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 aureus (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 aureus (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 manner.
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.