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The greatest story never told? ICPs must raise voice on infection prevention

Former health secretary keynotes APIC in Tampa

Infection control professionals must do a much better job of telling their "story" if they are to thrive in a competitive health care market where every dollar is in demand, former U.S. Secretary of Health Tommy Thompson recently said in Tampa at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

Fielding questions at a press conference after delivering the keynote address before some 3,600 APIC attendees, Thompson said ICPs are playing a critical but underappreciated role in the health care system.

"You have a wonderful organization, but I don't think APIC is receiving the kind of publicity or the political influence that it deserves," he said. "I'm not being critical; I just think that is a fact. I think your hospital administrators and [financial] people in the hospital look at your end of the scale as one that [they] can always take money away [from]. You have not told your story well enough to get the attention of the hospital administrators and the opinion makers. You have to start talking about your successes. You have had huge successes in your hospitals and [in] public health. You need to tell that story to the opinion makers."

Indeed, in a rapidly changing health care system, the analogy may be extended to say that APIC needs to get its story straight before telling it. Gone are the days of benchmarking and rote data collection, as new pressures come to bear in an age of growing public awareness and demands for disclosure.

"We have this great pressure to use our data now to demonstrate the effectiveness of our health care programs and our health care systems," said APIC president Kathy Arias, MS, MT, SM, CIC, APIC. "There is a great call from the public, the media, insurance payers, consumers, consumer organizations for mandatory and public reporting of health care associated infections for more transparency. There is increased scrutiny of health care outcomes worldwide. People are watching us and they really want to see improvement."

Major initiatives for change began when APIC held a futures conference in 2004 and tried to imagine the ICP of the future in hammering out its APIC Vision 2012 strategic goals, Arias noted. At that time, Denise Cardo, MD, director of the division of health care quality promotion at the Centers for Disease Control and Prevention said, "We must de-emphasize benchmarking because being better than a bad benchmark is not the same as being good," Arias reminded, drawing applause from the audience.

"When we developed out strategic plan APIC Vision 2012, goal number one was to emphasis prevention and promote zero tolerance for health care-associated infections and other adverse events," Arias said. "This was a bold move because a lot of our members were really upset with us and saying, 'You can't reach zero. Some infections are not preventable.' Well, zero tolerance is not a number. It's a culture. It's a culture of patient safety in which every single health care provider knows that it is their duty to do everything that they can to prevent our patients from getting an infection."

Indeed, even the nomenclature is in flux, as the proactive sound of "prevention" gains favor over the time-honored "control" of infections. "We must shift our focus," Arias told APIC attendees. "We must shift it from infection control to infection prevention. [But] do we change our names? Do we change APIC's name? If we are going to design the ICP of the future we have to think what we want to call ourselves. We started out as infection control practitioners. Then we went to infection control professionals. But what's next?"

Attendees were invited to go to computers stationed at the conference for a nonbinding vote on some proposed names (e.g., infection prevention & control professional) or suggest one of their one. Though advising attendees to have some fun with it, the identity issue underscores that APIC is trying to hone its image to meet the demands of a changing health care market. The process is tricky because APIC is an established brand name and the acronym ICP is synonymous with the field.

In such heady times, allies are needed, said Trish Perl, MD, president of the Society for Healthcare Epidemiology of America (SHEA). Perl spoke to the APIC audience to underscore the potential for collaboration between the nation's two major infection control groups, which are essentially divided along the traditional lines of physicians and nurses. It was announced that 89% of APIC attendees were registered nurses.

"We have similar challenges [in] helping the CDC support us [and], advocating for patients and patient safety," Perl said. "We have similar needs to meet the opportunities to prevent infections. We are moving toward zero tolerance, and we can only do that together. We have to advocate for preparing health care facilities. We are going to be central in any kind of pandemic influenza or infectious disease, mass casualty [incident]. We have got to grow our memberships. We do not have enough infection control practitioners and health care epidemiologists."

