IPs, patient advocates: Can marriage be saved?

Despite antagonism, a powerful partnership

The infection prevention community has lost some measure of credibility in the public and political eye and must embrace the patient advocacy movement to regain a leadership role, said Steve Weber, MD, a health care epidemiologist at the University of Chicago.

Speaking recently in Chicago at a Joint Commission infection control conference, he said IPs must "retake the lead on these issues — to really reclaim our place as the folks that are best positioned to make the difference."

In a current climate that can blur the line between patient advocacy and antagonism, IPs run the risk of being seen as part of the problem as outraged patients demand action to prevent health care-associated infections (HAIs). Citing strongly worded messages from the growing number of consumer web sites and advocacy groups, Weber said patient stories resonate powerfully with legislators.

"The Consumers Union — not a fringe group by any stretch — [has a] slogan on their web site: 'End hospital secrecy and save lives,'" he said. "We might disagree with [many of the charges], but the fact of the matter is this is what the folks who represent us in Congress and state legislatures are hearing. From the outside looking in, we are not seen as the experts or authorities anymore. We might be at our institution, but when we step out of that community, people are looking at us and saying, 'Why [do HAIs] happen in hospitals?"

Weber's remarks carried particular emotional heft because he followed an impassioned speech by Victoria Nahum, who founded the Safe Care Campaign after the death of her son Josh due to an HAI. Such patient advocates can provide compelling emotional context to the mission of IPs, if a spirit of collaboration can overcome an "us-and-them" mentality that too often divides the groups, Weber said.

"It is easy to see what a powerful ally [Nahum] could be in our institutions and to our profession," he said. "If we want to reclaim leadership, we need to really understand that and not be the ones who are giving technical, qualified [explanations about HAIs]. We need to be ready to get out there and say, 'Here is what we think is a good practice, and here is what we don't think is a good practice.'"

IPs must convince patient advocates that they may not have the passion of a lost loved one driving them, but they have dedicated their careers to preventing HAIs. "We need to align with them instead of being lumped together with the other forces in health care that frankly don't see this as such a serious problem," Weber said.

However, bridging this divide involves conceding past failures, including the historic problem of achieving health care worker compliance with basic hand hygiene. With many studies showing that workers only wash their hands appropriately in about half of patient encounters, achieving compliance rates in the 70% range are ironically seen as successes, he noted.

"A lot of you have public relations posters or banners hanging outside your institution touting this or that," he said to conference attendees. "How many would like to see a sign that says, '[Welcome to our] hospital, where one-third of contacts with your loved one will not [include] a basic infection control measure.' It's awfully embarrassing. I think we need to move beyond the era of saying this is impossible and that is the best that we can do. Accepting that [level] is not appropriate."

Though conceding that past efforts have not been sufficient could give IPs credibility with patient advocates, Weber acknowledged that it may be frustrating in light of individual campaigns and efforts to achieve better compliance. The reality though is that legislators considering HAI bills are not going to start out by writing, "whereas, folks in infection prevention have really been working hard on this," he noted.

Likewise, IPs can expect little sympathy to the traditional argument that it is increasingly difficult to prevent infections in patients with high severity of illness. "I know this is unfortunate and difficult to think about — and it is not to undermine or devalue any of the incredible and generally heroic work that has [been done] by folks in this room over the last few years and beyond," Weber said. "But the fact is from the outside looking in, we need to acknowledge that we are not at 'zero'; we are not making the differences that people need to see."

Dramatic infection reduction programs like the Keystone project in Michigan have captured the public's imagination, raising expectations in the process. "It was great to see the public [reaction], but it was scary to see people in our field say, 'I never knew this could happen.' What have been working on all these years if we did think we could at least try to get zero?"

In general, the field must err on the side of action rather than research, Weber noted. The recent publication of a brief concise infection control recommendations in a landmark compendium should help that effort.