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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

IPs must make the tough calls for patient safety

Infection preventionists must "draw the line" for patient safety by identifying and reporting infections despite pressure from consumers, colleagues and administrators in a new age of transparency, a leading health care epidemiologist urged.

Allan Morrison, MD, epidemiologist at INOVA Fairfax (VA) Hospital and professor at the Graduate School of Public Policy at George Mason University in Washington, DC, recently delivered a rousing keynote address in San Antonio to some 2,300 IPs attending the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

"Sometimes it is not enough to do our best. Sometimes we must do what is required," Morrison said, quoting Churchill at the June 4th opening session of APIC.

A former Green Beret and a 20-year veteran of hospital epidemiology, Morrison mixed a serious message with levity in a call to action for IPs to make a difference for patient safety.

"We are quintessential lone wolves," he said. "You walk on a unit and what is the first thing that happens? 'I'm washing my hands! Why are you here?' Nobody ever says, 'How are you doing?' We are pariahs. We don't get a lot of 'atta boys.'"

In particular, IPs must make the key call in many cases to make sure infections are correctly reported. The downside of increased transparency about infection reporting and campaigns for "zero infections" is an increased pressure in health care to meet the high expectations of administrators and consumers. This leads to questionable claims about zero infections for "38 months" or attempts by clinicians to parse and narrow the definition of infections, he said.

"What about honesty?" Morrison asked. "I am not going to say that zero is not achievable — it is not sustainable."

There should be zero tolerance of "passivity" toward patient safety, he emphasized, but consider the patient population many are expecting zero infections to occur in: aging patients with immune deficiencies requiring a complex array of invasive devices. That is currently complicated by economic woes and insurance problems that may create incentives to defer care until absolutely necessary. Bacterial strains of whatever subsequently infects them could be any of the increasing variety of pathogens resistant to antibiotics, he added.

"Zero? Difficult," he said.

In addition to HAI definition challenges, beware of "avoidance strategies" like blaming other units or facilities for an infection, Morrison said.

"It's our job to draw the line," he said. "To say, 'No, that is [an infection].' Last time I checked we are a vertebrate species. Have one."