Behind the Scenes at the CDC
A Conversation With William R. Jarvis, MD
By Kelly M. Pyrek
William R. Jarvis, MD, is associate director for program development, Division of Healthcare Quality Promotion, in the National Center for Infectious Diseases. He has authored or co-authored 380 publications, 25 book chapters and one book, and specializes in epidemiology of infectious and noninfectious complications associated with healthcare delivery as well as nosocomial infections and antimicrobial resistance. In an interview in February, Jarvis spoke about the need for continued vigilance against infectious agents.
Q: How have the events of Sept. 11 and the recent bioterrorism threat affected the work of the infection control community?
A: The aftermath of Sept. 11 sparked a greater awareness of the potential for bioterrorism, but more importantly, it heightened the general public's recognition of what infection control is and why it is important. As we recover from Sept. 11 and the anthrax scare, many people are thinking when, not if, a major public health threat could emerge. The importance of infection control programs becomes apparent as more healthcare facilities step up their surveillance for infectious agents within their walls and in their communities. It is critical to continue educating people about infection control. Groups like the Society of Healthcare Epidemiologists of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) do a great job in spreading the word among healthcare workers, but it's like preaching to the choir. The challenge lies in reaching the ordinary citizen, the potential hospital patient, the person who isn't aware of the dangers of pathogens.
Q: Are infection control professionals hampered in this era of managed care and cost-cutting?
A: Hospital administrators are constantly looking for ways to contain costs. A hospital's infection control program is a tempting candidate to eliminate or reduce in size because they only see this department as an expenditure and not a revenue producer. Physicians only spend 30 percent of their time in surveillance, while infection control practitioners (ICPs) spend up to 70 percent of their time in surveillance. ICPs and epidemiologists have had their responsibilities increased -- especially since Sept. 11 -- but their resources haven't increased. Healthcare workers everywhere are required to do more with less these days. It is essential that hospital administrators support their ICPs and epidemiologists. They take these professionals for granted until there is an infectious outbreak or a sentinel event and then they need their experience and knowledge. The key is to convince more schools of medicine to integrate infection control and epidemiology into medical training as early as possible. My first exposure to infection control principles was as a senior resident in pediatrics. How can someone go four years in med school and not get IC training? It's a continuing challenge to get infection control onto a med school's agenda.
Q: What are the infection control-related challenges the CDC is addressing on behalf of ICPs and epidemiologists?
A: The CDC has established seven healthcare safety challenges which the Division of Healthcare Quality Promotion plans to address within the next five years: reducing catheter-associated adverse events by 50 percent among patients in healthcare settings; reduce targeted surgical adverse events by 50 percent; reduce hospitalizations and mortality from respiratory tract infections among long-term care patients by 50 percent; reduce antimicrobial-resistant bacterial infections by 50 percent; eliminate lab errors that lead to adverse patient outcomes; eliminate needlestick injuries among healthcare personnel; and achieve 100 percent adherence to guidelines for the immunization of healthcare personnel. We are making an aggressive statement that we can reduce these challenges by half, and we think we will be successful. If we are actively identifying pathogens, we can eliminate them. We can reduce VRE in high-risk populations. Why aren't we conducting active surveillance? We must prevent transmission of pathogens and show administrators that infection control is cost effective in a time when costs are going out the window for treatment of community-acquired pathogens and nosocomial infections. Infection control is at the heart of resolution of these issues.
Q: Is the infection control community too fractious for its own good?
A: Sometimes it can be. Take the draft hand-hygiene guideline for example. When it was out for review, everyone who wrote in to give his or her feedback had an ax to grind. That's the way it's been for the last 50 years. Unfortunately, we have a science community whose members regard themselves as scientists with a capital S. It's a community filled with politics and where anecdotal experience outweighs scientific evidence. Many theories cannot be proved by double-blind, randomized studies, so for many issues there is a lack of conclusive findings. It's a push-and-pull community that the CDC is trying to serve. Our recommendations are either too specific or not specific enough. The CDC bases its recommendations on science, but the wording of a recommendation or guideline can be translated differently by a lawyer or by a manufacturer, and confusion reigns. You could assemble a group of 10 infection control professionals and each one would have something contradictory to say. You could never reach a consensus. Maybe the only way to do so is to make the CDC's recommendations regulatory in nature. If JCAHO or OSHA were involved somehow, perhaps people would heed what the CDC has to say.
Q: ICPs and epidemiologists soon will gather at APIC to celebrate their profession. What would you say to them?
A: Members of the infection control community should be very proud of what they have accomplished, despite all of the challenges. We have some of the best infection control practices in the world and we have made tremendous strides in public health. We must look on this with pride. It's all because of dedicated people who continue to work toward achieving patient-safety standards, reducing hospital-acquired infections, doing interventions and proving their efficacy to hospital administrators. Their work saves lives and cuts costs. They perform a critically important job because ICPs are the people standing between the patient and a life-or-death situation.
Editor's Note: Jarvis will participate in the Meet the Expert panels during the APIC conference on Wednesday, May 22, making a presentation on outbreak investigations.