Behind the Scenes at the CDC


Behind the Scenes at the CDC
A Conversation With William R. Jarvis, MD

By Kelly M. Pyrek

William R. Jarvis, MD, isassociate director for program development, Division of Healthcare QualityPromotion, in the National Center for Infectious Diseases. He has authored orco-authored 380 publications, 25 book chapters and one book, and specializes inepidemiology of infectious and noninfectious complications associated withhealthcare delivery as well as nosocomial infections and antimicrobialresistance. In an interview in February, Jarvis spoke about the need forcontinued vigilance against infectious agents.

Q: How have the events of Sept. 11 and the recent bioterrorism threataffected the work of the infection control community?

A: The aftermath of Sept. 11 sparked a greater awareness of thepotential for bioterrorism, but more importantly, it heightened the generalpublic's recognition of what infection control is and why it is important. As werecover from Sept. 11 and the anthrax scare, many people are thinking when,not if, a major public health threat could emerge. The importance of infectioncontrol programs becomes apparent as more healthcare facilities step up theirsurveillance for infectious agents within their walls and in their communities.It is critical to continue educating people about infection control. Groups likethe Society of Healthcare Epidemiologists of America (SHEA) and the Associationof Professionals in Infection Control and Epidemiology (APIC) do a great job inspreading the word among healthcare workers, but it's like preaching to thechoir. The challenge lies in reaching the ordinary citizen, the potentialhospital patient, the person who isn't aware of the dangers of pathogens.

Q: Are infection control professionals hampered in this era of managedcare and cost-cutting?

A: Hospital administrators are constantly looking for ways to containcosts. A hospital's infection control program is a tempting candidate toeliminate or reduce in size because they only see this department as anexpenditure and not a revenue producer. Physicians only spend 30 percent oftheir time in surveillance, while infection control practitioners (ICPs) spendup to 70 percent of their time in surveillance. ICPs and epidemiologists havehad their responsibilities increased -- especially since Sept. 11 -- but theirresources haven't increased. Healthcare workers everywhere are required to domore with less these days. It is essential that hospital administrators supporttheir ICPs and epidemiologists. They take these professionals for granted untilthere is an infectious outbreak or a sentinel event and then they need theirexperience and knowledge. The key is to convince more schools of medicine tointegrate infection control and epidemiology into medical training as early aspossible. My first exposure to infection control principles was as a seniorresident in pediatrics. How can someone go four years in med school and not getIC training? It's a continuing challenge to get infection control onto a medschool's agenda.

Q: What are the infection control-related challenges the CDC is addressingon behalf of ICPs and epidemiologists?

A: The CDC has established seven healthcare safety challenges whichthe Division of Healthcare Quality Promotion plans to address within the nextfive years: reducing catheter-associated adverse events by 50 percent amongpatients in healthcare settings; reduce targeted surgical adverse events by 50percent; reduce hospitalizations and mortality from respiratory tract infectionsamong long-term care patients by 50 percent; reduce antimicrobial-resistantbacterial infections by 50 percent; eliminate lab errors that lead to adversepatient outcomes; eliminate needlestick injuries among healthcare personnel; andachieve 100 percent adherence to guidelines for the immunization of healthcarepersonnel. We are making an aggressive statement that we can reduce thesechallenges by half, and we think we will be successful. If we are activelyidentifying pathogens, we can eliminate them. We can reduce VRE in high-riskpopulations. Why aren't we conducting active surveillance? We must preventtransmission of pathogens and show administrators that infection control iscost effective in a time when costs are going out the window for treatment ofcommunity-acquired pathogens and nosocomial infections. Infection control is atthe 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 forexample. When it was out for review, everyone who wrote in to give his or herfeedback 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 asscientists with a capital S. It's a community filled with politics and whereanecdotal experience outweighs scientific evidence. Many theories cannot beproved by double-blind, randomized studies, so for many issues there is a lackof conclusive findings. It's a push-and-pull community that the CDC is trying toserve. Our recommendations are either too specific or not specific enough. TheCDC bases its recommendations on science, but the wording of a recommendation orguideline can be translated differently by a lawyer or by a manufacturer, andconfusion reigns. You could assemble a group of 10 infection controlprofessionals and each one would have something contradictory to say. You couldnever reach a consensus. Maybe the only way to do so is to make the CDC'srecommendations 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 theirprofession. What would you say to them?

A: Members of the infection control community should be very proud ofwhat they have accomplished, despite all of the challenges. We have some of thebest infection control practices in the world and we have made tremendousstrides in public health. We must look on this with pride. It's all because ofdedicated people who continue to work toward achieving patient-safety standards,reducing hospital-acquired infections, doing interventions and proving theirefficacy to hospital administrators. Their work saves lives and cuts costs. Theyperform a critically important job because ICPs are the people standing betweenthe patient and a life-or-death situation.

Editor's Note: Jarvis will participate in the Meet the Expert panels duringthe APIC conference on Wednesday, May 22, making a presentation on outbreakinvestigations.

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