care unit (ICU). If that catheter is contaminated, infection will grow inside them. The two times I have been catheterized, I got CAUTI. I realized I had a bladder infection after the catheter was taken out, and I asked for antibiotics. But if I had dementia, or I remained unconscious, or I was in some other situation, I would just keep having CAUTI. Maybe the hospital would catch it before I die, but I could still get seriously ill.

CAUTI is a huge problem in the US, and it's just one of the HAIs!

COVID-19 Forced a Focus on HAIs and on Burnout

We are supposed to do infection control protocols in healthcare (like starting over if we contaminate a catheter when inserting it), but we obviously don't do a good job, or the US would have a better track record for healthcare quality. Interestingly, COVID-19 forced us to actually follow our protocols, and had unintended positive effects on infection control!

But it had a really terrible impact on healthcare workers in terms of physical and mental health. So it basically improved HAIs, but totally caused burnout. Burnout was already bad among clinicians in the US before the pandemic. But a webinar I attended recently suggested that not only were we forced to clean up HAIs because of COVID-19, now, we are probably forced to face the epidemic of burnout among healthcare workers.

Joe Mull's Advice on Trauma-informed Care

Joe Mull was the speaker for the webinar, and he struck a tone that equally heart-attack serious and fiercely compassionate. I think a lot of people working in healthcare over COVID-19 will burst into tears when listening to him; he made me emotional. First, he described what the clinicians had been through with the pandemic, both professionally and personally. He reflected how that during all the panic, they had been underappreciated, and never been allowed to recover from the trauma of what they experienced. He reminded us that many were burned out to begin with.

But like with HAIs, he pointed out that now that COVID-19 has happened, we can't look away from burnout anymore. Healthcare providers will just leave after that horrible episode if they are miserable. This is life and death now.

Here are a few things that I especially liked about what Mull said in the webinar:

• There are three levels of responsibility for facing burnout: Organizational, leader, and personal. Mull basically told organizations and leaders to do their part.
• He even gave suggestions of scripts for leaders to use to express compassion and empathy. As a practical matter, many people do not know what to say, and he addressed this in a pragmatic way.
• We often talk about cultivating a "culture of safety" in healthcare. Mull described something I would call cultivating a "culture of trauma-informed care". I was happy to see the focus on providers, and not just patients.

To Address Burnout, Healthcare Leadership has to Change

This is a fact - it is based on evidence-based research. Leadership styles that have been promoted historically in healthcare lead to worker burnout, and not enough work has been done to incentivize healthy leadership in healthcare. We already knew this - just like we knew that HAIs are at high levels in US hospitals and are causing high levels of patient health risk. Leadership had to change to address CAUTI - and now, leadership has to change again to address burnout.

Mull gave very practical ways that leadership has to change:

• Everyone has to stop blaming each other, and assuming bad intent from each other.
• People need to be given way more time off for more days in a row, and no one from work should contact them during their time off.
• The workplace just needs to be totally trauma-informed. People need to be able to express emotions and decompress at work. There needs to be more compassion in what happens in healthcare to the providers.

But it will take work. I am extremely critical of the National Institute of Nursing Research (NINR), as there is no mission to actually research nursing as it impacts the nurse. It is only focused on nursing science as it applies to patients. Right now is exactly when we need that research on preventing burnout in nurses, and it's not there.

Like I said, healthcare leadership has to change.

Monika Wahi is a LinkedIn Learning author and advises health systems on quality assurance/quality improvement (QA/QI). Read more on her blog here.