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By John Roark
When Beth Young, RN, BSN, CIC presents grand rounds, its standing roomonly. Passionate about infection control, she makes learning creative, memorableand fun.
Grand rounds at Robinson Memorial Hospital are anticipated with as muchexcitement as the opening of a Broadway show, thanks to the creativity ofinfection control coordinator Beth Young, ICTs 2004 Educator of theYear. She really believes in what she does, says Diane Zelasko, RN, MSN,director of performance improvement. She has a unique way of educating bybringing out things that are fun, that help you remember infection controlprinciples, which usually is a dry subject.
A certified infection control professional since 1987, Young has devotedlyserved Robinson Memorial for 30 years.
In healthcare today, 30 years is a very long time to be in the samefacility, says Young. But this is a great place to work! We are the onlyhospital in Portage County in Ravenna, Ohio, and we were just named one of thetop 99 places to work in northeast Ohio. I think that says a lot for RobinsonMemorial. I have been here for 30 years, and Im planning on staying a littlelonger. No one would have stayed in the same place unless it was a pretty goodplace, especially in infection control.
We have everything that the bigger hospitals have, but on a smaller scale,says Young. Infection control, even in a hospital this size, is very challenging.Theres nothing boring about it. I went into infection control pre-AIDS,pre-multiple drug-resistant organisms, MSRA, VRE. Today, infection control hasmoved way beyond the walls of the hospital. We have two urgent care centers, an outpatient surgery center, home healthagency and many physician offices, so infection control is not just here on thehospital campus.
Through Robinson Memorials tuition reimbursement program, Young receivedher bachelors degree at Kent State University.
Young has served on the board of the Northeast Ohio chapter of APIC for thepast three years, and is its current president. An active participant withcounty public health officials, she represents her APIC chapter as a member of astatewide bioterrorism task force.
Two topics about which Young is passionate are hand hygiene and sharpssafety. I think for years, infection control practitioners were asking staffto do something that they really didnt have the time to do, she says. Youmight be getting tired of hearing about alcohol hand sanitizers, but this is oneof the most exciting tools that has come our way to achieve compliance. You haveto believe what you say, and I believe that they can use hand sanitizer beforeand after contact with the patient and the patient environment. After you readthe research about soap and water, its hard to say that people are reallygoing to have time to do that. Im not tired of hearing about hand sanitizeryet, because this is a great tool for those of us in infection control. They cando this, but we have to show them that they can do it.
We are a county hospital, but very progressive in many areas, says Young. In the fall of 2001, Robinson Memorial installed hand sanitizerdispensers in every room of the hospital. We were about a year ahead of thefinal Joint Commission on Accreditation of Healthcare Organizations (JCAHO)standards because our infection control committee felt that there was goodscience-based evidence that these products worked, and that they would help usachieve higher compliance.
In 2000, Young created the Ignaz Award, presented annually at grand rounds tothe physician who best exemplifies good infection control practices, especiallyhandwashing. You know how articles say that physicians are not among the besthandwashers? Young asks. What I really believe is important is that wehave good physicians who are good role models. We let our clinical staff votefor the physician who practices the best infection control, of which handhygiene is an extremely important part. The Ignaz Award has generated a lot ofinterest. Its been a good tool for us. And of course, were like everyoneelse, and are looking at a variety of ways of being able to monitor compliancewith hand hygiene, since its the seventh patient safety goal now. I thinkthat hand sanitizers are whats going to help us be successful in that way.
The Ignaz Award was created and named to honor Dr. Ignaz Semmelweis, theHungarian physician who demonstrated that puerperal fever (also known as childbedfever) was contagious, and that its incidence could be drastically reduced byenforcing appropriate handwashing behavior by medical caregivers. Ivealways said that Ignaz Semmelweis is my hero, says Young, But he died fromblood poisoning in an insane asylum. For those of us who are passionate abouthand hygiene, thats a little bit of a concern, isnt it?
When the 2003 Ignaz Award was announced at grand rounds, an infectiousdisease physician who received an honorable mention rather than the Ignaz trophyshouted out, I demand a recount!
When it comes to education, Young is a big believer in positivereinforcement. Reward the person whos doing the right thing and you knowwhat will happen? That person will continue to do the right thing because you acknowledgedthem. And their behavior may rub off on someone else.
Taking the hand hygiene message one step further, Young implemented a safetyletter provided for every patient at Robinson Memorial. Right in the letterit says, If you see us forget to wash our hands, remind us.
Young is also a strong proponent of sharps safety. In a two-year period,Robinson Memorial decreased sharps injuries by a remarkable 66 percent. We were one of the first hospitals in northeast Ohio to bring in a safetyIV catheter, says Young. We started long before President Clinton signedthe Needlestick Safety Act.
