Meet our 2002 Educator of the Year
By Kelly M. Pyrek
Each day, Educator of the Year Susan Dolan receives dozens of calls from healthcare professionals seeking expert advice on pediatric infection control matters.
Hospital epidemiologist Susan Dolan is on the move. It's 8 a.m. and she's already pulled reports from the microbiology laboratory, the first clues as to how her busy day at The Children's Hospital in Denver will be spent. As Infection Control Today magazine's 2002 Educator of the Year, Dolan proves that being an educator requires both mobility and the ability to multi-task.
"My day starts with basic surveillance, where I look at all of the significant cultures that are positive for the day and decide what I need to investigate," Dolan says. "It also prepares me for our daily microbiology meeting." Lest she or her colleagues should be slowed down, these meetings are held standing up and are characterized by a quick exchange of pertinent information about specific cases. "Much of my time is spent at meetings where special projects, like addressing an infection control issue, are addressed. Many of these are issues that require input and consensus, so I work collaboratively with almost all of the departments at the hospital. This award is a reflection of those with whom I work closely every day, for they are my teachers. Without the support from people in epidemiology, microbiology, virology, medical education (residents), and infectious diseases-- I truly would not be able to do my work to such a high standard."
Dolan is determined to make the most of her meetings, using them as an opportunity to educate other department personnel about epidemiology and infection control.
"The key is to go to meetings prepared, and have the best research-based information available. You bring your data and your gut feelings and present issues in a way that gives you credibility and helps you develop into an instrumental person who identifies and solves problems. Or, sometimes you have to present epidemiological data in a way that indicates there is a problem. This happened recently with a department involving a surgical procedure. After presenting their infection rates, we showed them that their current targeted antibiotic prophylaxis may not be addressing the organisms that comprised a significant portion of their post-operative infections. This led to a discussion about appropriate antibiotic utilization and new recommendations. In addition, they said, 'We think we can make your data even better, we need to stratify it by risk factors unique to our patient population.' We realized this, but it was nice to have them suggest it. Also, once they get to know who you are, then when you see them in the OR or when there's an issue, they know who to call and how we can help them."
Dolan's sense of teamwork was fostered during her early years as a staff RN and charge RN in pediatrics, and was further cemented as a member of the pediatric nursing faculty at Jamestown Community College in New York. She came to The Children's Hospital in Denver in 1987, working as a clinical nurse specialist in the hospital's community health program. In 1994 Dolan became the facility's epidemiologist, responsible for the management of its infection control program. She received her certification in infection control and hospital epidemiology in 1997. Dolan holds a master of science in pediatric nursing from the University of Rochester and her bachelor of science in nursing from State University of New York.
Elaine Dowell, John James, Susan Dolan, and Chris Nyquist work as a team to identify patient and employee health issues within the realm of infection control.
As part of her job, Dolan develops educational materials for monthly department meetings and quarterly infection control committee meetings, often incorporating what she has learned at her monthly Mile-High chapter meetings of the Association for Professionals in Infection Control and Epidemiology (APIC). (Dolan has served in many capacities, including serving on the nominating committee in 1997, serving on the program committee in 1998, the board of directors in 1999, and now as the membership coordinator.)
With so many opportunities to compare notes on infection control issues, Dolan says nosocomial infections are high on her hit list, and she makes a concerted effort to partner with her APIC infection control colleagues to raise awareness on the part of patients and healthcare workers.
"I think it's an important issue for everyone to know about," she says. "We have targeted the high-risk areas where we can perform intervention techniques and make a significant impact on reducing the opportunities for nosocomial infections to develop.This allows us more time to examine a specific department's risk factors. For example, we've specifically targeted bacteremia related to central lines in our ICU, NICU, and oncology departments, where the majority of these infections occur. We also are using this data to compare ourselves with other Children's Hospitals throughout the country."
According to Dolan, one of the more urgent challenges to infection control is the nature of the patient population at her facility. "At a children's hospital, you have a higher percentage of patients who need isolation. Our facility doesn't have all private rooms, so we've been very creative with our cohorting. We examine this closely, especially during the winter months because not only do we have the issue of shortage of beds, there's an increase of patients being admitted. We recently submitted a paper for publication that includes data showing that we were able to utilize cohorting without having an increase in our infection rate."
