Infection Control Today - 10/2003: A Day in the Life of an ICP

A Day in the Life of an ICP
How One Nurse Found Her Passion in Infection Control

By Kelli M. Donley

The task of profiling the “average” infection control practitioner (ICP) is nearly impossible and certainly laborious. ICPs by nature are not undistinguished people. Their duties are rarely atypical and their workplace interests are not mainstream.

Mary Ellen Laskowski, BSN, MPH, CIC, is no garden-variety healthcare worker (HCW). This ICP fits the pattern of having an exceptionally interesting story.

Laskowski, who is the sole ICP at Arrowhead Community Hospital in Glendale, Ariz., was persuaded to join the bug-busting field while working as a neonatal ICU nurse at Cornell Medical Center in New York City. It was 1981 and Laskowski was a young and determined, yet intimidated nurse. She didn’t know anything about infection control and the idea of changing units wasn’t appealing. Enter Lew Drusin, MD, MPH — the hospital’s senior epidemiologist who would eventually become a life-long friend and mentor. Drusin told Laskowski that infection control was the cream of the crop, the paragon of hospital departments. The choice was hers, he said, but the decision would be one that would influence the rest of her life.

Today, Laskowski laughs when she looks back at her choice to become one of four ICPs at the 1,400-bed hospital. “To give you an idea of the sheer size of the hospital, our office was on the 24th floor,” she says, shaking her head. “I was with three seasoned nurses and one epidemiologist; it was a forced learning curve. I read infection control books nonstop. My new interest became outbreak publications.”

Working as the ICP covering women’s and children’s services, Laskowski said her first few years in the position challenged her to stay ahead of that curve. She quickly racked up infection control experience in handling chickenpox exposures and the associated restrictions and quarantines placed on the affected unit. HCWs would stop her in the hall with pressing questions; she would run up to her desk, search through one of many reference books, find the answer and run back downstairs with the solution. Soon enough, the answers were on the tip of her tongue, rather than at her fingertips, and the healthcare workers were none the wiser. They got their answer and infections were truly being controlled.

Until one fateful day Laskowski will never forget. A wave of hepatitis A suddenly struck the pediatric ICU.

“It was Labor Day weekend 1983,” she says. “We had two nurses with signs and symptoms of hepatitis A admitted. We had to do a total workup and ended up giving gamma globulin shots by the hundreds. After we reviewed patient charts, time of exposure, time of symptoms and ruled out staff parties and meals, we decided it couldn’t be the hospital cafeteria. It had to be a patient.”

Before the source of the outbreak was identified, Laskowski says seven nurses, a nursing supervisor, a respiratory therapist, and a healthcare worker’s sister, husband and cousin all fell ill with hep A.

“I had to look at every patient who had been in the pediatric ICU and pediatric wings,” she says. “I found a child who had cancer and was showing signs of hep A infection, but they were similar side effects to the chemotherapy he was receiving.”

The child hadn’t been eating well; the parents thought they could help by bringing in food from home. The child later arrested and many healthcare workers in the area were exposed to his urine and feces. Viola — the formula for an outbreak.

“Everyone who became infected either had a part during the arrest or dealing with the body post mortem,” she says. “The staff insisted that they had worn gloves as part of the protective equipment. However, hand hygiene should be followed even when gloves are worn. The staff who became sick all showed evidence for potential transmission from hand to mouth — they chewed their nails, put pens/pencils in their mouths or were smokers.”

The family members of HCWs who also fell ill either ate food prepared by the healthcare worker or shared the same pack of cigarettes. To complicate the outbreak further, the cousin of a healthcare worker who became ill didn’t show signs until he returned to his native England, adding an international twist.

“It was quite overwhelming,” she says. “We didn’t have any deaths and our work was later published in the Journal of Diseases and Childhood. You really had to use your brain on this one. All of these people had taken part in so many activities. We did a food questionnaire and nothing came out. We had a hard time figuring out what made the infected different from others.”

By the time gay-related immunodeficiency (GRID) hit New York City, Laskowski was just finishing her master’s degree in public health. It was the early 1980s and she says homosexual men with unknown infections were entering her hospital.

“They were getting sick with stuff we’d never seen,” she says. “We had Kaposi’s Sarcoma, and wasting diarrhea from cryptosporosis. That was previously only seen in veterinary cases. It wasn’t a human infection. I along with other ICPs would attending infectious disease grand rounds to learn the latest developments.”

