Broad-spectrum Infection Prevention Strategies in Behavioral Health Settings: Lessons Learned

Session Description: The COVID-19 pandemic increased the numbers and severity of individuals with behavioral health and substance abuse disorders, due to social isolation combined with the behavioral health and physical healthcare disruptions. This had led to multiple infection prevention challenges as patients present to inpatient and outpatient behavioral health settings.

Patients may lack preventative healthcare services, be homeless with suboptimal personal hygiene, and have integumentary breakdown with infection and infestation. Additional risks include not being up to date with recommended vaccinations, bloodborne pathogen infection, pneumonia, and impaired immune functioning.

Patients with substance abuse disorders are at increased risk for bloodborne pathogen and integumentary infections. Persons with an alcohol use disorder are at increased pneumonia risk. Individuals with tobacco use disorders may have impaired immune functioning. Some patients have the potential for violent, pugilistic behaviors, including biting, that can lead transmitting bloodborne pathogens to staff and other patients.

The therapeutic behavioral health unit presents additional challenges. Evidenced based recommendations such as alcohol-based hand rub (ABHR) products, may not be practical where patients have a substance abuse history. ABHR dispensers may become weaponized by aggressive patients. Violent patient behavior, including biting, may lead to a bloodborne pathogen exposure.

Contact precautions and confining patients to their rooms isn’t practical, when there is a therapeutic, daily expectation to attend group therapy. Patients may become oppositional when asked to wear a facemask. Sexual activity between patients may result in sexually transmitted and bloodborne pathogen infections.

By attending this session, the infection preventionist will gain an increased knowledge of the infection prevention challenges and mitigation strategies in behavioral health inpatient and outpatient settings. The importance of safeguarding patients and staff in a high-risk congregate setting will be emphasized.