Nurses are careful no one wants to have a needle stick injury, saysYoung. But caution alone does not decrease sharps injuries. What brings sharpinjuries down is better devices, she continues. Were always looking for something thats just a little bit better. Transmission of a bloodborne pathogen in a healthcare facility is most likelygoing to be from a sharp, especially from a hollowbore sharps. So thats whereyou start. You start with the phlebotomy devices, and IV starts. I keep on topof that I follow every sharp object injury, and I talk with people who wereinvolved to try and find out the details from them. The person who was stuck is whom you have to ask: what do you think could have been done to prevent this injury from happening?
A lot of times they beat up on themselves and say, I should have been morecareful. Its not always about just being careful. Its having the rightdevice. And if people are still using the devices they were using five or sixyears ago, they probably arent using the right device. Thats part of whatI teach at for the physician offices they struggle with that too. Ivebrought in the types of devices were using here so that they can see theopportunities that are out there for them.
The legend of Youngs grand rounds began in 1999, when she incorporated themusical theme, Rock and Roll Infection Control. Driving with a taperecorder in her car, she would record any song whose lyrics could be adapted tothe theme of infection control. The hit parade included pop-music takes oncommon OSHA violations (I Fought the Law, by the Bobby Fuller Four), sharpobject safety (Needles and Pins by The Searchers) and tuberculosisprecautions (I Cant Get Next to You by The Temptations).
The music was such a hit that she now incorporates a theme song whenever shecan. By all accounts, Youngs 2003 grand rounds were the best ever. Havingjust returned from the APIC National Educational Conference in San Antonio,Young was inspired by a trip to the Alamo. She incorporated the legend ofColonel Travis, who purportedly drew a line in the sand with his sword and askedthose who were willing to stay and fight to step over the line. All but onestepped over the line. So that was my theme, says Young. Step over theline for infection control.
Through imagination, originality and enthusiasm, Young creates valuablemnemonic tools for her audience. Another brainchild is Jayco, the DidjaknoBird, who is always squawking about infection control issues. Jayco posters were placed in department lounges throughout the hospital andchanged weekly for the eight weeks preceding the JCAHO visit. Messages were department-specific, with special bulletins created expresslyfor patient care services, hospital-owned physician offices, environmentalservices and so on.
You have to seize every moment that you can to educate staff, saysYoung. I dont think you can separate infection control from education. Youcant just do surveillance, you have to feed that information back, and itreally isnt of any value whatsoever unless you communicate it back througheducation. Its not just what I know, its what the staff knows thatswhat makes a good infection control program.
Young is quick to point out that the practitioners she works with keep her onher toes. My nurses, respiratory therapists, and radiology techs are prettycritical thinkers, she says. And they do challenge me. I dont alwaysget off easy. They definitely challenge me to show them the evidence. They arecritical thinkers.
At the end of the day, Young is grateful to have fun in an environment thatis both challenging and supportive. I am a true believer in infection control, she says. I believe inwhat I do. I believe with my heart and soul that infection control professionalsmake hospitals safer for patients and for visitors. I want other people tobelieve that too, and so I really am passionate about it. We are the people whomake healthcare facilities safer places.
Jayco, the didjakno bird
Educator of the Year Runners-Up
Frank E. Myers, III, CIC, CPHQ, epidemiologist for ScrippsMercy Hospital/Scripps Health, San Diego, Calif.
Frank Myers will never be accused of mincing words. Educating ICPs abouthepatitis A, spread by oral-fecal transmission, he offered up the followingadvice: If you dont want to get hepatitis A, you may want to write thisdown, its so common in California my advice to you would be, dont eatpoop. Thats with two os. Hepatitis A is not very funny, but ifyou are communicating in a way that people remember, it will reach them in a waythat will be more meaningful, says Myers. One of the things I frequentlysee are people who put on things like crazy bug hats. Well, as an adult, if youwalk into a room looking like an idiot, Im probably not going to be listeningto you for very long. Reaching them in a way that is adult makes it veryapproachable.
Now, thats not an approach I would necessarily use with the interns andresidents, adds Myers. They would roll their eyes. But with general population, thats going to work pretty well. Theyre going to come up to you three months later and go, Dont eatpoop! They walk away with something.
Myers holds bachelors and masters degrees in political science, andworked as an HIV seroprevalence statistician and an AIDS surveillance officerfor the State of Delaware before joining Scripps in 1994. President-elect of the 2003 California APIC Coordinating Council, he hasreceived numerous awards and nominations and is a member of the San Diego GermCommission. That stands for Group to Eradicate Resistant Microbes,he says, laughing. Myers is also a reviewer of a number of different nursingjournals, contributes frequently to industry journals and is a frequentlyrequested speaker at association conferences.
For Myers, the IC hot spot is hand hygiene. Thats one subject wherefeeding back data to people is very useful; going back to a specific unit,saying, Heres how much alcohol-based hand rub you use, and heres howmany times we had poor hand hygiene result in a patient not having an optimaloutcome.
Located in San Diego County, Myers frequently sees cases of community-acquired MRSA. We still see a lot of tuberculosis because of our proximity tothe border and our homeless issues, he says. So the nontraditionalpresentation of tuberculosis is something I need to communicate. Getting peopleto think that just because someones coming in with rectal abscesses doesntmean that they dont also have tuberculosis. You may actually have to look atboth orifices. And some day you may have to look at the whole patient. Werenot there yet someday we have that vision, but right now we start small andbuild towards greatness!
