In essence, infection prevention and control isn’t just one measure, like personal protective equipment (PPE), but all of these layers. Each layer is imperfect but plays a critical role in reducing risk.
The coronavirus disease 2019 (COVID-19) pandemic has taught several painful lessons. With the United States experiencing more than 200,000 cases a day, a new high of 3000 deaths a day, and the initial vaccine deployments underway, this is a pivotal time. As we move into the next phase of COVID-19, not only in terms of the current surge but also in this period of vaccination for healthcare workers and essential workers, there is still a critical need for infection prevention measures against COVID-19.
Early on in the pandemic, we in healthcare were trying to piece together the right guidance to try to protect against the novel coronavirus, much of which was sure to change—from masking to the role of environmental transmission. One of the biggest mistakes we made in communicating during the pandemic was not preparing the public for the fact that guidance would likely evolve with science. One of the largest pieces to that is that risk reduction is additive. In essence, infection prevention and control isn’t just one measure, such as personal protective equipment (PPE), but many practices and strategies have taken all together. Each layer is imperfect but plays a critical role in reducing risk.
For years in harm reduction, this has been called the Swiss Cheese approach but, more recently, it has been updated and harnessed. Virologist Ian Mackay, PhD, recently updated this model to address the need for defence against respiratory pathogens, such as SARS-CoV-2, the virus that causes COVID-19. In one succinct image, this captures what we do in infection prevention—stress the additive layers that are needed to reduce the spread of infection. From masking to government messaging and vaccines, these layers all work cohesively to reduce the risk of not only COVID-19 infection but also transmission. Really, this is a concept we have been reinforcing and growing in the field of infection prevention—a holistic approach to disease prevention.