APIC Conference: Is it time to tell the public what ICPs actually do?
APIC Conference
Is it time to tell the public what ICPs actually do?
Public: ICPs invisible, infections preventable
With increasing demands for infection rate data and public accountability, infection control professionals are finding that the public has very little understanding of the ICP’s role in the hospital.
This became clear recently in Baltimore at the annual conference of the Association for Professionals in Infection Control and Epidemiology (ACIP). In discussions about the public demand for infection rate data, ICPs lamented that the public doesn’t understand what they do and generally thinks that all hospital infections are preventable.
"We have realized from reading a lot of the press that there is a great misperception that 100% of infections are preventable," noted Kathleen Arias, MS, MT, SM, CIC, of Arias Infection Control Consulting in Crownsville, MD.
"It behooves us all to collect the information and the articles and show that to our administrators. A lot of times, even the administrators might not realize that infections are not totally preventable," she noted.
While urging ICPs to focus on the infections that are preventable rather than fighting the battle to explain that many are not, Arias conceded that infection control has got to do a better job of clarifying its role in health care.
"We have been focusing on patients for so long that we really need to focus some of our efforts on educating the public on what infection control is, what is available in health care facilities — not only what is being done but what the patients can do to protect themselves from infection," she explained.
For various reasons, hospital infection control has never been well understood — not only by the public, but by other clinicians and health care administrators. The development of an arcane nomenclature that includes terms such as "surveillance" and "nosocomial" added to the field’s mysterious nature.
With concerns about liability from infected patients, infection control as a field developed in hospitals with little outside visibility or public awareness. As a result, lay press reports now herald health care-associated infections as "dirty little secrets" and consumers think they are being subjected to a risk that is completely preventable.
SENIC: One-third preventable
Also speaking at APIC was Robert Haley, MD, who directed the Centers for Disease Control and Prevention’s (CDC) landmark Study on the Efficacy of Nosocomial Infection Control (SENIC) project. The decade-long study established that 32% of nosocomial infections could be prevented by well-run infection control programs, which reported back data to clinicians.
"We don’t want to settle for 32%," he stressed. "We can do better. But I think the PR’ message is at least 32%, but not every one [can be prevented]. We need to protect ourselves and our profession a little bit by using that number."
The hospital infections movement really began in the 1950s and 60s with the staphylococcal pandemics. The CDC began investigating hospital outbreaks, and were about as popular as Ignaz Semmelweis when it delivered its findings to hospitals.
"[The CDC] called it nosocomial infections, using that word to defuse some of the anxiety," Haley recalled. "They opposed everything we did and tried to stop us, but as soon as we would measure this and show [them the infection rates], they would all gasp and say, "Oh, my God, I suspected that might be true, but I didn’t believe it."
Complex, unpopular message
But infection control had a complex and unpopular message to deliver, ultimately losing power to quality assurance types that focused more on sentinel events than the daily bleeding at the baseline.
"I often look at the epidemiology I learned at CDC as similar to a religion," Haley said at APIC. "It causes you to see the world in a different way and act in a different way.
"Our unfortunate clinical colleagues don’t get it because they haven’t looked thorough the eyes of epidemiology. Nonepidemiological clinicians always focus on sentinel events. They are motivated by the horrible case. They don’t understand the surveillance methodology. They don’t understand the power of feeding back rates — using rates to design a [prevention] program that is really going to have an impact," he added.
Amid all the debate about the benefits and risks of public infection rate laws, there is the underlying possibility that the action will allow ICPs to better position their programs in the hospital.
"The [clinical] staff who we are trying to influence are not accountable directly to infection control," said Patrick Brennan, MD, epidemiologist at the University of Pennsylvania Hospital in Philadelphia.
"Then at the other end of the organizational chart, the administration does not understand what we do. We are content experts in what for the administration is an unusual area of knowledge, sort of outside of their realm. So one of the important opportunities for transformation here is to get ourselves positioned differently within organizations so that we are not yelling down at people who are not accountable to us and up to people who don’t understand us," he added.