Darla Silavent, RN, MSN, CIC

Location: Dothan, AL

Title: Director of Infection Control

Company/Organization: Flowers Hospital

First Certified: November 2013

As an Infection Preventionist for 12 years, I had attended multiple trainings to prepare for the influx of disease to include National Emerging Special Pathogens Training and Education Center (NETEC), Emory University, and the Center for Disaster Healthcare Preparedness (CDHP), University of South Alabama. These institutions provide stellar education; nonetheless not unique from many other healthcare entities, preparedness was 60% below the needed 100%.  

1. When did you realize that COVID-19 was truly a public health disaster?

When Personal Protective Equipment (PPE) became difficult, impossible to obtain.

2. What was your greatest challenge when working to limit the spread of COVID-19 in your facility?

Greatest challenge was educating and communicating the dire warnings of the illness. Our area did not experience the influx and death toll until 
August 2020. Despite the national coverage and continuous information shared by all media, there were staff without complete buy in.  

3. How did you adapt or change your processes to overcome these challenges? 

Perseverance and consistency with policy, proces, education and training. Despite the staff member's personal belief or opinion related to CDC guidelines or our process, holding everyone, all discip[lines to the same accountability and scrutiny related to infection control practices resulted in a team approach to the situation. This involved support from the C-Suite.  An example of support, the C-Suite allowed staff from outpatient areas to work making gowns to be used if and when we were unable to receive any from any vendor. 

4. What was your greatest success in implementing COVID-19 guidance?

While we had staff members to develop COVID 19 illness, there were no employee deaths and only one department to have an outbreak related to a lapse in infection control practice. Additionally, watching the mechanism of the incident command "stand up" and begin to take action. Nevermind there were days the members of the COVID 19 task force were exhausted physically and mentally, angry, scared, it was productive and stayed true to the challenge. I was known to become slightly aggressive during some meetings. "Do not attempt to make the entire floor negative, I'm telling you that is not the best approach!!" All CAPS. 

5. Did you make any unexpected partnerships during the pandemic?

No unexpected partnerships.  Alabama was extremely blessed to have certain things in place prior to the event. The Healthcare Emergency Response Coalition of Southeast Alabama had conducted drills and table top exercises prior to and during the event. The coalition is voluntary for hospitals. We were certainly grateful that we were active members. Out of the tragic, traumatic event I developed some strong meaningful relationships with certain staff members. 

6. How did your existing partnerships affect your response?

Existing partnerships were a core component. CDHP developed and implemented the Alabama Incident Management System (AIMS) following the tragic Katrina Hurricane event. The system was part of the state's emergency preparedness plan. At no cost every acute care hospital and long term care facilities had access to the system and it became mandatory to enter site specific information. The information was then relayed to the federal mandated database. Offering a real time report for the "state of the union" if you will for the state of Alabama. The number beds, ventilators, staff, therapists, PPE, etc that were in use or available allowed the public health staff to reach out and coordinate supply relief.  The local healthcare coalition was integral as well for many local facilities.  

7. Were you called upon to work in an unexpected healthcare or community setting?

I was not expecting to have to become a frontline, bedside caregiver in the beginning, again our area lagged behind other counties and states. Our first case was transferred from Georgia. The lag time allowed me and my team to train, face to face, over 300 employees prior to any influx. In August I was pulling different shifts on the COVID 19 med surg unit, 4 hours, 8 hours, 12 hours. This allowed me to truly understand what it meant to care for an active COVID 19 patient. This afforded me observations, immediate remediation and adjusting the process for improved workflow.  

8. How did your certification prepare you to face the challenges of an emerging novel respiratory infection?

Understanding of Epidemiology, all of the terms, mode of transmission, fomites, incidence, specificity, sensitivity, herd immunity, novel, PCR, antigen, mRNA...

9. Is there anyone you would like to honor, why do you want to honor him or her?

ABSOLUTELY! Dr. Robert A Latimer (Alan Latimer) the intensivist for Flowers Hospital. He is a pulmonary specialist with 45+ years experience with an understanding of infectious disease and transmission. He faithfully served on the COVID Task Force and continues to serve as the clinician expert. Consistently he fights for the right thing to be done for the patient. Even at his lowest point, feeling defeated stating "we have got to figure this out" referencing physicians, clinicians, researchers, CDC, etc., he pushed forward. He read countless papers and studies both internationally and nationally. When most physicians and hospitals chose not to use monoclonal antibodies, he wasn't swayed and we successfully administered 784 doses with a low % of admissions. The ICU staff became his troops, his special forces and as the commanding officer, the general, he created a determined atmosphere despite the number of bad outcomes in the beginning. He wept for the defeats and rejoiced for the victories, however small in the beginning. He frequently assisted with the non ICU patients. Physicians much younger, without years of experience, turned to him for advice and mentoring, he accepted the role and managed them up to the task. Those providers are better now and forever will be because of him. I am unable to express in verbiage the gratitude the staff, the C Suite and the community have for this man.  Realistically working hours and days straight without time off is not unique in this situation, but he did it for us, our staff, our patients, our community. He was the doctor, the teacher, the coach, the counselor, the liaison that interpreted research, the defender, the supporter, the G.O.A.T.! (just in case you don't know what that means = Greatest Of All Time!!!)