By Deborah Paul-Cheadle, RN, BSN, BHCS, CIC
I have been an infection preventionist for 18 years. I am constantly thinking about the how, why and when, living and dreaming infection control, just like all of my co-preventionists. I am passionate about the objective of infection prevention. Currently, the press is full of the need to reduce healthcare-acquired infections (HAIs). I am not going to bother cutting and pasting the national HAI rates. We are already very familiar with them.
When I read my first "press release" on the nation’s goal to reduce HAIs, I thought, "Finally, maybe with political and administrative support, we can accomplish this goal."
Now, I push the delete button, and toss into the recycle bin when I see that published. Why? Well, I feel like Dr. Ignaz Semmelweis ... sometimes closer to the insane asylum than not! And I know I am not alone in these feelings.
I attended the Fifth International Decennial Conference on Healthcare-Acquired Infections held in Atlanta this year. It was worth every penny. I came back with exciting, cutting-edge processes that could help us eradicate HAIs. But you see, there is no money to implement these processes. And the stance of infectious disease physicians is, "This or that is not proven to reduce HAIs." Show me this data... data that takes much time and money to collect validate and publish.
I decided that approaching a state senator to request funding to help with obtaining funding and support in a study that could show whether eliminating organisms in the environment does impact HAIs. A flashing whiter-than-white smile embedded in a beautifully tanned face listened to my story and request, with pathetically feigned interest. When I had finished, he informed me that there were really no funds available for this. So what is the money funded by Congress to help hospitals eliminate HAIs really for?
It seems that we again are tasked with a monumental, possibly impossible, task — to accomplish without financial support or the "scientific data" that proves a positive outcome. We are left with history. So, the premise of this diatribe is to explore some infection prevention history as it has shaped our current practice, and to explore the potential for using it to obtain support for the implementation of other approaches in the efforts for prevention of HAIs.
Case No. 1 is the cornerstone of infection prevention, and involves Dr. Ignaz Semmelweis and Dr. Oliver Wendell Holmes. Both physicians identified the link between unwashed hands and HAIs. Two hundred years later, we are still doing hand hygiene education and audits.
Case No. 2 is the cornerstone of epidemiology, John Snow’s pump handle. Once it was removed by a town’s sheriff without the support of the town council or physicians, the cholera epidemic stopped.
Case No. 3 illustrates the need for every hospital to have an infection control nurse. A major hospital experienced a Staph aureus outbreak in a hospital nursery. Healthy infants died from healthcare-acquired Staph aureus infections — Staph aureus carried to them on nurses’ hands.
Case No. 4 includes two cornerstones for surgical suite sterility. First, Joseph Lister, in a series of delicate and intricate experimental research projects, proved that when the atmospheric germs are absolutely excluded, no changes in exposed tissue occur: "In the interior of the grape, in the healthy blood, no such germs exist; crush the grape, wound the flesh, and expose them to the ordinary air, and then changes, either fermentative or putrefactive, run their course. But place the crushed fruit or the wounded animal under conditions which preclude the presence or destroy the life of the germ, and again no change takes place; the grape juice remains sweet and the wound clean." The application of these facts to surgical operations, in the able hands of Joseph Lister, has revolutionized surgical practice.