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“First do no harm...” This phrase from the Hippocratic Oath resonates for all healthcare professionals. The infection prevention and control professional is no exception. Consider the following scenarios:
A patient care tech is cleaning the room of a patient on a ventilator. The patient is minimally responsive so is unable to be an active participant in her care. The tech sees the Ambu bag lying on the windowsill with some crusty secretions on the mouthpiece. In her zeal to provide a clean environment, she takes the Ambu bag to the sink and rinses it inside and out in tap water, placing it carefully back inside the plastic bag. The respiratory care practitioner uses that same Ambu bag to breathe for the patient on and off during the next several days. The patient develops Serratia pneumonia and dies.
The nurse in a very busy emergency department is preparing to assist the emergency medicine physician in placing a central line. The patient is severely ill and desperately needs the fluid replacement that will be provided through that line. The RN goes to the clean utility room, pulling several kits, thinking he has everything needed for the insertion. He gets to the bedside and realizes he is missing the appropriate barrier precautions. He leaves the room to retrieve them, but the patient’s condition is deteriorating, and there is no time to wait. The line goes in after a rushed preparation of the site. Two days later the patient has a central line bloodstream infection with Staphylococcus aureus.
An RN in the neonatal ICU is not feeling well. She has tiny vesicles on the side of her face that are painful. She knows her unit is short-staffed tonight and her nurse manager will be very upset if she calls in sick, so she just puts on some extra make-up and reports for her shift. She is still feeling poorly the next day and the vesicles are leaking a clear fluid, so she goes to see her primary care practitioner who makes the diagnosis of shingles. In total, she cared for approximately 10 babies in the NICU. All babies have to undergo immune globulin injections and immunizations for chickenpox.
These scenarios are just a few examples of what happens on a daily basis in our healthcare settings. No one comes to work thinking that today is the day they will do a bad job and potentially harm one of our patients. Well-intentioned, smart people strive to do the right thing in an environment that is hectic, demanding and exhausting. Healthcare is not delivered on an assembly line. There are human factors on the patient side and the caregiver side that make this a dynamic and fluid process, one shift never being exactly the same as the shift before it. Our healthcare team is required to have instant recall for thousands of pieces of information, many of which can directly impact the quality of life for our most vulnerable patients. It is a tremendous responsibility and deserves as much automation and system redundancy as we can possibly build in.
We have taken great strides in the right direction for prevention of infection. By focusing on infection prevention process measures, we are reducing the variation in care for patients by applying systematic, evidence-based interventions proven to be successful in reducing the risk of an infectious adverse event. But how do we “hard-wire” those processes? What automated systems do we give our bedside caregivers to alert them that the pneumonia patient needs the antibiotic within six hours for optimal outcomes? Do we create one-stop shopping for the staff member at the point of care so staff does not have to scurry about trying to get all the “parts” they need to put in a central line for a seriously ill patient? Does our management team have a consistent, supportive approach for employees who are ill? Can there be built-in systems that would require hand hygiene be performed prior to and after working with any patient in any setting? Could ICU beds be designed to automatically have the head of bed raised to the appropriate angle for our intubated patients? How do we create an environment where infection prevention is not an afterthought or an inconvenience, but rather at the core of providing the safest patient care?
Think of the surgical suite. Here is an environment where infection prevention is a way of life. It would never occur to a scrub tech or surgeon to walk into a surgical suite and begin surgery without scrubbing. What components of that education and training can we draw from to help our floor staff better manage infection prevention?
As we move forward in this era of heightened attention to patient safety, ICPs have the opportunity to share our unique knowledge about error-proof systems and processes that need to be consistently put into place. We must advocate for research that will identify ways to prevent infections and for improved technology that will deliver real-time information to bedside caregivers. All members of the healthcare team need to have the time to focus and plan for optimal outcomes so that we can protect the lives of those entrusted to our care and bring healthcare-associated infections in our nation’s institutions to an irreducible minimum.
Janet E. Frain, RN, CIC, CPHQ, CPHRM, is the 2008 president of the Association for Professionals in Infection Control and Epidemiology (APIC) and director of integrated services at Sutter Medical Center in Sacramento, Calif.