Series

Assessment Infrastructure & Infection Prevention (STRIVE) Toolkit

Introduction

The COVID-19 pandemic demonstrated the nation's healthcare systems lack and inability to manage large-scale incidents that require surge and increase demand for services for patients. Healthcare facilities struggled to meet surge capacity and provide care and many implemented contingency and crisis standards of care, as well as contingency and crisis standards in the use of personal protective equipment (PPE). One critical area of concern was the ability of healthcare facilities to implement infection prevention and control practices to reduce the risk of nosocomial transmission. In 2019, Massachusetts General Hospital (MGH), in collaboration with New York City’s Health & Hospital-Bellevue Hospital (Bellevue) received funding for the National Infection Control Strengthening grant, CK19-1905 FY21, project from the Centers for Disease and Control and Prevention (CDC) to develop a suite of resources to assist healthcare facility leaders and managers to establish processes and infrastructure for high-level isolation, as recommended for pathogens such as Ebola and other viral hemorrhagic fevers. In 2020, additional funding to the NICS CK19-1905 FY21 was awarded to broaden the scope to understand how healthcare facilities responded to the COVID-19 pandemic – specifically with respect to use of alternative care spaces (ACS) to meet surges in demand while implementing infection prevention and control practices in these settings. The expanded scope was to create guidance that would support healthcare facilities maintain and enhance infection prevention and control practices when establishing ACS. To supplement the team's subject matter expertise in infectious diseases, infection prevention and control, emergency preparedness MGH and Bellevue hosted a national workgroup with representation from the Facilities Guideline Institute (FGI), Society for Critical Care Medicine (SCCM), American Hospital Association/American Society for Healthcare Engineers (AHA/ASHE), Association for Professionals in Infection Control and Epidemiology (APIC) and NBBJ to leverage their expertise and experiences. Why was the STRIVE toolkit developed?

Purpose-The purpose of the STRIVE toolkit is to provide practical, step-by-step guidance for healthcare facilities to use when establishing ACS that optimize infection prevention and control measures, which present a particular challenge in physical locations not initially designed for care, or the type of care, that will be delivered. This toolkit is available both in printable and digital form to allow healthcare facilities to 1) decide whether there is a need to increase capacity and or enhance your clinical spaces to meet airborne infection isolation (AII) requirements using our Healthcare Leader Pre-assessment Decision Tree Tool, 2) identify key stakeholders that should be a part of your decision using the Team Composition Recommendation Tool 3) Assess your target clinical space to meet the intended use/purpose using our Surge Site Assessment Tool 4) identify the infrastructure minimum standards for identified clinical spaces using our infrastructure evaluation tool 5) propose solutions to various gaps and barriers while highlighting time, cost, potential barriers, regulatory requirements, and clinical considerations as identified by our Surge Site Assessment using or IPC mitigation/optimization strategy for Space Tools. In addition to reflecting current guidance and recommendations, these tools incorporate lessons learned from subject matter experts and regulatory persons. Intended Audience - The STRIVE Toolkit has been designed for healthcare leaders including administrators and clinicians. The toolkit can be used in order as detailed below, or individual tools can be used on their own to support facility evaluation and processes as needed.

5 tools