Keep your eyes on the prize: The patient

Keynote speaker credits contributions of ICPs

Sharing three decades of experience in a field whose sole constant appears to be change, a veteran epidemiologist recently reminded some 900 of his colleagues to keep their focus on the patient.

"The patient is central to everything we do," William Scheckler, MD, said in Toronto at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA). "The patient is why we exist."

A hospital epidemiologist at St. Mary’s Hospital in Madison, WI, Scheckler is also a professor of medicine at the University of Wisconsin Hospital and Clinics. He delivered a keynote address at the conference as the recipient of the SHEA Lectureship Award for career contributions to the field. In his address, Scheckler reminded an audience comprised mainly of physicians of their debt to infection control professionals.

"We hospital epidemiologists wouldn’t have any data, wouldn’t do any good, wouldn’t be anywhere without our colleagues — infection control professionals," he said.

Amid all the changes in the field of infection control and the widespread discussion of patient safety and medical errors, Scheckler pointed out that epidemiologists must bring their history of rigorous science to the fray. "Involve yourself with your hospital or health system patient safety quality initiatives," he said. "They will be improved by your participation."

While critical of the Institute of Medicine’s (IOM) much publicized report last year on patient safety, Scheckler said the issue has eclipsed bioterrorism as the latest hot topic in the field. Such changes and paradigm shifts have marked his long career in infection control, he added.

"After 33 years of trying to find the answer, there is no answer," he said. "The answer keeps changing. [Now] it’s time to get onboard the patient safety and quality express or be left behind forever. The IOM report is not going away; we ought to be at the table."

Indeed, there was no hospital epidemiologist on the IOM panel that compiled the report, which barely reflects the achievements of the profession, he noted. "In the content of that whole thick book, there are two pages that talk about hospital epidemiology and infection control."

Referring to the source medical papers extrapolated in the IOM report, Scheckler noted that the data were based on research that was done in clinical settings in 1984.

"Of course, nothing has changed in health care since 1984," he noted dryly. The orchestrated publicity about the projected patient deaths due to medical errors was the aspect of the report that ingrained the issue in the public consciousness, he observed.

"The first paragraph of every newspaper article in the country and every newscast about this talked about 44,000 to 98,000 deaths per year due to medical errors in hospitals," he said. "However, that quickly got shortened to [as many as] 98,000 deaths. That’s why this report became so widely known — that extrapolation. That 98,000 is now etched in stone."

One of the founding members of SHEA, Scheckler also was one of the pioneers at the Centers for Disease Control and Prevention’s hospital infections program in the late 1960s and early 1970s. He questioned some of the semantic changes that are under way at his old program, such as downplaying the use of words such as "surveillance" because the public and policy-makers do not understand the profession.

"[And] even though this feels like a stake in the heart to me sometimes, the [CDC] hospital infections program is now called the division of healthcare quality promotion," he said. "[But it] isn’t what we call things; it is meeting the challenge with the best science."

Now, as at the beginning of his career, it still comes down to a dedicated group of people tracking patients and implementing measures to protect them from infections, he said. "Those three things: Good data, good policy, and good people are what will protect the patient in the future," Scheckler said.