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By Gary Evans, Medical Writer
Infection preventionists (IPs) were called to action recently in Minneapolis at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). A keynote speaker who suffered a devastating healthcare infection urged IPs to stand their ground and protect patients.
“I want you to know that patients want you to take the lead,” former patient Alicia Cole said to roughly 5,000 IPs at the 2018 APIC conference. “You are the experts. Stand your ground. Stand up for patients, because now more than ever patients need you.”
Speaking at the same opening session, APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, said IPs, as longstanding patient safety advocates, are poised to take leadership roles in healthcare, but first they must demonstrate objective competency through professional certification.
“I believe that infection prevention is at a crossroads, and we as APIC members have an opportunity to determine our future if we identify it and prepare for it now,” she said. “Patient safety is at the very center of everything we do as IPs.”
An actress and national patient safety advocate, Cole described her horrific experience with a postsurgical healthcare-associated infection (HAI) that caused necrotizing fasciitis.
The flesh-eating condition almost led to the amputation of her leg and has required multiple surgeries over a period of years.
“We know that the CDC estimates that 75,000 patients a year will die of HAIs,” Cole told APIC attendees.
“Well, I’m one of the lucky ones. I survived a hospital-acquired infection. That’s why the work that you do is extremely important to me in becoming an advocate to help make a change and improve the system,” she said.
Cole often played doctors or nurses in television acting prior to a 2006 routine surgery that would prove to be life-changing.
Showing some clips of her television shows, Cole said, “I may not be a doctor, but I played one on TV.”
She became a patient in real life when she was told she had to have two noncancerous uterine fibroid tumors removed.
Cole went on an exercise program to speed her recovery and told her parents there was no need to travel to Los Angeles for what she thought would be a routine procedure. They came to the hospital anyway, making a decision that would prove critical to help their daughter through the ordeal that was about to ensue.
“What I didn’t know is that 2 million patients a year develop HAIs after coming in for something else,” Cole said.
Soon after the procedure, she spiked a fever and felt discomfort, but was told it was probably a reaction to the anesthesia.“After the next day or two I still didn’t get better,” she said. “I said to my doctor, ‘Is this normal?’”
In what became a recurrent theme of reassurance, she was told it would pass even as the pain and swelling increased and she became nauseous, Cole said.
When a nurse was changing her surgical wound dressing, her mother noticed a black spot on her abdomen. When the dressing was next changed, it became clear that Cole had an aggressive infection.
“The black spot was gone, and in its place was a quarter-size pustule like a blister,” she told APIC attendees.
Cole did not name the hospital nor the clinicians involved, but said a nurse told her parents confidentially to ask for an infectious disease specialist.
According to Cole, the nurse told them, “I have to talk to you in confidence because I could lose my job. Your daughter is very sick. This doctor is a bit of a cowboy, and he doesn’t want to hear from anybody. But if you as a family request an infectious disease specialist, they have to get you one.”
The ID consult was performed, and Cole was diagnosed with multiple infection problems that occurred during her surgery.
“Finally, I was diagnosed with sepsis, Pseudomonas, MRSA, VRE, and necrotizing fasciitis,” she said, adding that the combination of pain and seeing the graphic destruction of her tissue caused her considerable fear.
“I can’t explain to you in words what it does to your mind,” Cole said. “They finally took me back to surgery and started cutting away.”
After discharge, care continued for years, and the misery of the unhealed wound was compounded by recurrent swelling and boils, sometimes on her face.
“I had an open wound for three years,” she said. “It had to be packed twice a day. I had home healthcare nurses for a year and a half. I went to a wound care center for five and a half years.”
Cole began blogging about her experience as the ordeal continued, first using only a talk-to-type program. With the help of a wound care specialist, she managed to eventually heal without secondary infections.
As her blog posts resonated with other patients and infection control advocates, Cole was asked to share her story at meetings and conferences.
Becoming a leading voice in patient safety, Cole lobbied for passage of California legislation requiring healthcare workers who work with patients to undergo infection prevention training, and mandating that hospital infection rates are made publicly available.
She continues that advocacy, now more than a decade beyond her initial surgery, urging IPs at APIC and elsewhere to use her story as inspiration for patient safety.
“As an infection preventionist, as a nurse, as a team member, stand up for your patients,” Cole said. “Speak up and help them. Take the lead and help your patients understand what’s going on. Give them the diagnosis” if they have an HAI, she said.
IPs must be patient “champions” but they cannot do it alone, she said. “Patient safety is no accident — it is strategic,” she said. “Everyone is a part of the infection prevention team.”
Indeed, healthcare-associated infections are more broadly understood by patients and the public, and accordingly IPs are emerging from the early days of crunching HAI rate data in silos.
With patient safety at the forefront of healthcare quality improvement and regulatory initiatives, IPs are well-positioned to take the lead and speak up to prevent infections, Haas said.
“We have to be recognized as the experts and leaders in our facilities,” Haas said.
“To do this we have to have a high level of competence — to be the go-to people for our facilities, our colleagues, our patients, and our colleagues in public health.”
As part of this, APIC is pushing professional certification in infection control (CIC), even lobbying states to require it.
“It’s time to rally around certification,” she said. “Certification is the best objective way to show your competence to the wider world. It shows your commitment to your patients and to your profession.”
Thus armed, IPs should bring their expertise to bear on decisions that affect patient safety. This means taking a “seat at the table” with the key clinicians and administrators at your facility, Haas emphasized.
“It might be more comfortable to take a back seat,” she said. “But I’m here to tell you if you are not at the table — you are not at the table. And if you are not at the table, you are not an advocate for infection prevention that could save patient lives.”
To growing applause, Haas said, “This doesn’t take an advanced degree — it just takes some courage. So, make the commitment right here, right now, to do this. Are you with me?”
The renewed challenge fits well with a profession that has “a long history of getting things done,” she said.
Clinical care is collaborative, and infection prevention as a critical component of that warrants commensurate resources and support, Haas added.
“You must be prepared to ask for what you need,” she said.
“Prepare, practice, and present like your patients depend on it — because they do.”
With the broad demographic changes occurring in nursing-dominated professions, it is important to support and inspire others coming into infection prevention.
“Let someone know you have confidence in them,” Haas said. “Help them with an abstract or a first paper. No man is an island, and no IP is an island. When we are alone our challenges can be overwhelming. To reach our desired [goals] as infection preventionists, we need to work together.”
Financial Disclosure: Peer Reviewer Patrick Joseph, MD, reports that he is a consultant for Genomic Health Reference Laboratory, Siemens Clinical Laboratory, and CareDx Clinical Laboratory. Senior Writer Gary Evans, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Patti Grant, RN, BSN, MS, CIC, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.