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You first met Karen L. Martin, RN, BS, MPH, CIC, in the September issue of Infection Control Today, when we took a look at the success Martin has had in uniting infection prevention (IP) and environmental services (ES) at Advocate Christ Medical Center and Hope Children’s Hospital in Oak Lawn, Ill., as the director of both departments. Martin was selected as the 2010 ICT Educator of the Year because of her outstanding work in developing partnerships that have reduced infection rates, sped up room turnover, and overall improved the way that IP and ES communicate and work together to protect patients from healthcare-acquired infections (HAIs).
A series of personnel changes and departmental reorganizations at her facility allowed Martin to focus new time and energy on overhauling the ES department and place renewed emphasis on environmental cleaning within the context of her expertise in infection prevention and control. As infection control director, Martin had already been working with ES staff from an education standpoint, but the reorganization allowed her to start making key changes, such as raising the bar on ES managers’ and supervisors’ professional credentials, empowering staff members to create positive change, and most importantly, retraining staff on the importance of making HAI prevention a priority.
Influenza infection, both H1N1 and seasonal, has become a significant opportunity to educate hospital employees and the local community, Martin reports, adding that while H1N1 influenza cases have been sporadic over the summer, within the last several weeks the hospital has had a number of flu-related hospitalizations. From a flu-education standpoint, Martin says Christ Advocate has been working with physician groups as well as reaching out to the community via advertisements in local newspapers to instruct the general public about influenza.
“Through the ads our hospital acknowledged that because there are so many people getting sick, we need to explain when people should come to the hospital emergency department and when they should just stay home and do the routine flulike-illness care,” Martin explains. “We also educated them that if they do come to the hospital, it doesn’t necessarily mean we are going to test for H1N1 flu. We do the respiratory antigen profiles, the PCRs, but our labs can only do a capacity of 1,000 a day from all of the hospitals they do, so we’re not going to test everybody like we did in April and May.”
Martin has also made a number of presentations to community groups and high schools to update the public about flu-related issues.
“I recently held a class for local school nurses focusing on infection control precautions and the importance of vaccinations, and I also held a class for clergymen in our hospital’s service area because there are so many questions about Communion handling and shaking hands. I tried to alleviate their fears by telling them you can shake hands, but be sure to wash them. It’s just a few examples of how flu has caused us to gear up our education efforts quite a bit, and it’s keeping us really busy.”
In the hospital setting, Martin says that there are signs that staff members are taking the threat of influenza infection to heart – or at least taking a few precautions. “We see a number of people walking around our halls with masks on, and a number of people are concerned about the flu, but we are yet to see whether or not whether they are going to follow through on vaccination because the vaccines haven’t been released yet. I do know that we are getting a ton of questions and hearing a lot of concerns. Our phones have been very busy; there are a lot of questions, such as how long you need to air out a room after a patient with the flu has been there, so there is definitely a heightened awareness about influenza and the importance of infection prevention and control measures.”
Cultivating that awareness and providing answers is an ongoing challenge for Martin and her IP colleagues. “Not to say that we are successful 100 percent of the time, but certainly are trying our best, because it’s a critical message,” Martin says. “There’s just so much to do out there to prevent viral spread. It’s important to keep working on things like communication, such as encouraging nursing to leave the isolation signs where they are posted so that when ES staff get there they know the patient was under contact isolation or droplet precautions or even airborne precautions, so they are protected as well.”
