In an age of epidemics and emerging infections, the new normal for infection prevention is an “unending series of challenges” that require interprofessional partnerships and learning from mistakes, said Mary Lou Manning, PhD, CRNP, CIC, president of APIC.
Delivering a keynote address recently in Nashville at the annual APIC conference, Manning cited some of the infections and outbreaks that have come in waves at the profession: ARS coronavirus (2002-2003); H1N1 pandemic influenza A (2009); MERS coronavirus (ongoing); Enterovirus D68 (2014), the return of measles and certainly Ebola (both ongoing).
“And this has been within the backdrop of every single thing that we do every day to begin with,” said Manning, director of the doctor of nursing practice program at Thomas Jefferson University School of Nursing in Lafayette Hill, PA. “So these new challenges are placed on top of what we already have. That is the new normal. It seems like it is just accelerating.”
Enduring partnerships must be formed with a wide variety of colleagues to meet the continual challenge of the next crisis.
“The work of the infection prevention team, while very specialized, cannot be performed independently,” she told some 4,300 APIC attendees. “We need all of the professions. The work requires multiple healthcare workers from different professional backgrounds working together with patients, with families, with communities and organizations. [We must call on] lots of others in order to do our work, and that is to deliver safe, quality care free from infection. Ultimately it is about the patients that come into our care every single solitary day. That is our mission: [Keep them] free from infection.“
But it was two other major infectious disease events that “shaped my thinking,” Manning said, recalling the first occurred in 1981 when she had entered nursing practice. “It was June 5 in the MMWR — a report of gay men who had this unusual pneumonia. It was the first report of what would become the AIDS epidemic. This was something we had never seen and knew nothing about.”
As the epidemic began to expand nationally and globally, Manning had the sense that she was “living history” as the number of HIV infections continued to increase.
“This became very personal to me because my brother was one of them,” she said.
Then in 2001 following the 9/11 terrorist attacks, envelopes containing high-grade anthrax were mailed out to various political and media offices, setting off a series of exposures and deaths that were followed by the “white powder” panics and hoaxes for months after. As with AIDS, Manning found herself facing a new threat that she and other infection preventionists knew very little about.
“To me, AIDS and anthrax each showed that IPs work with and are connected to others to figure out what to do when there is no rule book,” she said. “So there is no rule book and you are mobilizing action, but you are not doing it alone. You are doing it with lots of others. The IP is often the calm voice of evidence-based reason. We are also reminded that there are limitations in our knowledge. You have to learn from your mistakes and keep moving forward.”
Viewed over time, these events reveal the pattern of recurrent crisis that continues to this day.
“You are doing real work in real time as history is happening,” she told APIC attendees. “In times of crisis, infection prevention and control becomes a very interprofessional, collaborative endeavor. The takeaway here is that there is strength in our combined efforts, there is energy in our collaboration, but probably most of all, there is wisdom in our collective experience. It is the power of all of us.”