Presenting the 2005 ICT Educator of the Year, Maureen Zilles, RN
A hands-on approach to education, a respect for history and a
passion for health promotion bring dedication, satisfaction and respect for this
By John Roark
Education is the primary tool of infection control practitioners (ICPs), says Maureen Zilles, RN, nurse epidemiologist at Pascack Valley Hospital, Montvale, N.J. What we do, we do by working through others, she says. Hands-on support that staff and caregivers need in order to prevent healthcare-associated infections really comes from us. We have to be able to imbue them with the principles and practices that will keep everybody safe.
A gerentological nurse practitioner by education, Zilles spent 13 years in long-term care, and 10 years in ambulatory care. She made the leap to infection control four years ago.
Our institution was looking to replace an infection control practitioner who left, Zilles recalls, who worked at Bergen Regional Medical Center in Paramus, N.J. for 27 years before making the move to Pascack Valley Hospital in May 2003. One of the frustrations of this work is there are not enough capable ICPs. They looked all around to find someone with experience. Failing that, they decided they could train someone. The individual who was our original infection control person, who was trained by Centers for Disease Control (CDC) and had worked at it for 25 years, trained me. Thats the way it happens for a lot of people. You come into it without having had prior experience. Some people come from nursing, some people come from laboratory sciences, and some people come from public health.
From the start, Zilles realized how vast the world of infection control really is; a world, she says, which continues to expand. Since I became an ICP, the flu pandemic was a new threat on the horizon, bioterrorism attacks with anthrax and smallpox, construction risks and the need for infection control risk assessment for construction and renovation projects became issues. Then came safe needle legislation.
West Nile virus wasnt around when I started, and its just so commonplace that no one even thinks about it as new anymore. SARS, monkeypox, multi-drug resistant organisms and the public focus on healthcare-associated infections have also come into the spotlight. There wasnt really any focus in the mind of the public about the infection dangers in the hospital, she says.
Transitioning from the large scale Bergen Regional which is licensed for 1,200 beds to the decidedly more intimate Pascack Valley licensed for 291 beds brought Zilles the realization that size doesnt matter. Pascack is much more active, even though its small, she says, Which brings me to see that the public is not truly going to be able to compare infection rates between one hospital and another. Its like theyre looking for a cookie cutter some recipe for how to figure out where the safest hospital is to be. But the patient population in every hospital is different, and the services that hospitals offer are different, so the potential risks are totally different. Its apples to oranges to grapefruits to pears. What the legislators are trying to accomplish and what the public really wants is not anything that theyre going to be able to get.
What makes Zilles tick? Health promotion is probably the thing Im most passionate about, and it comes from all those years in long-term care, and all those years in ambulatory care, she says. If youre not always thinking of prevention, then youre not maximizing the potential of your immune system. On the back of my handouts for general orientation is information on personal wellness, and we never, never get to talk about it. I tell my students that theyve got to take that home and put it in the bathroom where everybody in the family is going to read it. And I hope that they do.
I really want to make sure that patients who are in the hospital are helped, not hindered on their road to recovery, she continues. I think that people dont realize how much of a setback can occur when you find yourself in an acute-care setting. You dont have to be a prestigious, large institution to have good techniques and good, caring staff. But without those things, no matter where you are, your patients are in trouble.
Infection control is very diverse, says Zilles, and research and educating bring great rewards. One of the things that Ive never had any problems with in infection control is finding a new topic, she says. I keep a little book I call Infection Control in the News. I pass it around to my students as Im talking to them. I always can find articles fresh off the headlines that will give me an infectious agent to talk about. There will always be questions that people have about certain situations that theyre aware of. I try to weave that into whatever Im talking about as far as chain of infection is concerned.
When it comes to education, Zilles is very hands-on. Having tools to use makes the experience more memorable and effective, she says. Hand hygiene is definitely a challenge. I take the waterless hand sanitizer with me to the class, I put a little squirt in everybodys hand, even if theyve used it many times before, so that they can see the product that we use here. They can see how it feels, that it leaves their hands soft, and they wont be reluctant to try it when they need it.