At Thompson's press conference, Perl asked the former health secretary and governor of Wisconsin what ICPs can do to secure a greater share of federal health dollars. "There is $15 million that goes every year at CDC to West Nile virus, which [causes about] 100 cases a year," she said. "Whereas $2 million is appropriated for the study of health care [infections]."

Seeking a seat at the table

Thompson said the key is awakening the powers that be to the benefits of infection prevention. "Everybody is pulling on Congress for this appropriation or that appropriation," he said. "But with the war on terror, the Katrina [aftermath], there aren't any extra dollars. The only people that are going to get funded are the ones with the best stories. I think [ICPs] have one of the best stories, but how we communicate that — how we sell it — is important."

Thompson tossed out several ideas, including getting Congressional recognition for the annual infection control week in October and holding a yearly press summit on health care infections jointly sponsored by APIC, SHEA, and CDC. "You've got to contact congressmen and U.S. senators and ask if you can come in and talk to the people on the health committees and the appropriation committees about what you want to do and what you can do to change health care in America," he said. "You have got to be there when they are divvying up the money. And I don't think you are there. I don't think you have a seat at the table. . . You have to first convince your own administrators at the hospital where you work how important you are."

For example, ICPs will be of critical importance if pandemic flu emerges, Thompson stressed. Basic infection control measures may have to hold the day if there are insufficient stocks of vaccine to prevent infections and antivirals to treat them, he noted. "If we do have pandemic flu and we don't have medicine, who are going to be the most important people to control that pandemic in America?" he said. "The people in this arena."

Thompson lamented that he was unable to convince Congress to fund new flu vaccine production research and development four years ago. "We produce vaccine in a way that was started in 1950 and it can't be ramped up," he said.

The annual process of producing a trivalent flu vaccine using chicken eggs is time-consuming and particularly vulnerable since avian influenza H5N1 can be deadly to chickens.

"If avian flu gets to the chickens, it may kill the eggs and we may not be able to produce any vaccine," Thompson said. "That is really not very smart for America. I asked four years ago to change that to a cell culture [vaccine production process], which we have the knowledge and capability to do. So you can ramp up. Right now, the maximum dose of vaccine you can produce is 100 million — maximum."

New vaccine production research now is under way, but there is a global race against time. Thompson urged building up domestic vaccine manufacturing capacity by providing liability cap limits for companies that produce vaccine and guaranteeing them the federal government will provide the final market. "If there is not an end purchaser, companies are not going to risk the loss of millions of dollars every year," he said. "If we had started four years ago, we would be in much better position to protect America against H5N1 or any flu because we would have a way to [rapidly produce] the vaccine."

In an interesting aside, Thompson said he had a flu pandemic planning meeting on his schedule five years ago on a particularly fateful day for America. "People didn't believe we were facing a pandemic, but I was talking about it," he said. "9/11/2001 was the day I [had scheduled] all my specialists to come in to talk to me about pandemic flu. We canceled it, of course, but it was on my calendar."

Indeed, the war on terrorism was an underlying theme in Thompson's keynote address, in which he called for "medical diplomacy" to improve America's image in the world. Major initiatives, such as fighting HIV in Africa, offer a strong antidote to anti-American hatred that fuels terrorism, Thompson said. By the same token, world-class CDC epidemiologists need access to disease outbreaks in other countries if they are to thwart the rise of global epidemics, he emphasized. For example, severe acute respiratory syndrome (SARS) spread globally in part because China was reluctant to let American epidemiologists participate in the investigation of the first cases, he said. Medical diplomacy efforts and working with other nations through the World Health Organization in Geneva will hopefully head off a similar situation should pandemic flu arise in a country reluctant to welcome U.S. involvement, Thompson said.

"It is very necessary to be immediately called to make sure our epidemiologists get a chance to go into the field and see the deceased early on and come up with a laboratory analysis to determine what it is," he said. "We didn't get a chance to get in there soon enough on SARS, and I think we would have done a much better job if we could have."