Infection Prevention: The Past Is Prelude
Carbapenem-resistant Enterobacteriaceae challenge will take collaboration
Looking to the past and the present, Association for Professionals in Infection Control and Epidemiology (APIC) President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, recently gave a keynote address in Philadelphia at the annual APIC conference. Hoffman also is an infection prevention consultant for the Survey and Certification Group at the Centers for Medicare & Medicaid Services (CMS) and a clinical instructor in the division of infectious diseases at the University of North Carolina School of Medicine.
Hospital Infection Control & Prevention asked Hoffmann to discuss some of the themes she raised in her address in the following interview, which has been edited for length and clarity.
HIC: Infection prevention has come a long way from its origins, but you stress the importance of the bedrock science.
Hoffmann: The foundations for our practices of hand hygiene, asepsis, and disinfection were really laid down by the early scientists of the mid-1800s, like John Snow, Pasteur, and Lister. I sometimes think we too easily put them to the side in considering why isolation precautions work, and the importance of hand hygiene. Asepsis and environmental cleaning are becoming more and more relevant as time moves on.
The 100 years from 1900 to 2000 was a period of learning but not a period of cooperation. It was a period of silos. We did have some significant things happen, like the first infection control nurse in 1968 as an outcome of Staph outbreaks. The first CDC Decennial meeting in 1970 was a major occurrence. Then, APIC was founded in 1972. That same year, the Joint Commission began requiring infection control programs.
HIC: Do you have personal experience with infection prevention operating in a silo?
Hoffmann: Yes. As someone who has done infection prevention for 35 years, who started in the field back in the 1980s, I began in infection control very much isolated. There was difficulty with implementation of policies and procedures, and working with facilities as a whole. We functioned in silos, which really did not have much impact. We wanted to be more impactful, so we started doing a lot of partnering within our facilities. The federal bloodborne pathogen rule, for example, created a partnership for prevention of needlestick injuries.
There have been several national partnerships with which infection prevention has become involved over the period from 2000 on. What we have learned is that the more we partner, the more success we have — because nothing changes when we work in isolation.
HIC: Now, we are in an era of more collaboration and opportunity for IPs. As you mentioned, there are programs at the federal level focused on reducing specific hospital-acquired infections (HAIs) and implementing antibiotic stewardship programs.
Hoffmann: We are looking at these national efforts that can support us at the local level. IPs can use these to demonstrate to their leadership the importance of infection prevention in terms of complying with regulatory bodies. We have made a major impact in the last 10 or so years for widespread practice change. We’ve seen from the CDC National Healthcare Safety Network [NHSN] data a reduction in HAIs. We are very concerned about patient safety and preventing HAIs, so that’s the direction we want to keep going.
HIC: CMS “pay for performance” initiatives have helped make the business case for preventing HAI costs that may not be reimbursed.
Hoffmann: It has really gained leaderships attention, which from a financial business case aspect is important. I think IPs can use that to their advantage, even though it is an imperfect system. They need to use data to improve practices at their facility. I believe there are always practices that can be improved upon in every facility. It’s up to the IP to use the data that is presented to them through these national systems like NHSN and Hospital Compare to their advantage and implement evidence-based practices. I think that is the best use of this value-based purchasing that leadership is so concerned about.
HIC: We’ve seen a succession of emerging infections, from SARS to Ebola in this century alone. Do you see the next big challenge as containing multidrug-resistant organisms?
Hoffmann: Control of antibiotic-resistant bacteria is an area where we can use partnerships the most, because we have room for improvement. For example, CRE [carbapenem-resistant Enterobacteriaceae] is spreading into the wider world and becoming vastly more common. It is going to be harder to detect and harder to control.
The CDC does have evidence-based steps in their CRE toolkit that they really want all healthcare facilities to follow.1 In their modeled data from their NHSN and emerging infections programs, they show that coordinated approaches to interrupt the spread of HAIs can have a big impact on increasing incidence of these infections — [as opposed] to independent efforts by facilities alone.2 They projected, compared to independent facilities, that a coordinated and partnership response to CRE could result in a 74% reduction in five years in interconnected facilities. With that kind of collaboration, they projected that more than a half-million antibiotic resistant HAIs could be prevented over five years. That is really something to think about in terms of working within systems. This calls for infection prevention to be leaders in this area.
- CDC. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit. Available at: https://bit.ly/2F3bHUw.
- Slayton RB, Toth D, Lee BY, et al. CDC. Vital Signs: Estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States. MMWR 2015;64:826-831.
Looking to the past and the present, Association for Professionals in Infection Control and Epidemiology (APIC) President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, recently gave a keynote address in Philadelphia at the annual APIC conference. Hoffman also is an infection prevention consultant for the Survey and Certification Group at the Centers for Medicare & Medicaid Services and a clinical instructor in the division of infectious diseases at the University of North Carolina School of Medicine.
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