Sharps safety is another cornerstone of infection control. I do more specifically for the departments that handle sharps, like nursing, she says. I like to have a collection of items that we use at the hospital and make sure that everyone can try them and become comfortable with them. In this day and age, people have many jobs. Most nurses have more than one; they work in different organizations, and they use different equipment. They may think when theyre discontinuing an IV that they know what that device is, but then when they get it out of the patients arm, and have a look at it; it may not be what they thought it was. If they dont activate the safety features right away, they risk a stick for themselves and the people who handle the waste after us. I like to have stuff that I can practice with, and let them use and see and play with and waste.
Zilles list of professional accomplishments at Pascack Valley is a testament to her productivity and success. She has raised the awareness of infection control within the facility by revitalizing fit testing, expanding the roles of the infection control committee to include regular reports on preventing healthcare-associated infections; she has championed programs on SARS, respiratory etiquette, bioterrorism, and fit testing. She participated in the development of the hospitals smallpox preparedness plan, which was submitted to the state and rewarded with funding. She is active not only teaching, but in surveillance, policy and performance improvement as well.
Delivering the Message
It all adds up to a lot on her plate. Zilles has quickly become a familiar figure at Pascack Valley Hospital, toting her rolling suitcase full of the tools of her trade. The hospital is a 24-hour-a-day, seven-days-a-week place, and Im one person, she says. In some situations, hospitals have intranet and a lot of educational programs online. When I came into this situation, they didnt have a real live person doing the annual updates. They have a booklet called The Essentials, which covers all of the mandatory subjects. You read it all and then take a test at the end. Thats very good for paper compliance, because you can demonstrate to anyone who inspects all of this education, because you have all of these competency tests. But its so dry.
I find that the live presentation is much, much more meaningful, she continues. I usually begin by promising my audience that Im not going to tell them anything that that they already know, because they tend to zone out. All I am going to do is take the information that they have at the base of their skull at the occipital lobe, and put it right up in the front, right between their eyes. If it isnt in the very front of their mind, theyre not going to have it at their fingertips when they need it. Of course, one of the challenges is that its at the moment when they need the information they youre not there.
Im not above being silly or dressing up or singing songs, telling jokes or having anecdotes, Zilles explains. When youve been a nurse for almost 30 years, you have lots and lots of those. When you weave them into the situation it makes it much more memorable. Of course, in some situations, games and the prizes dont work. You have to be careful how you do it otherwise its demeaning, says Zilles. Its hard, because most of the time, your audience is very mixed. I did a class for physicians, and I was very nervous. In my previous job I had a very strong hospital epidemiologist who handled the physician education at their grand rounds meeting. There isnt that kind of person in my situation now, so it fell to me to do. With them I used PowerPoint. I gave them information that was specific to their areas of practice, where this particular institution is in respect to nosocomial infection rates and how we cant use misdata to compare our surgical sites. I spoke to them on what I thought were their issues. I think that thats really the key to making this work.
The Hard Part
While Zilles is passionate about what she does and finds her work deeply rewarding, she cites two points of challenge in infection control. This field has grown has so tremendously, but the number of people that are involved in the work has stayed very much the same, she says. I am not unique in being an only infection control practitioner in a facility. The job that I do is just so much larger than it ever was before. Its a 24/7 place, youre trying to keep up with people who are not there when you are there, so youre coming in all kinds of hours. Its every persons job to be an infection control practitioner. The challenge is to instill that in everyone, to make them see that they each play a role.
Hospitals give a lot of lip service to how important infection control is, but its not a revenue-generating area, Zilles continues. Cost efficiencies are difficult to see, they dont have any staffing concerns the one or two people that they hire come in every day like theyre supposed to. Infection control doesnt dominate an organizations priority list. And few resources are really allocated to doing this job not personnel, not support services, not technology.
The second challenge is that theres no easy way to learn this; its kind of an apprenticeship, she says. Our very first practitioners were trained by the Centers for Disease Control and Prevention (CDC), and they went out to their states and they formed the Association for Professionals in Infection Control and Epidemiology (APIC). They trained their colleagues. APIC is a very strong organization nationwide in New Jersey we have two chapters, we have many very active infection control practitioners who are out teaching and doing consulting work. They form the nucleus of the faculty that teaches the APIC courses to those people like me who come into it without any background. But theyre not university-affiliated there are no college education credits for this. There arent even good textbooks. There are microbiology and epidemiology textbooks, but there are no good textbooks that put all of this together. The two basic texts from APIC are huge, and they written in an outline form, so theyre difficult to learn from. I would like to see before these practitioners go over the horizon theyre all getting ready to retire that they form a nucleus of experts, affiliate with a university, and make this really an academic way of preparing someone instead of an apprenticeship.
