Infection Control Today - 06/2004: ic community

Pandemicals Surveillance for the Tortured ICP
A shallow, unscientific “path-pourri” guaranteed to postpone lunch

By Roger Freeman, DDS

A team of researchers from the London School of Tropical Medicine conducted an international study on what really “disgusts” people. A follow- up study was then done by the BBC, who asked folks to rank disgusting pictures on a scale from one (not very disgusting) to five (major yuck). In both studies, people found disgusting things, well ... disgusting! Body fluids, lice, festerati, colorful repugnatia ... they all evoked what may be “a very ancient emotion, one that evolved with us to give us an instinct to avoid disease.” What a shock! The pound-sterling at work. Note: The Australians were statistically the most “yuck-resistant” to gross-out. (Put another what? on the barbie?!)

The data dump is in, and the new survey says ... depending on the geography, anywhere from two to 12 unsuspectables per hundred will bite the i-bullet during their high-risk stay. Median hospital stays can increase four to 22 days over the uninfected; median costs can increase from $2,700 to $11,000 ... and this is in the U.S.! If you’re thinking about that surgical cruise or that tropical “tuck,” you may want to check out the local “infectometer” first. The perspectivo: figures are always startling, especially when considering that promising or effective drugs can be killed by serious complications in just 1 per million. Grossly longer odds, but much better (worse?) press.

If you were to go sub-crevicular — no, not attack a post office — but simply examine the microbes between teeth and gums, you’d likely find entire brigades of potential pathogens. More than 500 organisms have been identified to date, and the sulcus sleuths are running out of fingers and toes. Bite-o-gram from the house DDS: break up the brigands STAT! with floss, pick, barbed wire, missiles ... whatever! The enemy troops marshal up toute-suite following meals — often within 20 minutes — so the sooner the shock, the better. Politically correctly (or not), pre-empt or start check under “p” for periodontists!

Do your fingers parch, dessicate, crack, bleed or otherwise scream as if manicured with a Cuisinart? Here’s a tip that might help, when all other slathers fail: gulp ... diaper ointment! The anecdotals have it that A&D infa-bottom spread is replete with vitamins A and D in a cod liver (gulp, again) and petroleum base — good both as a skin humidifier and a moisturizer. Haven’t tried it yet, but maybe the secure among you will do some trials and report back. Just don’t confuse the mission.

Your shower curtain is likely teeming with some bacterial opportunists capable of infecting wounds or sickening the immuno-suppressed and elderly. A University of Colorado microbiologist has studied this problem and discovered that taking a shower aerosolizes the scumbags, engulfing the unwary in bacteria. He strongly suggests frequent washing of the shower curtain every few weeks. Probably good to know ... maybe that’s what got into the football coach ...

Piercing the upper ear (cartilaginous part) has lead to a number of infections in kids ages 10 to 19, a group of whom had their ears poked recently in a jewelry kiosk in Oregon. Pseudomonas aeroginosa turned out to be the villain, leaving four patients “cosmetically deformed.” Think cauliflower. Apparently, antibiotics do not work well on the poorly vascularized cartilage, blocking the get-well juice from its target. Obvious lesson (we guess): pierce something soft. Ouch.

I’m primarily a foodborne freeloader, mostly in coqs-sans-vin or in dairy doodles. Depending on my tailor, I can do typhus, or, if in the mood, a simply wretched case of food poisoning. My case load is probably in the millions, although mostly I’m unreported or misunderstood. I’m oxidase-negative, whatever that means; but then, who cares when you’re arching your guts out. Oh yeah, I can infect kids via you-know-what from those healthy pets with a glowing coat. Better cook me or you’ll surely be courting the porcelain princess. ID my squiggly-looking self, whose name sounds like a former rebel without a cause. (We’ll reveal the answer in the next column.)

Pandemicals wanted. Are you privy to an interesting, educational or even useful infecto-byte? Send it to: roger@iAwareables.com,  along with a trackable — preferably legitimate — reference source. If it makes the editor’s cut, you’ll receive a miniscule citation and an extraordinarily modest gift.

Roger Freeman, DDS, is a dentist and educator who obviously inhaled too much tooth dust in 30 years of practice. He is currently president of Infectious Awareables, Inc. (www.iawareables.com), an occasionally for-profit company producing science based awareness products.

A Passion for Healthcare
APIC’s New Executive Director Introduces an Ambitious Agenda for the Future

By Tina Brooks

For those in infection control, it won’t be a surprise as to what motivated Kathy Warye to join the Association for Professionals in Infection Control and Epidemiology (APIC) as its new executive director. “It was an opportunity to lead an organization at a very critical point in its history,” Warye says. “I think that infection prevention and control has never been more important to us, and infection control professionals have never faced greater challenges. If you look at everything from emerging diseases to the threat of bio-terrorism and even this past flu season, the healthcare community — and infection control in particular — is facing an increasing number of challenges.”

