Infection Prevention Veteran Shares Views on Patient-Safety Challenges

Sue Barnes, RN, BSN, CIC, national leader of infection prevention control/patient safety at Kaiser Permanente, comments on this development and other situations facing infection preventionists.

The Joint Commission and its Patient Safety Advisory Group are conducting a thorough review of National Patient Safety Goals (NPSGs), according to an announcement by the Association for Professionals in Infection Control and Epidemiology (APIC). The organization says that as a result, there will be no new NPSGs developed for 2010 and that the Standards Improvement Initiative will be used to clarify language and ensure that goals are program-specific.

APIC recently reported that the Joint Commission is going to review the National Patient Safety Goals to see if they are program specific. How important (in general) are National Patient Safety Goals and other organization guidelines to the well being of patients?

In general, regulatory requirements from the Joint Commission, legislation and elsewhere are well intentioned and will really help us improve the safety of patients in the long term by shining a bright light on the good work being done, as well as opportunities for improvement. However, in the short term these requirements are serving to divert very limited infection prevention and control resources away from preventing and controlling healthcare-associated infections, in order to create reports and processes to ensure compliance with these regulations/requirements and avoid citations and associated negative press.

What are the main barriers staff members face in regard to protecting patients from infection?

First, mandates from regulatory agencies for reporting outcome and process indicators. Second, staffing constraints and ongoing hiring of inexperienced nurses into infection control positions, without the dedicated infrastructure to provide the training and long-term mentoring needed. Lastly, there is lack of resources necessary to provide comprehensive infection-prevention oversight to all areas of the continuum of care, especially ambulatory care. In terms of regulatory mandates — although in the long term the recent legislated reporting of infection rates and process measures will help to improve our capacity to prevent infections by shining a light on both what is done well, and opportunities to improve — in the short term it is diverting constrained infection prevention and control staff away from improving patient outcomes, to creating reports in order to comply with the mandates. This challenge is further impacted by the great numbers of experienced infection preventionists who are retiring and being replaced with nurses having no prior infection control experience. There are currently limited training opportunities for these nurses to support a very long learning curve. More long-term mentoring and preceptor programs will need to be developed. And finally, there are just not enough infection preventionists in most medical centers to provide oversight for inpatient areas, in addition to the growing ambulatory care clinics, outpatient surgical centers, home care, dialysis, skilled nursing facilities — the whole continuum of care. As more and more invasive procedures are performed in the ambulatory arena, there is a greater need for infection prevention and control oversight. Barriers to healthcare workers (not infection preventionists) are different. Many do not recognize their role in preventing infections and sometimes the products needed to prevent infection are not easily available at point of use. The mindset of “I have always done it this way” is sometimes a barrier to introducing new practices/products to further reduce infection risk.

A recent study conducted by Northwestern Memorial Hospital showed that team training and pre-operative discussions increased staff teamwork, and reduced the potential for operating room errors. Do you think that pre-operative discussions could lead to a decrease in surgical-site infections, since surgical-site infections are often caused by a breakdown of infection-control protocol?

There are a number of published studies which provide the evidence to support embracing teamwork as a discrete intervention to reduce adverse events including infections. The pre-operative and pre-procedure time outs do address certain aspects of infection prevention, but enhancement of this type of focus in the time outs may be beneficial.

How involved should patients be in their own infection prevention? For instance, to what extent should they ask questions, apply antiseptics on their own, etc.?

Patient empowerment is a critical component of a comprehensive patient safety program. Patients should absolutely inquire about how their care is being provided, and we as healthcare providers should (and do) provide guidance regarding what questions they should be asking related to infection prevention.