Infection Control Today - 11/2002: The Changing Times of Infection Control

November 1, 2002

The Changing Times of Infection Control

By Jimmie Ahmed, RN, MPA, CIC

If you reside in the northeastern United States, you probably know that New
York City has more hospitals than some entire states. What you probably don't
realize is that New York City is the Mecca of communicable diseases. Being a
port city and one of the most densely populated cities in the world are
precursors for an infection control nightmare.

Each year as an infection control practitioner (ICP), the question is,
"What is going to be the next big disease occurrence?" In recent years
we have worried about an increase in methicillin-resistant Staphylococcus
(MRSA) and vancomycin-resistant Enterococcus (VRE). Then the first
case of intermediate vancomycin-resistant Staphylococcus aureus was
reported. All of the doctors and nurses were informed that antibiotic control
was essential to prevent a completely vancomycin-resistant strain of Staphylococcus
(VRSA). To date, we are fortunate that the New York City area has not
experienced a case of VRSA.

The infection control staff in every hospital understands that this would
adversely affect the quality of care to all patients if this organism is allowed
to reach out its ugly arms and embrace our patient population. While we were
busy worrying about the emergence of VRSA, it was noted that an old organism was
re-introducing itself. Acinetobacter baumanni started to show up in our
intensive care units, particularly in our ventilator-dependent patient
population. Slowly, it was noted that the Acintobacter organism was becoming
resistant to our formulary of antibiotics. ICPs began to worry about how to stop
or slow down the emergence of this life-threatening disease.

Just as the momentum was building to tackle these resistant organisms, West
Nile Virus reared its frightening head. People in New York City look forward to
the warm months of summer when they can enjoy the outdoors. All of a sudden dead
birds were showing up in the city and the surrounding areas. People started to
show up with signs and symptoms that closely resembled encephalitis. The New
York City Department of Health became very busy educating the staff while
investigating the cause of this new illness. Many people stopped sitting outside
at dusk because this is when the mosquitoes are more abundant. As the city
experienced its second frost of the year, the public fear began to subside.

ICPs took this opportunity to go back to the nurses and doctors to
re-emphasize the importance of following the Centers for Diseases Control and
Prevention (CDC) guidelines on controlling infections in healthcare facilities.
Standard precautions were reinforced. Staff members were reminded to place known
or suspected cases of communicable diseases on transmission-based precautions
such as airborne precautions.

The second summer of the West Nile Virus epidemic was coming to a close when
New York City was shaken to its very soul by the horrible September 11 terrorist
attacks. ICPs have always had to deal with uncertainty and death because every
communicable disease has the potential to cause death. In the past, a small
segment of the population had been at risk for exposure to communicable
diseases. Now there existed the possibility of entire cities being at risk from
diseases such as smallpox and the plague.

Soon after the World Trade Center disaster, we had our first case of anthrax
and the fear had become a reality. Exactly what is anthrax and how is it
transmitted? ICPs and infectious disease physicians scrambled to acquaint
themselves with this frightening disease. Thankfully, cutaneous anthrax was not
the nightmare we assumed it would be. Routine standard precautions sufficed.

The summer of 2002 has come and gone ... what will be our next epidemic? What
will be our next priority?

ICPs have a duty to assist in training all healthcare providers in early
detection of diseases that can be utilized by terrorists. Staff must be trained
to isolate as soon as a case is suspected. Not only do we have to stress the
utilization of standard precautions for all patients, we must monitor compliance
of staff to all written policies and procedures. All suspected or diagnosed
cases must be reported to the local department of health in an expeditious

ICPs should probably be renamed "investigative practitioners"
because they have become experts at investigating and following up communicable
diseases and their origins. The goal of every ICP is to prevent the spread of
communicable diseases and thereby save lives. The organism changes but the
message must remain the same. We must prevent the spread of infection.

Jimmie Ahmed, RN, MPA, CIC, is employed by Saint Vincent Catholic Medical
Centers in Jamaica, N.Y.