The Centers for Disease Control and Prevention (CDC) reports there are approximately 2 million hospital-acquired infections per year, many of which can be prevented. “As a nation, we need to address this issue, primarily to improve patient outcomes, but also, when you look at the rising cost of healthcare, a business case can be made for this as well,” Warye says. “But to do this, infection control will need greater resources and recognition.”

Along with these challenges come great opportunities. For APIC, they include securing the kinds of resources that infection control professionals need to reduce and prevent infection in their own hospitals, Warye says. APIC also is faced with addressing mandates that can put a crimp in hospitals’ operations.

When asked about APIC’s current activities to overturn OSHA’s new mandate applying the General Industry Respiratory Protection Standard to M. tuberculosis, Warye mentions that the association is working to bring about an outcome that is amenable to a variety of healthcare organizations and workers. The mandate, which becomes effective July 1, 2004, requires the annual fit-testing of respirators in healthcare settings.

APIC has written to John Henshaw, assistant secretary of the Occupational Safety and Health Administration (OSHA), to urge revocation of this mandate, due to the lack of scientific justification for annual fit-testing of respirators. APIC has also mobilized its members to write to OSHA to explain how this mandate will affect their facilities.

APIC continues to enlist members of Congress in dialogue with OSHA and Secretary of Labor Elaine Chao in an effort to overturn the mandate. By press time, APIC will have met with OSHA officials to discuss its concerns and testified on this issue before the House Appropriations Subcommittee on Labor, Health and Human Services in late April.

In terms of APIC’s activities in the coming year, Warye says, “We’re about to launch a dynamic new Web site. It is going to be central to our organization, and our approach to services will be very cutting-edge. For example, members will be able to create their own personalized home pages that will enable them to receive information aligned with their interests. This new service will be introduced early next year and is only one of many value-added attributes that we envision through the new Web site.”

Warye continues, “Education remains critically important to us. We’re planning to broaden our educational offerings to better address the needs of people responsible for infection control and prevention in a variety of non-acute care settings and internationally. We are very excited about the introduction of a new course on bioterrorism preparedness designed for infection control professionals in state health departments. We also are concerned about the shortage of nurses and what this means for the pipeline of professionals needed to advance infection prevention and control. To ensure adequate numbers of future ICPs, APIC needs to reach out to a younger demographic and encourage pursuit of infection control careers.”

Warye continues, “Our practice guidance activity is also increasingly important, as we are receiving a growing number of requests for expert guidance and information from a host of organizations. This increased level of activity will go hand-in-hand with our ability to influence public policy and potentially increase the funding that goes into this particular area of healthcare.”

Warye mentions that the association’s primary objectives for the near future include representing an uncompromising standard of excellence in all of its products, programs, and services. Another objective is increasing the association’s expert reputation and visibility among a variety of audiences from Capitol Hill, to healthcare executives, to the general public. Lastly, growing and developing membership consistent with APIC’s mission and goals will be important as well.

“I would like for us to reach beyond the acute-care hospital base membership to others who are increasingly in need of infection prevention and control knowledge and skill,” Warye says. “And by that I mean people in emergency medical services, long-term care, correctional facilities, home care, and behavioral health. I met recently with an individual who is responsible for identifying infectious disease in people coming from across the border. There is tremendous need in the community beyond the hospital setting for the type of information and skill that our members possess. It will be important for us to increase our strategic affiliations with other non-profits that have a similar mission and also with for-profit organizations that are interested in advancing the public health to reach out to these professionals.”

Working with associations like APIC isn’t new for Warye. She has more than 20 years of non-profit experience and has held key managerial positions at high-profile organizations in the Washington, D.C. area. Most recently, she oversaw the National Science and Technology Education Partnership’s extensive efforts to expand and improve K-12 education programs.

Previously, Warye served as senior vice president of education and government programs for the Association for the Advancement of Medical Instrumentation (AAMI). She was responsible for the association’s educational program and services, certification programs, government affairs efforts, and promotion and marketing activities. “Healthcare non-profits in particular appeal to me because I have an affinity for protecting and advancing the public health,” she says. “During my 20-plus years in association management, I have spent more than nine years in health-related associations. I find that work to be particularly fulfilling.”

Based on her years of experience, Warye notes that there are two ingredients that are critical in any strong professional association. The first is having tremendous subject-matter expertise, which APIC has in its members. APIC has more than 110 regional chapters in the United States and more than 10,000 members worldwide. The other is a staff with strong business experience.

“This is the most knowledgeable, dedicated and committed group of member volunteers I’ve ever worked with,” Warye says. “Sometimes it can be difficult to get volunteers to really give the time and energy needed to move the organization forward. APIC is unique in that its volunteers are 100 percent devoted to the advancement of the association. It is the vision of the members combined with their commitment and expertise that is going to propel this organization forward.”