Amid rapid change and new challenges, it is critical for infection preventionists to preserve their core values, including protecting patients and families, APIC President Linda Greene, RN, MPS, CIC, FAPIC, said recently in Portland at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
“I am astonished by how much the profession has changed — surveillance, technology, emerging pathogens, public reporting — [across] the entire continuum of care. We continue to grow and change at a pace that is unparalleled,” Greene said at an APIC opening session that included some 4,700 IPs from 31 countries.
Those aforementioned patients and families over time become the IPs’ own loved ones, as all of us come to the same crossroads between illness and health. This is the moment infection prevention is critical because one lapse could lead to a healthcare-associated infection (HAI), severely disrupting that patient’s life or, in tens of thousands of cases, ending it. The CDC estimates that at any given time, one of every 25 hospitalized patients develops a HAI.
“Despite all the technological advances, we must continue to make infection control personal,” Greene said. “It may be a simple test, a simple procedure, but one lapse in asepsis, a lapse in hand hygiene, a lapse in high-level disinfection — even a dose of unnecessary antibiotics — can result in an HAI.”
IPs, as the poet Robert Frost termed it, have “promises to keep,” she noted.
“With infection prevention, we must blend the art and the science,” Greene said. “Every day, we have the opportunity to touch a patient’s life — sometimes in a small way, sometimes in a large way.”
The promise IPs made to keep patients safe must be extended to the next generation of practitioners “harnessing their passion” through mentoring, Greene said.
It is a passion that has driven many to a field where, if everything goes exactly right, it’s entirely possible that no one will notice.
“The impact of infection prevention for people who do not [acquire] an infection is not visible to a lot of people and, frankly, not broadly acknowledged, if at all,” said Jodi Vanderpool, MBA, LNHA, CPPS, HACP, vice president of quality at St. Luke’s Health System in Boise, ID. “But the impact is so significant. As you all know, the impact truly saves lives.”
Vanderpool received APIC’s Healthcare Administrator Award for her commitment to infection prevention at her facility.
One challenge for IPs, noted another keynote speaker, is retaining the empathy central to their mission in an age where human communication is both aided and undermined by technology. Since 2000, technology has eroded human conversation in the sense of truly conversing, particularly the lost art of listening, said Celeste Headlee, journalist and communications expert with Georgia Public Broadcasting in Atlanta. As more communication became electronic, there has been a corresponding decline in empathy, the emotional state of recognizing and sharing the feelings another is experiencing. Research has shown “almost a 40% decline in empathy since the year 2000,” Headlee said, urging IPs to talk to people — and, more importantly, listen — while disconnecting from the electronic exchanges for a while.
“Humans do conversation better than any species on the planet,” she said, adding that the context of communication is often emotional rather than logical.
“You can’t debate with an emotional argument — that’s absolutely true,” Headlee said. “But conversation is not a debate. Human beings are inherently illogical. You can’t have a good ‘logical’ conversation. We are emotional creatures. No matter how awkward it feels to you, you can’t retreat into logic when emotions are strong.”
Learn to listen without being defensive and recognize that everyone you meet knows something you don’t, she said. Don’t be afraid to say, “I don’t know.”
“You will change more people by listening than talking,” she said.
One of the major news topics APIC attendees were listening to and talking about was the recent CMS announcement that hospitals must implement water management plans to prevent transmission of Legionella. (See related story in this issue.)
Bottom line: If you don’t have a water system management plan for this increasing threat, you’d better start collaborating with other key departments and get one in process. The CMS listed “immediately” as the effective date.
Hospital Infection Control & Prevention sought out one of the top Legionella experts at the APIC meeting, Janet Stout, PhD, president of the Special Pathogens Laboratory in Pittsburgh. Stout has been researching this waterborne bug since it first emerged in a dramatic 1976 outbreak at a Philadelphia hotel.
“What I see the CMS doing is really putting their feet to the fire because they control funding for hospitals,” she tells HIC. “The language in the CMS memorandum was pretty dramatic. It said implement a risk assessment, do a water management plan, evaluate the effectiveness of the plan through testing. The language then said if you don’t, you will be cited and funding may be affected. Well, this is like [the commercial], ‘when E.F. Hutton talks, people listen.’ When CMS says something like this, people jump to it. So, I see it having a pretty dramatic effect on implementation. People will start doing what, in my opinion, they should have done a long time ago. But better late than never.”
With federal health officials reporting a striking surge in healthcare-associated Legionnaires’ disease (LD), CMS issued the memo to its inspectors on June 2, 2017.1
“In a recent review of LD outbreaks in the United States occurring in 2000–2014, 19% of outbreaks were associated with long-term care facilities and 15% with hospitals,” CMS said in the memo. “…The CMS expects Medicare-certified healthcare facilities to have water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building water systems.”
The regulatory move was supported by the CDC, as the threat of healthcare-associated LD warrants action beyond voluntary efforts like those recommended in a CDC toolkit on the issue. The recently updated CDC tool kit2 was modeled on a 2015 standard by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).
“Hospitals have been aware of the ASHRAE standard since June of 2015, so the whole concept of looking at Legionella in water systems is not new,” Stout says. “But that was a voluntary standard, so there were kind of early adopters and others taking their time — ‘I don’t have to, so I am not going to do it.’”
With the exception of VA hospitals already in compliance, many facilities must develop policies now.
- CMS. Center for Clinical Standards and Quality/Survey & Certification Group. Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD). Ref: S&C 17-30-ALL. June 02, 2017: http://go.cms.gov/2r3ue6B.
- CDC. Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards. Version 1.1 June 5, 2017: