Wisdom Teachers

IP as change agent: Be an enemy of the status quo

Everyone accountable for doing the right thing

With the move to "targeting zero" infections and abandoning benchmark ranges comes a new role for the infection preventionists: agent of change.

"I'm here to provoke, to challenge and to motivate you to be discontent with the status quo," Kathleen Arias, IP, CIC, MT(ASCP), SM (AAM), said recently in Fort Lauderdale, FL, at the annual conference of the Association for Infection Control and Prevention (APIC). A former APIC president and currently director of Arias Infection Control Consulting LLC in Crownsville, MD, Arias described how the "zero infections" movement has galvanized the field.

"Basically I think of zero tolerance as being a culture — a culture where we cannot tolerate noncompliance with standardized protocols," she told APIC attendees. "We hold everyone accountable for doing the right thing. That's my vision of zero tolerance."

Some have taken the phrase to literally mean eliminating all health care-associated infections, while others view more it more as a marketing slogan and an ultimate goal. The zero-tolerance aspect has been viewed as potentially punitive and counterproductive by some, while others see it is a much-needed move from the safety and inaction of benchmark infection ranges.

"It is controversial," Arias said. "There are a lot of seasoned people here. Did you ever think when you started doing infection control that we would be talking about targeting zero infections? I certainly didn't. This is a really exciting time that we live in. Those of you who are new in infection prevention, networking and building your team are the most important thing that you can do."

IPs, to some degree, are in a process of "continual learning and continual evolution," Arias noted. "Understand the processes that produce the results. In other words, why do patients get infections? Well, it might be because somebody [did not] disconnect the urinary catheter. It might be they didn't wash their hands before they did something. We really need to understand the processes. And you might have to ask a lot of questions. But we need to learn and share information."

Collaboration remains critical, but in a role as change agent, IPs may need to be more of a "provocateur" or a "confronter," she said. "The real key is to foster creativity. We cannot give people the answers. We have to ask the questions and we have to let them give us the answers.

For example, Arias described an approach to a MRSA problem in a small children's rehabilitation hospital. Inspired by the "positive deviance" model — which suggests answers to an institutions problems may already be present at a facility — Arias gathered employees from all stripes and asked for solutions. Answers and strategies came forth from housekeepers to physicians, she recalled. "It was wonderful," she said. "Set the stage and foster creativity. Deliberately encourage discontent with the status quo. We have an MRSA problem. This is not good; what are we going to do about it?"

In general, it is better to enact change by focusing on goals rather than roles, collaboration rather than competition, ideas rather than personalities. The desired outcome is lower HAI rates, reduced transmission of infectious agents, increased compliance, and culture evidenced by new language (e.g., infection prevention rather than control).

HAIs are a worldwide problem, but they are not — as was once widely thought — an inevitable outcome of patient care. Efforts to change perceptions and target zero infections require new thinking in the form of change, but the infection preventionist is in an ideal position to be the agent for such action.

"It's time to leave the status quo," Arias said. "We are going to target zero. That's our vision. Articulate that so that others can embrace it. Then listen."