Myers is the first to admit he has occasionally erred, and uses those lessonsas a springboard for educating others. Were all human and we all makemistakes, and sometimes if you look back on them it can be rather enlightening,he says. Ill always remember one situation where I thought I had done thisgreat intervention. I was going to do a presentation for the emergency roomstaff, about how we did this really great intervention. Having lunch rightbeforehand, the safety officer was sitting across from me. He looked at me andhe said, You did WHAT? I described the intervention, and he said,You didnt think about this other regulation when you did that, did you?What I had done wasnt the great intervention that I thought it was. Soinstead of giving an hour-long presentation on what a great job I had donesolving the problem, I talked about what we thought we had solved, and how wedidnt solve it. It really worked for people because they followed the logicall the way through and said, Whoa! I hadnt thought of that either.
DJ Flournoy, II, director of microbiology, Department ofVeterans Affairs Medical Hospital, Oklahoma City
DJ Flournoy has published more than 230 articles, 36 abstracts and 88research posters for teaching purposes, and has been a part of 57 directresearch grants.
My job description has stayed the same, but my job has changed in that Iused to do a lot more research when I first came here, says Flournoy, who hasbeen with the Oklahoma City VA for 28 years. Now Im doing very little, ifany research, doing more benchwork and more one-on-one teaching than I used to.I used to do more group teaching.
In the course of 28 years with the Oklahoma VA, Flournoy has been able to seethe fruits of his labor. Ive gotten to meet a lot of really great people,and actually several of them ended up being my doctors or my familys doctors,he says. I even had one student, whose son or daughter came back and was astudent in the same module under me.
For Flournoy, the transmission of pathogens holds special interest. The issue is trying to make people aware of how easily pathogens can bespread among patients and other healthcare providers, he says. As acorollary to that, how important it is that they know this and understand it,because they play a vital role in it. I dont think that everybody who workswith patients really appreciates how easy it is to spread pathogens amongthemselves and among patients.
Part of Flournoys weekly routine is going on rounds with interns,attending residents and third-year students. Unbeknownst to them, I keep track of who they touch and if they wash theirhands, and I write it down each time, he says. Over a period of eight ornine years, Ive observed more than 1,200 different rounds. They wash theirhands about 50 percent of the time. One day, a resident on the team I was withtouched five different patients and never washed her hands. And with the lastpatient she took a bandage off of an open wound and poked around it to see howtender it was and never once washed her hands. Heres a person whose been through medical school, through her internshipand everything, and didnt appreciate how critical that is. Of course, thisgets my attention. I pass that information on to the infectious diseasephysicians, and let them use it as ammunition to try to get the resident internsbe aware of that.
In addition to teaching a variety of students, Flournoy monitors unusualoccurrences of organisms such as MRSA and VRE. I monitor certain organismscontinuously and collect data on them, he says. I save the organisms inskim milk and freeze them. In my hospital I have all the MRSA weve ever hadsince the 80s. There are over 1,700 of them. I have all the VRE also. So ifwe want to go back and study them, or if a new antibiotic comes out and we wantto check it out against these organisms, I can pull it out of the freezer and dosusceptibility testing on it. Its a powerful tool. Or should we have some sort of outbreak of some VRE at our hospital, I wouldalready have a lot of data on how we might use other antimicrobials to overcomethese bugs.
An involvement in his local chapter of Toastmasters has given Flournoyadditional insight in effective communication. Ive become more aware ofhow important it is on the other end of it. Its important that the studentsactually learn what I try to get them, he says. Theyre the mostimportant person, not me. So then it becomes critical that they learn what Iwant them to learn. If I get frustrated with them because I think theyre notlearning, its probably because Im not teaching very well, and I need towork harder and make sure they know exactly what I want them to learn, and dothat in a fun way.
For 26 years, Flournoy taught a lab module of students in medicalmicro-immunology. But today, the majority of teaching is done on a one-to-onebasis. He finds that interaction on an individual basis can be very effective,if done right. We have a lot of what I call open-book exams. That way, thestudents dont have to memorize and be afraid of anything, but they still haveto find it and be aware of it. Thats my approach.
Even after more than a quarter of a century as an educator, Flournoy stillloves to teach. I like the students to have a wide variety of experiences inmy lab, so theyre well-rounded, so that people who come through the labunderstand how we work and what our frustrations are. I try to get them to seeeverything as much as I can. The thing that would make it uninteresting would beif the people that I teach had already heard it and knew all about it. But formost of them theyre pretty new to it. I try to go over really basic things.One of my pet peeves is, lets get somebody into this really esoteric researchproject or something way out the on the fringe but they dont even knowthe basics. I want to make sure they know the very basic things aboutmicrobiology. Lets ground them in the basics, and then they can take it fromthere.