Presenting the 2004 ICT Educator of the Year
By John Roark
When Beth Young, RN, BSN, CIC presents grand rounds, its standing room only. Passionate about infection control, she makes learning creative, memorable and fun.
Grand rounds at Robinson Memorial Hospital are anticipated with as much excitement as the opening of a Broadway show, thanks to the creativity of infection control coordinator Beth Young, ICTs 2004 Educator of the Year. She really believes in what she does, says Diane Zelasko, RN, MSN, director of performance improvement. She has a unique way of educating by bringing out things that are fun, that help you remember infection control principles, which usually is a dry subject.
A certified infection control professional since 1987, Young has devotedly served Robinson Memorial for 30 years.
In healthcare today, 30 years is a very long time to be in the same facility, says Young. But this is a great place to work! We are the only hospital in Portage County in Ravenna, Ohio, and we were just named one of the top 99 places to work in northeast Ohio. I think that says a lot for Robinson Memorial. I have been here for 30 years, and Im planning on staying a little longer. No one would have stayed in the same place unless it was a pretty good place, especially in infection control.
We have everything that the bigger hospitals have, but on a smaller scale, says Young. Infection control, even in a hospital this size, is very challenging. Theres nothing boring about it. I went into infection control pre-AIDS, pre-multiple drug-resistant organisms, MSRA, VRE. Today, infection control has moved way beyond the walls of the hospital. We have two urgent care centers, an outpatient surgery center, home health agency and many physician offices, so infection control is not just here on the hospital campus.
Through Robinson Memorials tuition reimbursement program, Young received her bachelors degree at Kent State University.
Young has served on the board of the Northeast Ohio chapter of APIC for the past three years, and is its current president. An active participant with county public health officials, she represents her APIC chapter as a member of a statewide bioterrorism task force.
Two topics about which Young is passionate are hand hygiene and sharps safety. I think for years, infection control practitioners were asking staff to do something that they really didnt have the time to do, she says. You might be getting tired of hearing about alcohol hand sanitizers, but this is one of the most exciting tools that has come our way to achieve compliance. You have to believe what you say, and I believe that they can use hand sanitizer before and after contact with the patient and the patient environment. After you read the research about soap and water, its hard to say that people are really going to have time to do that. Im not tired of hearing about hand sanitizer yet, because this is a great tool for those of us in infection control. They can do this, but we have to show them that they can do it.
We are a county hospital, but very progressive in many areas, says Young. In the fall of 2001, Robinson Memorial installed hand sanitizer dispensers in every room of the hospital. We were about a year ahead of the final Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards because our infection control committee felt that there was good science-based evidence that these products worked, and that they would help us achieve higher compliance.
In 2000, Young created the Ignaz Award, presented annually at grand rounds to the physician who best exemplifies good infection control practices, especially handwashing. You know how articles say that physicians are not among the best handwashers? Young asks. What I really believe is important is that we have good physicians who are good role models. We let our clinical staff vote for the physician who practices the best infection control, of which hand hygiene is an extremely important part. The Ignaz Award has generated a lot of interest. Its been a good tool for us. And of course, were like everyone else, and are looking at a variety of ways of being able to monitor compliance with hand hygiene, since its the seventh patient safety goal now. I think that hand sanitizers are whats going to help us be successful in that way.
The Ignaz Award was created and named to honor Dr. Ignaz Semmelweis, the Hungarian physician who demonstrated that puerperal fever (also known as childbed fever) was contagious, and that its incidence could be drastically reduced by enforcing appropriate handwashing behavior by medical caregivers. Ive always said that Ignaz Semmelweis is my hero, says Young, But he died from blood poisoning in an insane asylum. For those of us who are passionate about hand hygiene, thats a little bit of a concern, isnt it?
When the 2003 Ignaz Award was announced at grand rounds, an infectious disease physician who received an honorable mention rather than the Ignaz trophy shouted out, I demand a recount!
When it comes to education, Young is a big believer in positive reinforcement. Reward the person whos doing the right thing and you know what will happen? That person will continue to do the right thing because you acknowledged them. And their behavior may rub off on someone else.
Taking the hand hygiene message one step further, Young implemented a safety letter provided for every patient at Robinson Memorial. Right in the letter it says, If you see us forget to wash our hands, remind us.
Young is also a strong proponent of sharps safety. In a two-year period, Robinson Memorial decreased sharps injuries by a remarkable 66 percent. We were one of the first hospitals in northeast Ohio to bring in a safety IV catheter, says Young. We started long before President Clinton signed the Needlestick Safety Act.
Nurses are careful no one wants to have a needle stick injury, says Young. But caution alone does not decrease sharps injuries. What brings sharp injuries down is better devices, she continues. Were always looking for something thats just a little bit better. Transmission of a bloodborne pathogen in a healthcare facility is most likely going to be from a sharp, especially from a hollowbore sharps. So thats where you start. You start with the phlebotomy devices, and IV starts. I keep on top of that I follow every sharp object injury, and I talk with people who were involved to try and find out the details from them. The person who was stuck is whom you have to ask: what do you think could have been done to prevent this injury from happening?
