Wisdom Teachers

Twist of fate: Sometimes infections luck of the draw

'No matter what you do, there may be no answers.'

Such a confluence of events and unpredictable circumstances — e.g, host factors, medical interventions — can result in a health care-associated infection that, despite the best efforts of all involved, the patient suffers and the IP is left to ponder the "whys" and "what ifs." That's among the philosophical lessons one learns after 22 years in infection prevention. Just ask Susan Kraska, RN, CIC, an infection preventionist at Memorial Hospital of South Bend, IN.

"I was fortunate to have as a mentor, a medical director who was an ID doc," she recalls. "He would meet with me at least once a week for an hour or two. I would say, 'Why did this patient have to end up with this?' And he would say to me, 'Susan, sometimes it just bad luck.' I said, 'That's not a good enough answer.'"

But after dealing with untold numbers of patients and infections over the years, Kraska has come to begrudgingly accept her old mentor's wisdom: Try to prevent every one; accept that sometimes you can't.

"Twenty years from now, they will probably be able to run a test on your immune system and tell us exactly what kind of organisms may threaten you, and there will be vaccines [and other interventions available]," she says. "But right now, we don't know what kind of organisms everybody has in their respiratory tract. At a given point in time, 10 people could all be under the same conditions for the previous week or month, and one of them will fall intensely ill and may die. Nine will continue moving on as if nothing affected them. Why does that happen? Sometimes it is just bad luck and, no matter what you do, there may be no answers at this point."

Kraska became fascinated with microbiology just after elementary school, as she recalls reading science books one summer about the power of unseen microbes.

"It just hit me like a ton of bricks that there was an entire world going on simultaneously that we couldn't see and yet could have so much affect on us," she says. "Later, when I went into nursing, nothing horrified me more than to see patients with infections, regardless of whether it was hospital- or community-acquired."

It's for you

The career path toward infection prevention was seemingly inevitable, even though Kraska knew she was going to face a major challenge in going into the field. "I don't know why I wanted to put myself through that," she recalls with a laugh. "But I thought the greatest thing that could happen to me was to get a phone call asking me to pack a bag and come and help with the latest outbreak."

The enthusiasm was there, but the real key was getting institutional support for educational opportunities and having a mentor to help process those frustrating cases, Kraska recalls.

"I can't say enough about mentors in APIC," she emphasizes. "Those were the people — some of them retired now — when you picked up the phone and said, 'I am struggling with this situation,' they gave so freely. The generosity of other IPs has just been phenomenal."

Now, of course, infection prevention has been thrust in a national spotlight, an unprecedented profile that could result in more resources but carry the attendant demand of educating the public and politicians. In a sense, the mentored must become the mentors if all this public attention on infections is going to result in meaningful improvements rather than shortsighted mandates.

"It's kind of a double-edged sword; a lot of IPs are saying, 'It is about time,'" Kraska says. "But on the other hand, as my grandmother used to say, 'Be careful what you pray for.'"

That will be a challenge for the incoming new generation of IPs. Kraska urges them to keep asking those tough questions, seek better interventions, "and if you have a hunch about something, pursue it," she says.

You might get lucky.