Currently president of the Association for Professionals in Infection Control and Epidemiology, Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, was a new IP at Detroit Medical Center 38 years ago.
She recalls the day in 1981 when the Centers for Disease Control and Prevention (CDC) released a report1 on the first cases of what eventually would be called AIDS. Hospital Infection Control & Prevention talked to Hoffmann about the IP experience during the epidemic in the following interview, which has been edited for length and clarity.
HIC: What was your reaction when that first report came out in 1981?
Hoffmann: I was actually sitting in a lecture where they said the biggest threat for infectious disease was herpes. I went back to my office and the MMWR [Morbidity and Mortality Weekly Report] had just come out on those five cases. It was just a few months later we saw our first cases of Kaposi sarcoma and Pneumocystis carinii pneumonia patients. I just remember the panic in healthcare personnel was unlike anything I had ever seen. It was comparable to the [more recent] fear of Ebola.
HIC: How did the emergence of AIDS impact the role of the infection preventionist?
Hoffmann: It totally changed my career and all the careers of IPs moving forward. We didn’t really know what the route of transmission was originally; we could only presume what kind of precautions we needed. There was so much fear. Every time a new patient with HIV or suspected HIV came to a floor that hadn’t had a patient before, I would get a phone call. I would go to the floor to educate and support, explaining what the precautions should be for those patients and getting the healthcare providers comfortable enough to do the care. Sometimes, they were doing over-the-top things like bagging all the patient body fluids because they just had so much concern.
HIC: At that time, the isolation measures — the precursors to “universal” and then “standard” precautions — included body substance isolation and blood and body fluid precautions.
Hoffmann: We did pretty quickly get good information from CDC and people who were looking at the behaviors that were unique to this population. We did the epidemiology to look at the risk factors. We could kind of then put together what we needed in terms of risk of exposure. I always felt confident in the recommendations we were making. We really spent the first decade as IPs out there working at our own facilities, but I think many of us — including myself — were called on to go far beyond that. I spoke to people who did adoptions, foster parenting, the sheriff’s department — I can’t even count how many EMS and fire departments. It was the infection preventionists who really went out and did that work and did the training.
HIC: Training demands must have increased considerably with the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogen Standard in 1991.
Hoffmann: That started a whole other wave of IPs leading the way and creating the plans for their individual facilities and really figuring out for the first time how to implement an OSHA directive for bloodborne pathogens, administrative rules, work practice rules, and engineering controls. That was brand new to healthcare facilities to have to implement.
We were the ones as IPs who had to really work outside of our own departments in train-the-trainer programs and everything else we did to get that implemented. It’s really a great success story for IPs. It put us at the forefront of preventing infections within the facility and working with direct care providers.
HIC: There was great concern about protecting healthcare workers, particularly from needlesticks, at least until post-exposure prophylaxis became available.
Hoffmann: That is still an ongoing issue. We don’t want to put anybody on prophylaxis who does not need it. Because while the drugs are amazingly effective, they also have side effects.
That is still ongoing work, but we have had so few, and recently no HIV transmission to healthcare workers from exposures.
One of the first things that I heard when I started in infection prevention is that all outbreaks are opportunities for improvement. This was really a great example of that because of all the emphasis on safe injection practices, needleless symptoms, and safe transfer of sharps in the OR.
While we had hepatitis B and C transmission going on for decades, this really got people’s attention to focus on it. So preventing HIV also prevented HBV and HCV.
- CDC. Pneumocystis pneumonia — Los Angeles. MMWR 1981;30:250-252.