Infection protection
Pulse editor
Sunday, June 21, 2009
Five years ago, Marie Commiskey was a seasoned critical care nurse and hospital administrator who had a good rapport with every unit at Wishard Health Services in Indianapolis.
“When our long-time infection control nurse retired, our CEO asked me to step into the role,” said Commiskey, BS, RN, CCRN, CIC.
Photos by Barry Williams/Special
BEFORE: To demonstrate the importance of proper hygiene at Children’s Heathcare of Atlanta at Egleston, Renee Watson applied simulated germ spray to patient Jessica Goolsby’s hands and examined them under a black light.
Renee Watson and Amp Sathiphone demonstrate how to fit an N95 mask. ‘We can no longer kill all bacteria, so the best thing is to prevent them in the first place,’ said Watson, system manager for the Office of Infection Control and Occupational Health at Children’s Healthcare of Atlanta.
Traditionally, that job had been given to older nurses at the end of their careers and it consisted mostly of surveillance and compliance issues. Commiskey wasn’t enthusiastic about it.
“But when an employer asks you to do something, I feel like you owe it to your profession to do it,” she said. “Little did I know that I was entering this field at exactly the right time.”
Commiskey discovered that the role was exciting and challenging, so she stayed in the job for four years. After moving to Atlanta a year ago, she became manager of infection prevention and control at Gwinnett Medical Center in Lawrenceville.
The latest wrinkle in her job description is making sure the hospital’s construction of a new tower and the remodeling of existing buildings don’t adversely affect patient and staff safety.
“I love what I do,” she said. “Nothing that I have done in 30 years of nursing truly impacts patient care more than what I do now.”
Many factors have brought infection control out of the shadows and into a leading role in health care: bioterrorism, emergency management preparation, drug-resistant bacteria, global health issues such as malaria and tuberculosis, pandemic threats and the cost of hospital-based infections.
“We’re watching the role morph before our eyes,” Commiskey said. “APIC [Association for Professionals in Infection Control] wants to move it to toward an autonomous profession, a discipline unto itself.”
The need for highly trained professionals is critical because infection and control specialists must lead from the bedside to the boardroom to the community, Commiskey said.
“The stakes are higher, so the role is growing and commanding more respect than ever before,” said Denise Flook, coordinator for workforce and infection prevention initiatives for the Georgia Hospital Association. “There have been infections since the beginning of time, but the number of resistant infections is going up and our patients are more acute. An infection can cause additional morbidities or mortalities.”
Concerned by the growth of drug-resistant bacterial infections, the Centers for Disease Control and Prevention and the World Health Organization are working with physicians to set new guidelines for prescribing antibiotics.
“If we prescribe antibiotics when they are not really needed [for viral infections such as colds], then when we really need them, they may not work,” said Flook, RN, MPH, CIC.
The ramifications of increased global contact can be severe.
“Chronic diseases like diabetes and malaria also multiply the risk of infections. We’re seeing a huge rise in resistant TB, which is almost endemic in some countries, and spreads through immigrants and migrant populations,” Flook said. “We’re a global society now and infections like the new H1N1 virus [swine flu] spread quickly across borders.”
The bottom line
There also are financial considerations to infection control.
“Medicare and Medicaid and some insurers will no longer pay for hospital-related infections, such as ventilator-associated pneumonia, catheter-associated urine infections or bloodstream infections,” Flook said. “Preventing such infections is not only better for patients, it’s cost-effective for health care organizations.”
The average cost of treating ventilator-associated pneumonia is about $40,000, and bloodstream infections can cost between $10,000 and $40,000, Commiskey said.
“When our department can decrease MRSA [methacillin-resistant staphylococcus aureas] infections by 40 percent — as we have — we can make the business case that infection control is not a cost center, but a profit center for the hospital,” Commiskey said.
Flook works with hospital infection prevention and control departments, public health agencies and organizations like the Georgia Partnership for Health and Accountability to promote, share and implement best practices. For example, this month the Georgia Hospital Association is collaborating with researchers at Johns Hopkins University in Baltimore to prevent catheter-associated bloodstream infections.
Georgia hospitals will be adopting the “bundles” created by Dr. Peter Pronovost, the medical director of Johns Hopkins Center for Innovation in Quality Care. His research shows that following a standardized, common-sense set of practices — hand washing, using the correct aseptic in surgery, administering the correct antiobiotic after surgery and utilizing the right cleaning procedures for central lines — reduces the risk of adverse reactions in patients.
“Many hospitals have already instituted these bundles in their ICUs, and we’ll be introducing them in other units,” Flook said.
Infection preventionists will help educate staff about new, unit-based safety programs.
The importance of prevention
“We used to put out fires and now we prevent them. Prevention of infection spans all areas of the hospital,” said Renee Watson, system manager for the Office of Infection Control and Occupational Health at Children’s Healthcare of Atlanta and president of the Greater Atlanta chapter of APIC.
Keeping a hospital safe involves the entire campus.
“We’re not just responsible for the clinical environment, but all areas,” said Watson, RN, CIC. “How the dietary staff delivers trays or [how] volunteers are screened is part of my job. We have 7,200 employees and our office is accountable for instituting best practices throughout the hospital, with no authority.”
Watson has seen the role change from policing regulations to consulting with staff to initiate change for the better.
“I think we’ve finally gotten the point across that we don’t make things up,” she said. “Infection-prevention measures are evidence-based and they save costs and lives.”
As simple as it sounds, good hand hygiene is a key to decreasing infection risks and spread.
“We can no longer kill all bacteria, so the best thing is to prevent them in the first place. Prevention is our power,” Watson said.
Watson knew her two-year, hand-hygiene program had taken hold when she saw a security team member stop to apply an alcohol hand product before helping with a combative patient.
“We’re all about the elimination of risk,” she said.
There was a time when many hospital administrators and workers considered infection prevention and control departments to be a necessary evil. Now, clinical leaders involve Watson in selecting equipment and making sure products are safe and cost-effective.
“When news of the H1N1 virus broke, our senior leaders said, ‘Tell us what we need to do,’ ” Watson said. “I’m so proud of the evolution of our specialty. A lot of what we do seems mundane, but mundane things can save lives.
“We use our specialized skills and knowledge, and people see the return on that investment.”
Ten years haven’t diminished Watson’s passion for the specialty. She knows every day will be different and that there is always more to learn in the role that she calls the “quintessential patient advocate.”
“I may no longer touch a patient directly,” she said, “but I know that a child’s life is in my hands every day.”