Dolan says smart planning and careful surveillance not only help keep infection rates stable, they help hospital staff track down the culprit organism in event of an outbreak or sentinel event. Dolan also believes every infection is an opportunity for education.
The Children's Hospital had experienced an outbreak of gram-negative bacteremia associated with the introduction of pre-filled heparin and saline syringes, according to Dolan.
"The pre-filled heparin and saline syringes were first introduced to our home healthcare department; since it's easier to teach families if the solution is already drawn up and that's where the syringes had their initial trial," Dolan explains. "We also implemented them in our oncology unit, which is a population where we use lots of flushes and central lines. During the next two months we saw a dramatic increase in gram-negative sepsis. The morbidity was significant--some kids got ill very quickly. At the time we didn't know what was causing the outbreak, but we traced it back to home healthcare and in-patient oncology."
Susan Dolan meets with members of the microbiology, virology, epidemiology, infectious diseases, and pharmacy departments to review positive specimens and results of the testing that takes place around the clock.
Dolan continues, "We looked at the products they had received the week before, with the common thread being pre-filled heparin syringes. People needed to realize when the pre-filled syringes were taken out of the bag, they were not sterile as stated on the product label, while the other syringes used previously were sterile when the peel-paks were opened. However, we believe the product's design and some techniques used by the staff contributed to the introduction of gram-negative bacteria. We pulled them immediately, once we felt strong enough that they were the link, the problem stopped and our rates returned to baseline."
To this end, she uses the outbreak as a teachable moment in the use of the newer needleless or safety devices. When evaluating the new devices, she recommends examining the patient outcome as well as the worker protection aspect as well as healthcare workers' reliance on their safety even when used improperly.
"I tell healthcare workers to think twice and not assume anything about the safety of medical devices and products because not all of them work like they are supposed to. I say this so many times that they'll see me coming down the hallway and they'll say, 'What did we do now?" she says, laughing.
At the risk of becoming the hospital "nag," Dolan says being on the lookout for a teachable moment is key to being a good educator. She adds that many healthcare personnel at The Children's Hospital as well as at other healthcare facilities in the region seek her out. She's a walking 4-1-1, and Dolan wouldn't have it any other way.
"Much of my time is dedicated to being accessible to people and getting them the right resources," Dolan says, adding that she fields inquiries from staff nurses, infection control practitioners at other facilities, even pediatric infection control professionals from hospitals nationally. "We share our experiences, research and best practices, comparing notes and seeing how we can help each other. A lot of my time is spent being a resource and seeking out resources; I send information through e-mail, faxes, through whatever mechanism possible. Yesterday I bet I did it more than 50 times. For example, I received a call from another infection control nurse needing information on staff who have bloodborne pathogens, and I was able to send her a summary of the current literature we had reviewed. Staff members often call for information, wanting to know why do we do what we do and what the epidemiological support is for a certain procedure. And sometimes, I am responsible for creating policies that don't exist, such as the protocol for patients who do their own laundry at the hospital."
"Susan is very committed to making sure the education gets to all levels of staff and that they understand completely," says Rose Seavey, director of sterile processing and the person who nominated Dolan for the award. "She has presented topics nationally as well as locally, but most of all it's her commitment to keep digging until she finds the right answer. She is relentless about finding solutions to problems and is never too busy for any of the staff."
Microbial epidemiologist John James and Susan Dolan discuss the right way to perform a procedure based on national recommendations, research, and manufacturer's instructions.
"My favorite part of what I do is when I can help someone with an issue they are worried about, whether it's a personal question about an illness or an exposure at work," Dolan emphasizes. "I like getting them back on track through education, either putting their minds at ease or helping them work through the process. And if I don't know something, I am fortunate to work with wonderful, top-notch people from whom I learn every day."
While Dolan spends much of her day disseminating information within her hospital, she and her colleagues work closely with the county and state health departments to perform daily epidemiological reporting, prophylaxis, and the like.
"We now are working on issues that have never been explored before, such as what do you do about a child in the community setting that is MRSA positive," Dolan says. There have been some precedents set in a few states, but that issue is now showing up in Colorado. And no one has the exact answer. The state health department has decided to create a task force of community and hospital representatives to address the issue and develop consensus guidelines that will help community settings (e.g., schools) manage these children."
