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Time for full funding and support of infection control in the nation’s hospitals
While infection preventionists in the nation’s hospitals are diverting time and resources to Ebola preparedness there is a real risk that a host of other infections from Clostridium difficile to MRSA will increase and claim many more American lives than the highly publicized virus out of West Africa.
"Our fear is that while we are dedicating these resources to Ebola are infection preventionists ignoring other types of things?" said Linda Greene, RN, MPS, CIC, of the Association for Professionals in Infection Control and Epidemiology (APIC). "Will we miss those red flags if we have a flu epidemic or we have a number of patients with CRE [carbapenem-resistant Enterobacteriaceae]? We are taking care of [Ebola] patients — we are doing what we need to do — but when resources are dictated one way we may be missing other things. That’s really [why] we are sounding the alarm."
In testimony recently submitted to Congress, APIC argued that it was time for full funding and support of infection control in the nation’s hospitals.
"Our members are an essential link to understanding and addressing risks that can contribute to serious public health threats," APIC stated. "However, hospital infection control departments lack adequate funding and staffing to meet this need in addition to current HAI prevention and reporting requirements. In order for our nation to develop an adequate capacity to plan and prepare for the spread of novel infectious diseases, we respectfully submit that this limitation must be remedied."
Only 6% of U.S. hospitals are "well-prepared" to receive a patient with Ebola, according to an APIC survey of infection preventionists conducted Oct. 10-15. The survey asked APIC’s infection preventionist members, "How prepared is your facility to receive a patient with the Ebola virus?" Of the 1,039 U.S.-based respondents working in acute care hospitals, about only 5% admitted to being unprepared for Ebola. The remaining responses reported various levels of preparedness in between the two extremes, with the majority (40%) indicating they were "somewhat prepared." Survey responses were received from hospitals that ranged in size from less than 100 to more than 400 beds.
According to the survey, 51% of respondents had only one IP or less than one full-time equivalent infection preventionist on staff. Experts in identifying sources of infections and limiting their transmission in healthcare facilities, IPs have warned for years that they are under-resourced and have little surge capacity to handle epidemics like Ebola.
"We know that many hospitals do not have enough staff dedicated to infection prevention and control," said Jennie Mayfield, BSN, MPH, CIC, president of APIC. "Facilities that are inadequately staffed to begin with are stretched beyond capacity at a time like this."
Such times are expected to continue in one form or another, as predicted at last year’s APIC conference by keynote speaker virologist Nathan Wolfe, PhD, who warned that we will continue to see pandemics arising from animal reservoirs as emerging viruses take full advantage of unprecedented paths into susceptible human populations. The current outbreak of the Zaire strain of Ebola was possibly sparked by an African toddler handling a fruit bat, one of the known reservoirs of the deadly virus.
While thousands are dying in Africa, the truth is that only one patient has died of Ebola in the U.S. The only documented cases of Ebola transmission in the U.S. have been to two Dallas nurses who treated the late index case. According to the CDC — in what is almost certainly an underestimate — 75,000 people die annually of infections acquired in hospitals.
APIC is calling on healthcare facilities to assess their infection prevention programs by looking at all the care and services provided by the institution and determining the appropriate level of personnel and resources necessary to meet the increased need. APIC is urging facilities to focus on three aspects of infection prevention in order to effectively protect healthcare workers, patients, and the public.
Personnel — Because Ebola readiness demands intense, in-person training and drilling led by infection prevention experts, adequate infection prevention staffing is critical.
Training — To ensure that guidelines are followed precisely 100% of the time, healthcare workers must be trained and drilled on safety protocols so that they can demonstrate proficiency in essential infection control practices.
Technology and equipment — To maximize efficiencies and provide real-time data to help infection preventionists detect and control infectious diseases.