A lot of times they beat up on themselves and say, I should have been more careful. Its not always about just being careful. Its having the right device. And if people are still using the devices they were using five or six years ago, they probably arent using the right device. Thats part of what I teach at for the physician offices they struggle with that too. Ive brought in the types of devices were using here so that they can see the opportunities that are out there for them.
The legend of Youngs grand rounds began in 1999, when she incorporated the musical theme, Rock and Roll Infection Control. Driving with a tape recorder in her car, she would record any song whose lyrics could be adapted to the theme of infection control. The hit parade included pop-music takes on common OSHA violations (I Fought the Law, by the Bobby Fuller Four), sharp object safety (Needles and Pins by The Searchers) and tuberculosis precautions (I Cant Get Next to You by The Temptations).
The music was such a hit that she now incorporates a theme song whenever she can. By all accounts, Youngs 2003 grand rounds were the best ever. Having just returned from the APIC National Educational Conference in San Antonio, Young was inspired by a trip to the Alamo. She incorporated the legend of Colonel Travis, who purportedly drew a line in the sand with his sword and asked those who were willing to stay and fight to step over the line. All but one stepped over the line. So that was my theme, says Young. Step over the line for infection control.
Through imagination, originality and enthusiasm, Young creates valuable mnemonic tools for her audience. Another brainchild is Jayco, the Didjakno Bird, who is always squawking about infection control issues. Jayco posters were placed in department lounges throughout the hospital and changed weekly for the eight weeks preceding the JCAHO visit. Messages were department-specific, with special bulletins created expressly for patient care services, hospital-owned physician offices, environmental services and so on.
You have to seize every moment that you can to educate staff, says Young. I dont think you can separate infection control from education. You cant just do surveillance, you have to feed that information back, and it really isnt of any value whatsoever unless you communicate it back through education. Its not just what I know, its what the staff knows thats what makes a good infection control program.
Young is quick to point out that the practitioners she works with keep her on her toes. My nurses, respiratory therapists, and radiology techs are pretty critical thinkers, she says. And they do challenge me. I dont always get off easy. They definitely challenge me to show them the evidence. They are critical thinkers.
At the end of the day, Young is grateful to have fun in an environment that is both challenging and supportive. I am a true believer in infection control, she says. I believe in what I do. I believe with my heart and soul that infection control professionals make hospitals safer for patients and for visitors. I want other people to believe that too, and so I really am passionate about it. We are the people who make healthcare facilities safer places.
- Soiled linen must be bagged in the patients room
- There is no need to double-bag soiled linen unless the outside of the first bag is soiled or torn
- Never hold soiled linen or bags against your uniform yuck!
- Never throw soiled linen on the floor
- Single items, such as a wash cloth or gown may be carried to the soiled utility room if no visible body sub-stance. If visibly contaminated, even single items mustbe bagged in the patients room.
Jayco, the didjakno bird
Educator of the Year Runners-Up
Frank E. Myers, III, CIC, CPHQ, epidemiologist for Scripps Mercy Hospital/Scripps Health, San Diego, Calif.
Frank Myers will never be accused of mincing words. Educating ICPs about hepatitis A, spread by oral-fecal transmission, he offered up the following advice: If you dont want to get hepatitis A, you may want to write this down, its so common in California my advice to you would be, dont eat poop. Thats with two os. Hepatitis A is not very funny, but if you are communicating in a way that people remember, it will reach them in a way that will be more meaningful, says Myers. One of the things I frequently see are people who put on things like crazy bug hats. Well, as an adult, if you walk into a room looking like an idiot, Im probably not going to be listening to you for very long. Reaching them in a way that is adult makes it very approachable.
Now, thats not an approach I would necessarily use with the interns and residents, adds Myers. They would roll their eyes. But with general population, thats going to work pretty well. Theyre going to come up to you three months later and go, Dont eat poop! They walk away with something.
Myers holds bachelors and masters degrees in political science, and worked as an HIV seroprevalence statistician and an AIDS surveillance officer for the State of Delaware before joining Scripps in 1994. President-elect of the 2003 California APIC Coordinating Council, he has received numerous awards and nominations and is a member of the San Diego Germ Commission. That stands for Group to Eradicate Resistant Microbes, he says, laughing. Myers is also a reviewer of a number of different nursing journals, contributes frequently to industry journals and is a frequently requested speaker at association conferences.
For Myers, the IC hot spot is hand hygiene. Thats one subject where feeding back data to people is very useful; going back to a specific unit, saying, Heres how much alcohol-based hand rub you use, and heres how many times we had poor hand hygiene result in a patient not having an optimal outcome.
