HAI Elimination is a Continuous Improvement Process


“Toward elimination of healthcare-associated infections” – the theme around which the Society for Healthcare Epidemiology of America (SHEA) and its partners have built the Fifth Decennial International Conference on Healthcare-Associated Infections (HAIs) – may seem to simplify the complex reality of preventing HAIs. However, the term “elimination” implies the continuous application of best practices by all partners in the healthcare environment. The goal of elimination will not be met easily and is more appropriately viewed as a continuous improvement process. But elimination is feasible. It requires partnership and a global vision, and advancements will come only from dedication to science, the application of evidence, and new research.

There is never a time when we can turn our attention to the latest and greatest threat, the threat with the best press agent, or the one that sounds the scariest. If we do this, we invite unintended consequences. A narrow focus on the strongest signals will result in missing the weaker signals. The interconnectivity of the many factors influencing patient and healthcare worker safety – and SHEA’s role in translating them to create better policy and practice – has never been more visible than this past year. SHEA past-president Mark Rupp, MD, spoke to you in the December issue of ICT about the discussion around respiratory protection for healthcare workers treating H1N1 patients. It was our difficult role as healthcare providers to bridge fear to bring sound science to the policy arena for the utmost safety of patients and healthcare providers. This pandemic is one example. We face new and emerging pathogens, antimicrobial resistance and the many other changes in the healthcare environment – meaning brand new reasons for unwavering vigilance in meeting this goal responsibly, sustainably and scientifically.

March marks the publication of SHEA’s revised guideline on the management of healthcare workers infected with HIV, hepatitis B (HBV) and hepatitis C (HCV). This is an update of our 1997 guideline and incorporates newer diagnostic studies and therapeutic options. It clearly defines when infected providers can and cannot work, as well as what procedures may be performed safely. The new guideline also addresses ethical issues such as disclosure to patients, institutions and others. The document painstakingly brings together the substantial knowledge base gained over the past two decades to build a guideline that balances the risks of transmission with the burdens faced by infected healthcare workers. Through the synthesis of new information and advances in HIV, HBV and HCV treatments and prevention, SHEA has released a complete picture for the safety of patients and healthcare workers alike.

By focusing only on the strongest signals that compete to take over our attention we miss the unexpected ones or risk ignoring growing ones. The sometimes challenging message for SHEA to convey is this: it is crucial that our eyes remain trained on the whole picture – the big, the small and the future-trending – to ensure that we remain on the path of patient and healthcare worker safety. It is not an easy message, but little is more important to the welfare of everyone involved in healthcare.

It is therefore apt timing that March marks the Fifth Decennial, bringing together thousands of leaders in infection prevention and healthcare epidemiology to reflect on the past decade and discuss the path ahead into the next decade. As the pandemic wanes, H1N1 will be a major topic among attendees and within the scientific program, as will tuberculosis, methicillin-resistant Staphylococcus aureus (MRSA), C. difficile, resistant Gram-negative bacteria, antimicrobial stewardship, occupational health and safety, and many other key topics to advancing the practice of healthcare in the U.S. and abroad. This is an important time for individuals of all disciplines in healthcare to engage on the topic of preventing HAIs and adverse outcomes.

I hope to see many of you taking part in the Decennial. As the politics, economics and practice of healthcare grow increasingly complex I encourage you to build your relationship with SHEA and join a community of professionals dedicated to building progress toward elimination of HAIs.

Neil Fishman, MD, is president of SHEA and the director of the Department of Healthcare Epidemiology and Infection Control and the director of the Antimicrobial Management Program for the University of Pennsylvania Health System.

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