Behind the Scenes at the CDC

May 1, 2002

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