Just how many infections are preventable? That’s the question with which every hospital grapples these days. While facilities are preventing more infections than ever before, the news still reports illnesses and deaths attributable to breaches in infection prevention and control, prompting infection preventionists to ask themselves, “How low can we go?”
That dialogue is one that has been repeated among practitioners, researchers and scholars, and was a part of a pro-fessional association’s initiative to eliminate healthcare-associated infections (HAIs) through improved education about evidence-based practices. In January 2008, the Association for Professionals in Infection Control and Prevention (APIC) launched its “Targeting Zero” campaign which was designed to “accelerate both learning and the delivery of practical tools for infection prevention professionals,” according to Kathy L. Warye, CEO of APIC. Warye says the program underscores APIC’s efforts to create a culture of zero tolerance for noncompliance with measures proven to prevent HAIs, as well as demonstrates to healthcare administrators and clinicians how they can implement effective strategies and simpler systems for protecting patients from HAIs.
The Origins and Drivers of Zero
So where did zero come from? The concept of zero tolerance emerged in 2000 when then-director of the CDC Julie Gerberding, MD, MPH, noted that the goal of elimination has been applied to other public health imperatives, according to Warye and Murphy (2008). A few years later, the idea of getting to zero surfaced when APIC published APIC Vision 2012, a strategic plan for the future. According to Warye and Murphy (2008) Goal 1 of the plan stated that APIC will “promote prevention and zero tolerance for healthcare-associated infections (HAIs).” They add, “Since that time, APIC's approach has evolved and focused instead on promoting a culture where targeting zero healthcare-associated infections is fully embraced.”
Edmond (2008) observes, “The ‘getting to zero’ movement is the product of three forces: the expansion of external pressures on infection control programs, the intrusion of suboptimal evidence, and the convergence of quality improvement and infection control.”
Edmond (2008) explains that consumers and consumer watchdog groups have priorities that may not be fully aligned with those of infection prevention experts, and that professional organizations may be allowing other stakeholders to dominate the agenda. He notes, “These external influences have arisen in response to the increasingly common perception that healthcare is a commodity and patients are consumers. Thus, the key stakeholders are demanding higher levels of accountability, increased transparency, and rapid solutions to highly complex problems.”