Located in San Diego County, Myers frequently sees cases of community- acquired MRSA. We still see a lot of tuberculosis because of our proximity to the border and our homeless issues, he says. So the nontraditional presentation of tuberculosis is something I need to communicate. Getting people to think that just because someones coming in with rectal abscesses doesnt mean that they dont also have tuberculosis. You may actually have to look at both orifices. And some day you may have to look at the whole patient. Were not there yet someday we have that vision, but right now we start small and build towards greatness!
Myers is the first to admit he has occasionally erred, and uses those lessons as a springboard for educating others. Were all human and we all make mistakes, and sometimes if you look back on them it can be rather enlightening, he says. Ill always remember one situation where I thought I had done this great intervention. I was going to do a presentation for the emergency room staff, about how we did this really great intervention. Having lunch right beforehand, the safety officer was sitting across from me. He looked at me and he said, You did WHAT? I described the intervention, and he said, You didnt think about this other regulation when you did that, did you? What I had done wasnt the great intervention that I thought it was. So instead of giving an hour-long presentation on what a great job I had done solving the problem, I talked about what we thought we had solved, and how we didnt solve it. It really worked for people because they followed the logic all the way through and said, Whoa! I hadnt thought of that either.
DJ Flournoy, II, director of microbiology, Department of Veterans Affairs Medical Hospital, Oklahoma City
DJ Flournoy has published more than 230 articles, 36 abstracts and 88 research posters for teaching purposes, and has been a part of 57 direct research grants.
My job description has stayed the same, but my job has changed in that I used to do a lot more research when I first came here, says Flournoy, who has been with the Oklahoma City VA for 28 years. Now Im doing very little, if any research, doing more benchwork and more one-on-one teaching than I used to. I used to do more group teaching.
In the course of 28 years with the Oklahoma VA, Flournoy has been able to see the fruits of his labor. Ive gotten to meet a lot of really great people, and actually several of them ended up being my doctors or my familys doctors, he says. I even had one student, whose son or daughter came back and was a student in the same module under me.
For Flournoy, the transmission of pathogens holds special interest. The issue is trying to make people aware of how easily pathogens can be spread among patients and other healthcare providers, he says. As a corollary to that, how important it is that they know this and understand it, because they play a vital role in it. I dont think that everybody who works with patients really appreciates how easy it is to spread pathogens among themselves and among patients.
Part of Flournoys weekly routine is going on rounds with interns, attending residents and third-year students. Unbeknownst to them, I keep track of who they touch and if they wash their hands, and I write it down each time, he says. Over a period of eight or nine years, Ive observed more than 1,200 different rounds. They wash their hands about 50 percent of the time. One day, a resident on the team I was with touched five different patients and never washed her hands. And with the last patient she took a bandage off of an open wound and poked around it to see how tender it was and never once washed her hands. Heres a person whose been through medical school, through her internship and everything, and didnt appreciate how critical that is. Of course, this gets my attention. I pass that information on to the infectious disease physicians, and let them use it as ammunition to try to get the resident interns be aware of that.
In addition to teaching a variety of students, Flournoy monitors unusual occurrences of organisms such as MRSA and VRE. I monitor certain organisms continuously and collect data on them, he says. I save the organisms in skim milk and freeze them. In my hospital I have all the MRSA weve ever had since the 80s. There are over 1,700 of them. I have all the VRE also. So if we want to go back and study them, or if a new antibiotic comes out and we want to check it out against these organisms, I can pull it out of the freezer and do susceptibility testing on it. Its a powerful tool. Or should we have some sort of outbreak of some VRE at our hospital, I would already have a lot of data on how we might use other antimicrobials to overcome these bugs.
An involvement in his local chapter of Toastmasters has given Flournoy additional insight in effective communication. Ive become more aware of how important it is on the other end of it. Its important that the students actually learn what I try to get them, he says. Theyre the most important person, not me. So then it becomes critical that they learn what I want them to learn. If I get frustrated with them because I think theyre not learning, its probably because Im not teaching very well, and I need to work harder and make sure they know exactly what I want them to learn, and do that in a fun way.
For 26 years, Flournoy taught a lab module of students in medical micro-immunology. But today, the majority of teaching is done on a one-to-one basis. He finds that interaction on an individual basis can be very effective, if done right. We have a lot of what I call open-book exams. That way, the students dont have to memorize and be afraid of anything, but they still have to find it and be aware of it. Thats my approach.
Even after more than a quarter of a century as an educator, Flournoy still loves to teach. I like the students to have a wide variety of experiences in my lab, so theyre well-rounded, so that people who come through the lab understand how we work and what our frustrations are. I try to get them to see everything as much as I can. The thing that would make it uninteresting would be if the people that I teach had already heard it and knew all about it. But for most of them theyre pretty new to it. I try to go over really basic things. One of my pet peeves is, lets get somebody into this really esoteric research project or something way out the on the fringe but they dont even know the basics. I want to make sure they know the very basic things about microbiology. Lets ground them in the basics, and then they can take it from there.