Distinct change: IPs on team, still separate
'Looked to as consultants within'
When we caught up with Sue Sebazco, RN, she was knee-deep in pandemic flu planning, but not necessarily missing the old days when infection preventionists — and seemingly everybody else — was busily working in their respective silos.
"[Pandemic planning] is about communication — who's working on what," says Sebazco, an IP and employee health professional at Arlington (TX) Memorial Hospital. "That's a big challenge — getting the information decided at one meeting and then disseminating that to everybody that needs to know. We need to make sure we are not working in our silos and we are bringing everything together."
The 2005 president of the Association for Professionals in Infection Control and Epidemiology, Sebazco looks back to 1999 as a game-changing moment for the field. That was the year a landmark report on medical errors and adverse events was issued by the Institute of Medicine.1 "It was an opportunity," she says. The national patient safety movement, which for all practical purposes began with that report, is now a decade old.
"We are such a big part of the part of the patient safety culture that has developed," she says. "We are collaborating with our colleagues in patient safety and risk management — but we are still separate."
Not as in "silo" separate, but as in a distinct profession that has become all the more public with the increasing involvement of consumer and patient advocacy groups. "The emphasis now is on 'zero tolerance' for preventable infections," Sebazco says. "Infection prevention still has to be a separate profession because our focus is really on health care-associated infections and how we are going to protect our workers."
In that sense, the first influenza pandemic in 41 years is another opportunity for the infection preventionist to prove she's worth her salt. "How we are going to handle surge capacity so that we can quickly triage and treat, and yet still keep our emergency department flowing?" she asks rhetorically. "We are involved in all of that dialogue. We are looked to as consultants within our organizations to help guide the safest way to approach this with what we have in place and with what resources we have."
Infection prevention is sometimes criticized for factoring cost and resource issues into the job of protecting patients and workers, but if anything, such real-world concessions are more pressing than ever. "We are just like every other industry right now; we are facing significant financial burdens," Sebazco says. "We have to be as cost-effective as we possibly can be without risking safety. Cost is an issue, but safety is No. 1."
What will really drive down costs is attacking the annual toll in lives and dollars exacted by health care-associated infections. Forces are converging to make that possible on a national level, as more than 2,000 hospitals are now reporting infection data to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). "It's so important to make sure we are using standardized surveillance with mandatory [HAI] reporting in so many states," she says. "The NHSN has grown tremendously. The data will be there so that we will be able to compare nationally, and also to try to improve [interventions] and drive down our HAI rates."
As infection prevention pioneer Robert W. Haley, MD is fond of saying, "To measure is to control." Sebazco is very much in that school of thought, recommending that the most important, baseline practice for new IPs is to establish valid surveillance methods.
"Learn standardized surveillance criteria [like] the ones used in the NHSN," she advises. "That's the basic foundation of our practice, and we built on it from there. Once we identify what our issues are, then we can address those issues by implementing interventions — and then remeasuring."
- Institute of Medicine Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System.Washington, DC: National Academy Press; 1999.