An Eye on the Future
I think that infection control is a marvelously challenging field, says Zilles. The person who recruited me told me I would never be bored. Of course, the world didnt turn as fast back in her time as its turning for me now, but she said, Just when you think youve got a good handle on it, something new will come along that youve never heard of before. Shes absolutely right. And of course, with the threat of terrorism, it could be something truly disastrous thats new on the scene. But it pulls to mind the basic principals. Here we are in a flu vaccine shortage, and people are very concerned about it. If they never wanted the flu vaccine before, they want it this year, because they cant have it. What is the way that all of us through history have dealt with the threat of infectious disease? With the simple, basic principals: good hand washing, staying home when youre sick, staying away from people who are sick, covering your cough, using tissues its all basic. So lets not get crazy about this. In fact, it may turn out to be that this strain of influenza virus that becomes problematic this winter is not even a strain thats in this flu vaccination. So then we will definitely be back to basics, and all we will have are our basics. So if you dont promote wellness and keep your immune system healthy, and follow these basic principals, you will be susceptible to everything new world.
Its never too early to nominate an exceptional colleague for the 2006 ICT Educator of the Year award. For information, email Kelly Pyrek at firstname.lastname@example.org.
2005 ICT Educator of the Year Runner-up Debbie Bowling, RN, MSN, CIC
Quite honestly, I cant remember a time in my life that I havent been excited about education, says Debbie Bowling, RN, MSN, CIC, infection control practitioner and employee health coordinator at Helen Keller Hospital in Sheffield, Ala. A registered nurse with 25 years of nursing experience in medical-surgical nursing, medical oncology, management, consultation, staff development, infection control and employee health, Bowling is passionate about her profession.
I cannot imagine a more rewarding, fulfilling career, Bowling says. The possibility that I can make a difference in a persons life is such an incredible feeling. The Florence Nightingale Pledge, Practice my profession faithfully, drives me. Whether teaching a new employee about importance of handwashing, or how to use a new safety device that might keep them safe from a bloodborne pathogen it just overwhelms me that I can do this. This is what it means to me to practice my profession faithfully. The pledge I made more than 30 years ago is still real today.
What Bowling most enjoys in preparation for an education event is exploring the history, or historical perspective of her topics. It fascinates me to look back in time to find out when, for example, pneumonia was first documented, she says. It is equally fascinating and fun to find out how it was diagnosed and treated. My audiences are taken back in time and allowed to follow the timeline that brings them full circle to how we diagnose and treat that disease today. I think my fascination and excitement rubs off on them.
Bowling keeps things interesting by tailoring her presentations to her audiences. I try to impart relevant facts on the particular subject I am presenting, and gear those facts to the intellect of the audience I am addressing, she says. I also like to include handouts for the participants to follow along, as well as give them something to take away from the meeting. I find that this reinforces pertinent information that I want them to recall. I also encourage questions at the end of a session. This part keeps me on my toes as well as allowing for those who may desire a deeper understanding of a particular part of the subject matter to satisfy their thirst for knowledge.
Focusing on effective means of communicating is an ever-changing, ongoing process, Bowling continues. Just a few short years ago we didnt have the technology we have today. We graduated from a chalkboard to an overhead projector, to computer technology with PowerPoint presentations with sound and animation and color.
No. 1 is keeping up with the technology for presenting the information. That does not minimize No. 2, though knowing the latest information regarding your subject. I also think my effectiveness comes from the fact that I am not just an educator; I am first and foremost a practitioner. My daily hands-on experience better prepares me to present and answer questions.
Bowlings deepest satisfaction comes from one-on-one counseling with employees. I get such joy and a feeling of real accomplishment when I am able to help someone with a personal question or concern, she says. Whether that question is in regard to a patient situation, in reference to a family member or personal concern, when they come to me it says, I believe in you, I trust you and I believe you care about me, my family, and our patients. It reaffirms for me that I am practicing my profession faithfully.
2005 ICT EDUCATOR OF THE YEAR SPONSORS
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