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

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 NewYork City has more hospitals than some entire states. What you probably don'trealize is that New York City is the Mecca of communicable diseases. Being aport city and one of the most densely populated cities in the world areprecursors 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 yearswe have worried about an increase in methicillin-resistant Staphylococcusaureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Then the firstcase of intermediate vancomycin-resistant Staphylococcus aureus wasreported. All of the doctors and nurses were informed that antibiotic controlwas essential to prevent a completely vancomycin-resistant strain of Staphylococcusaureus (VRSA). To date, we are fortunate that the New York City area has notexperienced a case of VRSA.

The infection control staff in every hospital understands that this wouldadversely affect the quality of care to all patients if this organism is allowedto reach out its ugly arms and embrace our patient population. While we werebusy worrying about the emergence of VRSA, it was noted that an old organism wasre-introducing itself. Acinetobacter baumanni started to show up in ourintensive care units, particularly in our ventilator-dependent patientpopulation. Slowly, it was noted that the Acintobacter organism was becomingresistant to our formulary of antibiotics. ICPs began to worry about how to stopor slow down the emergence of this life-threatening disease.

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

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

The second summer of the West Nile Virus epidemic was coming to a close whenNew York City was shaken to its very soul by the horrible September 11 terroristattacks. ICPs have always had to deal with uncertainty and death because everycommunicable disease has the potential to cause death. In the past, a smallsegment of the population had been at risk for exposure to communicablediseases. Now there existed the possibility of entire cities being at risk fromdiseases such as smallpox and the plague.

Soon after the World Trade Center disaster, we had our first case of anthraxand the fear had become a reality. Exactly what is anthrax and how is ittransmitted? ICPs and infectious disease physicians scrambled to acquaintthemselves with this frightening disease. Thankfully, cutaneous anthrax was notthe nightmare we assumed it would be. Routine standard precautions sufficed.

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

ICPs have a duty to assist in training all healthcare providers in earlydetection of diseases that can be utilized by terrorists. Staff must be trainedto isolate as soon as a case is suspected. Not only do we have to stress theutilization of standard precautions for all patients, we must monitor complianceof staff to all written policies and procedures. All suspected or diagnosedcases must be reported to the local department of health in an expeditiousmanner.

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

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