Challenges to infection control in early communication intervention: A scoping review.

Background:  Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech-language therapists (SLTs) use IPC measures for providing early communication intervention (ECI).

Objectives:  To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1-5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review).

Method:  A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis.

Results:  Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies.

Conclusion:  This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.