Patient safety? ICPs were country before it was cool

Everything we have ever done is patient safety’

Reclaiming the hottest buzzword in health care as a bedrock principle of infection control, the president of the Association for Professionals in Infection Control and Epidemiology (APIC) said recently that ICPs have always been "patient safety" advocates and are now poised to take the lead in the national movement.

Patient safety was among the predominant themes as 3,000 ICPs gathered in Seattle for the 28th annual APIC conference. Judith English, RN, MSN, CIC, APIC president, outlined conference highlights and fielded questions at an opening press conference.

"During this week, we are going to be getting very intimately involved on every ICP’s level about patient safety." she said. "Just as everything we have ever done has been quality improvement, also everything we have ever done is patient safety."

The issue came to the forefront last year with release of the Institute of Medicine’s (IOM) much publicized report that estimated some 44,000 to 98,000 patients die each year due to medical errors in U.S. hospitals. The findings have been criticized and questioned, but the patient safety movement quickly gained so much political clout that ICPs were encouraged to get involved.

"From my perspective, IOM dropped a bomb," said Chris Laxton, APIC executive director. "It kicked up a lot of dust, and that dust is still settling."

Amid the confusion, APIC is coming out strong to advocate an ICP role in the process. APIC is using such terms as patient safety and "interventional epidemiology" to underscore the value of ICP skills in a changing health system. The change is occurring across a broad spectrum, with some ICPs continuing their traditional focus on preventing nosocomial infections while others span out to prevent other adverse outcomes for patients.

"We are trying to reassure and affirm to all of our members, wherever they are coming from or wherever they perceive themselves tomorrow to be." English said. "People who work in acute care settings and like it and want to stay there; they want to keep that niche of infection prevention and control — that’s fine. Nosocomial infections are a very important medical error."

Want it right? Do it yourself

But applying infection control epidemiology to other aspects of patient safety (e.g., medication errors) also will ensure that systems are set up properly to track and record incidents. "If you want something right, you do it yourself," she said.

Quality, risk-adjusted data on patient safety issues could be gathered in a system of sentinel hospitals such as the Centers for Disease Control and Prevention’s National Nosocomial Infection Surveillance system. Still, the goal would not be to settle into a comfortable comparative benchmark rate, but make a continuous effort to reduce medical errors. "Interventional epidemiology is not [aimed at] benchmarks," English said. "It is to constantly achieve better."

Regardless, now is the time for traditional infection control and prevention to highlight its long history in patient safety, said Julie Gerberding, MD, MPH, director of the CDC division of healthcare quality promotion.

"The opportunity is now," Gerberding told Hospital Infection Control. "We need to make this issue is as visible as we can, whether we frame i
t as health care safety, patient safety, quality, or dollars and cents. We have ample evidence that [infections and other adverse outcomes] are a major threat to patients in the health care environment. And we also have ample evidence that we know what to do about it. We just need the opportunity to put into action what we know will work."

Still, there is a lot of debate, discussion "and maybe even fear" among ICPs about what patient safety means and whether they are prepared to deal with it, adds William Jarvis, MD, associate director for program development at the CDC division of healthcare quality promotion.

"They forget the fact that most all of them are, in fact, patient safety experts," he told HIC. "Improving patient safety by reducing the risk of invasive devices and procedures has been the mainstay of infection control since its inception. There are no people who are better trained to apply epidemiological principles to adverse events — whether they be infectious or noninfectious in patients or in health care workers — than those in health care epidemiology and infection control."