Multi-drug resistant bacteria are not the only issues with which Dolan says she grapples. Headlines about vCJD or the potential for bioterrorism serve as further impetus to examine what The Children's Hospital is doing to prepare for a contingency.
"With any potential threat I ask myself, what departments are most involved?" Dolan says. "I read what the experts have to say, review the literature and then I get people together to discuss the issue. If it's not an immediate threat, there's a tendency to let it sit on your desk due to prioritization needs. But when something happens, it propels you into action. I was working on vCJD for some time now when an incident occurred just a few blocks away at a hospital I can see from my window, and it's a wake-up call. I ask myself, when things like this happen, it's an opportunity to get or raise people's attention about the issue and make sure we are prepared for every eventuality."
The following companies are sponsors of this year's Infection Control Today Educator of the Year award program:
Alliance Medical Corporation is the industry's most experienced reprocessor of disposable medical devices. Alliance's unique AIM (Assessment, Implementation and Management) program, the reprocessing industry's first clinically focused customer support program, provides facilities with the tools needed to maximize their savings from reprocessing. Alliance has agreements with leading national group purchasing organizations and alliances including VHA, Amerinet and University HealthSystem Consortium (HSC), as well as a number of nationally recognized hospital integrated delivery networks that collectively represent more than 3,000 healthcare facilities. www.alliance-medical.com.
Augustine Medical has developed the latest alternative to waterbath-based blood/fluid warmers: the Ranger® blood/fluid warming system. The Ranger system features SmartHeat technology, which warms fluids without the use of bacteria-prone waterbaths. SmartHeat continuously monitors the temperature of the heating surface to provide consistent heating, and, since the system contains no waterbath, the system is virtually maintenance free. In addition, the system delivers both high and low-flow rates for instant switching from routine to trauma situations. www.augustinemedical.com.
Becton Dickinson is a medical technology company that manufactures and sells a broad range of supplies, devices, and systems for use by healthcare professionals, medical research institutions, industry, and the general public. The company continues to build on its 100-year foundation of quality, reliability, and commitment to its customers and business partners globally. Recognizing the issues surrounding sharps-related injuries, BD leads the world in providing devices that can reduce the incidence of sharps injuries and exposure to bloodborne pathogens. www.bd.com.
Getinge/Castle is a worldwide leader in sterilization, disinfection, and surgical products and services for the healthcare market. We serve healthcare business globally by offering quality products with dependable service and ongoing support. From the OR to Central Processing, Getinge/Castle has products and services to keep you efficient and productive. Castle® Sterilizers, Washers, Sterility Assurance Products, Detergents, Warming Cabinets, Scrub Sinks, OR Cabinets, MAQUET® Surgical Tables, ALM® Surgical Lights, Ceiling Equipment Organizers, and Wilson® Stainless Steel OR Products. www.getingecastle.com.
Since 1968, Glo Germ has provided teaching hospitals, long-term care facilities, food service, day-care, public school systems, clinics, and other institutions with this unique product. The proven safe inert ingredients in the Glo Germ lotion or powder cast a revealing glow when exposed to standard UV light. Glo Germ gives a visual demonstration to show when improper cleaning or handwashing has taken place. Glo Germ also is great for the demonstration of contamination/transmission of germs. The Glo Germ kit contains a bottle of oil, a bottle of powder, and an ultraviolet lamp. The oil and powder contain the plastic germs, and the lamp lets you become the "germ detective." www.glogerm.com.
Kendall, a business of Tyco Healthcare based in Mansfield, Mass., manufactures and markets a broad range of wound care, needles and syringes, vascular therapy, urological care, incontinence care, sharps disposal, and nursing care products. These products are distributed and used in a variety of clinical settings including hospitals, rehabilitation centers, long-term care facilities, and homes throughout the world. Market-leading brands include such trusted names as KERLIX,® CURITY,® MONOJECT,® KANGAROO,® and ARGYLE.®www.kendallhq.com.
Mobile Instrument Service & Repair helps healthcare providers maximize the life of their surgical equipment investment by providing an independent, low-cost maintenance, and repair alternative, combined with an ongoing system of education, service, and support. A family-owned and operated business, Mobile Instrument revolutionized the surgical instrument care industry in 1978 when it launched the nation's first on-location service van in central Ohio. Today, Mobile operates more than 100 service vans across the US and Canada, as well as the country's largest instrument repair center. www.mobileinstrument.com.