Soon enough, GRID was renamed HIV/AIDS and Laskowski realized her city and hospital were caught up in the beginning of a serious global epidemic.

After a series of events in her personal life, Laskowski decided Arizona and a smaller hospital were in her best interest. She started work at Arrowhead in 1993. As the source of infection control knowledge for the facility, she says the staff regularly relies on her to work directly with patients.

“The chart will say, ‘Have IC nurse see patient,’ which I think is such a compliment,” she says.

Similar to many ICPs, much of Laskowski’s time today has shifted toward bioterrorism preparedness and prevention. She says her morning routine consists of checking census sheets, analyzing the surveillance information for trends, ensuring compliance with JCAHO standards including the newest sentinel event when a patient’s death is attributable to a nosocomial or healthcare-associated infection. .

“I have to make sure all of the ‘T’s’ are crossed and the ‘I’s’ dotted,” she says, grimacing over the annoying paperwork. “My top reportables are sexually transmitted diseases, hepatitis C, viral meningitis and Valley Fever. With this job, I’ve been able to learn about new diseases we never saw in New York — hantavirus and plague.”

Although there is increased paperwork and scrutiny since September 11, Laskowski says the changes are not all bad. In fact, these changes have also brought much needed increased funding and recognition of the role of an ICP. “We are better off today than we were before,” she says, referring to the field of infection control. “We’ve all made great strides, but there is a long way to go. At a community hospital, we may see one or two strange cases.

We don’t know if neighboring hospitals are also seeing these. Who is going to put this all together? Our threshold for identifying needs to be adjusted.”

Although she says without hesitation that being “regulated to death” is the biggest aggravation associated with her profession, Laskowski says certain aspects of her job make it all worthwhile — specifically, having the entire hospital at her beck and call.

“There is no area of the hospital off limits,” she says. “I go on environmental rounds and see how healthcare workers clean and store items. I ask how scopes are being cleaned and how they can be cleaned better. I examine the whirlpools and create standards for departments. I get to challenge myself and everyone knows me. I’m the bug lady.”

She says she particularly enjoys when she gets to go incognito.

“I go undercover during surgery to examine mask-placement and to see if the sterile field truly remains sterile,” she says. “I watch for sharps safety, training and how the stock is replenished.”

Although these are special occasions, it would be hard to find an area of the hospital where Laskowski isn’t involved.

“I work with environmental care, purchasing, patient care practices, pharmaceuticals and therapy, the disaster committee, the quality council and I run the infection control committee.”

In addition to this lengthy list, she is currently working on a focus study concerning wound infections.

“We target surgical procedures on which to do surveillance,” she says. “ This year we are looking at total abdominal hysterectomies, laparoscopic cholecystectomies and shoulder arthroscopies. We have concentrated even further on the hysterectomies to identify if appropriate antibiotic prophylaxis given one hour prior to incision can cut down on the number of surgical wound infections. The trick is to convince the doctors to implement the practice and then make sure that the hospital delivers the medication in a timely fashion. The study is ongoing.”

Laskowski says as complicated and involved as some of her duties are as ICP, the basis of true infection control remains: washing your hands.

“The most important aspect of infection control is hand hygiene,” she says. “Notice that I did not say hand-washing. We are getting away from soap and water. We also need to continue pushing for appropriate use of personal protective equipment.”

As an active member of both the Association of Professionals in Infection Control and Epidemiology (APIC) and the Grand Canyon chapter, she is very excited to have the next national conference in Phoenix in 2004.

“You know what they say about nurses? ‘Nurses eat their young.’ It is very difficult for young nurses to find a mentor,” she says. “APIC as an organization both locally and nationally is very active in making sure that new practitioners get the help, guidance and mentoring they need. Our local chapter here in Arizona offers seminars and conferences and guidance and we have an educational speaker at each of our meetings. There is also a listserv feature at both national and local levels where people can post questions and get feedback from their peers.”

From watching some of the first patients with HIV enter her hospital to establishing central sterile policy and procedures for variant Creutzfeldt-Jakob-exposed instruments, Laskowski says after all of these years, Drusin may just have been right. Her career in infection control has never been without challenge, or triumph.