Control... Prevent ... What's Your Purpose These Days?

Have you noticed lately that a lot of people are trying to categorize you? First, you have learned that your organization, the Association for Professionals in Infection Control and Epidemiology (APIC) has given you a new name. No longer are you an infection control practitioner (ICP); now you are an infection preventionist. (And of course, there are individuals out there still forgetting to refer to it as infection prevention and control.) If you notice that throughout ICT I still use ICP, I mean no disrespect; it’s just that I, along with many of you, will be struggling to remember to adopt that fancy title.

One of my recent blog entries was devoted to the topic, and a few people commented on the pros and cons of the new moniker, while many more called to express their opinions. I understand that APIC is attempting to elevate the position to that of other newly established titles, such as hospitalist or intensivist, but for me, I’m all about calling a spade a spade. So to that end, the new title makes sense, as that is what you are doing — preventing infections.

But I hasten to add that there’s another contentious issue there — can all infections be prevented? (Most ICPs won’t go on the record with their thoughts on that one, as it’s simply political suicide to do so. And I think that’s a shame. The most important dialogues are occurring in secret, which does not benefit the infection control community.) So are you a 100-percent preventionist or a 50-percent preventionist, or a what-day-is-it-today preventionist? Are you a preventionist or a controller? I feel like the late George Carlin as he delved into the intricacies of the English language and pointed out the absurdities of many of our words and turns of phrase. (No, he never did figure out why we park in driveways and drive on parkways.) No title will ever capture exactly what you do, but I suppose preventionist at least helps you aspire to the noble goal of zero tolerance.

It’s fascinating to watch how much dialogue is being sparked in the infection prevention community by this “getting to zero” campaign. Some people say it’s too simplistic and naïve, while others think it’s a worthy goal. This topic was addressed at this year’s annual meeting of the Society for Healthcare Epidemiology of America (SHEA) in April. Patrick J. Brennan, MD, president of SHEA and chief medical officer for the University of Pennsylvania Health System in Philadelphia, was quoted as remarking, “Like it or not, the concept of ‘getting to zero’ is here. As infection control specialists, our job is to recognize the policy implications as well as the unintended consequences.” Michael Edmond, MD, hospital epidemiologist for the Virginia Commonwealth University Medical Center in Richmond, had asked, “Getting to Zero: Is it Safe?” and examined the genesis of the concept as well as the forces driving it. He discussed the community’s concerns that “zero tolerance” regulations could lead to unintended consequences and is setting people up not to deliver. For instance, some fret that placing too much emphasis on the elimination of one pathogen in the hospital environment in response to legislation may contribute to conditions where another pathogen could flourish. Edmond proposed that all hospitals should be putting reasonable measures in place to prevent infections. Some have argued that using the term “zero” is an assertive way to motivate healthcare professionals and institutions to move in the right direction. Detractors of the zero movement assert that people are using the term “zero” even though it is not yet known what percentage of infections is preventable, nor is it known how significantly mortality rates can be impacted. What’s your opinion? Drop me a line!

Until next month, bust those bugs!

Kelly M. Pyrek

Editor in chief