The other challenge to education is matching the message to the recipient. As Martin explains, this is a critical step to ensure that the information is both received and retained. “When you educate about infection prevention, you must first consider your audience and what their education level is,” Martin explains. “It is a much different experience when you are working to educate nurses than when you are educating ES staff about something such as viruses or cleaning protocols. Professionals already connect to purpose because of their education, while support service workers perhaps don’t have that level of education. They need a connection to purpose in their work. You may tell them they need to clean a room in a specific way; a good example is using a 10:1 bleach solution for a C. diff patient. If you say to them, ‘This patient has C. diff, you need to go in there and use a disinfectant then a 10:1 bleach solution, make sure you cover everything and a wet contact time,’ what you are going to get is someone who may not measure the 10:1 solution correctly. They may think that more is better and you are going to end up having to evacuate the unit for bleach fumes. They also may be thinking, ‘Why do I have to do double cleaning,’ but if you explain to them that there are different kinds of bacteria, viruses and spores, and tell them very simplistically that nothing kills these things except a bleach and water solution and that’s why you need to use it for a C. diff patient room and not for a MRSA patient room. They need to understand those key differences in a lower-level way, and then when they have that ‘aha’ moment, they realize you’re not making double work for them for no reason.”
Martin continues, “It also depends on what you are educating about; if it’s a new resistant organism, people are going to perk up their ears and listen to it if they are a professional. If they are an ES support service worker, they are not going to really understand what a resistant organism is about. Sometimes you need to connect it to the bigger picture of what’s happening in the world; for example, with influenza, information about it is everywhere. The challenge is to educate people with the right information because the media is all about hype. People can’t get enough information about it and in their minds there’s a preconceived notion that there is something more they could be doing, but in reality it’s just taking basic precautions like we do with any patient. But because the news media has made it bigger, people worry. It’s like necrotizing fasciitis – you hear the horrible stories and see the awful pictures, and people want more information about it. It’s really about getting people the right information.”
Half the battle for many infection preventionists is delivering education in a fresh new way, especially when it’s about the perennial topics such as hand hygiene or surface cleaning. Martin says her teaching style incorporates presentations with everything from eye-catching graphics and animation, to music and games. “I like to make learning fun,” Martin says, “but again, it’s important to help them connect the information to a purpose. That’s when people pay attention and become engaged.” For example, by getting people to connect to purpose, Martin reports that the ES department decreased room turn-around times since July from 90 minutes down to a average of 47 minutes.
Another example of this is when Martin demonstrated the importance of thorough environmental cleaning to ES staff through the use of a biofluorescent gel used to show the presence of proteins left behind after inadequate cleaning.
“For nursing staff, it’s all about following evidence-based practices, such as handwashing observation. But for housekeepers it’s a bit different. You can observe them do a seven-step cleaning protocol in a patient room, but it helps to go in there like we did with [an ATP test] to show them what they may have missed. We said to the housekeepers, ‘This is what you have been doing and we think you have been doing a good job, but let’s take some cultures now, let’s clean the area and let’s culture again to see what grows.’ That visualization makes them stop and think the next time they are cleaning, and shows them that there is that evidence that the cleaning really wasn’t done the right way. People want to do a good job, but you have to give them the tools with which to do so.”
Those tools are part of an adequately resourced IP program, a luxury to some hospital infection preventionists who are struggling to keep resources, staff and funding at a level that sustains adequate education efforts. Martin says it is imperative to do the work it takes to keep infection control program needs in front of administrators.
“That starts with getting buy-in from your administrators,” Martin adds. “I am so blessed to have the administration I have. We are a very busy hospital and we need to get patients through the system very quickly – we are a level one trauma center seeing 88,000 patients annually, when we were only designed to handle 44,000 patients a year. Of course administration wants us to move patients through as quickly as possible. But in a meeting with the hospital COO, she said it’s not just about turning a room around; she said she wanted the room to be clean to protect our patients. I looked at her and said, ‘You got it!’”
Although that level of awareness may be uncommon at many hospitals, Martin says that an infection preventionist can cultivate that at their own facilities with time and diligence.
“The key is to go to administration and demonstrate your need while you also prove what you are doing to prevent infections and why you need what you need,” Martin says. “Showing what you do every day to prevent HAIs is key when working with administration; my hospital has yet to deny me anything, but I need to show them why I need it and how it will benefit our prevention efforts.”
Martin adds, “You need to speak up about your needs for the sake of your program and your patients, and don’t simply assume that it will never happen. You have to develop a relationship with your administrative team and it’s based on evidence-based practices – it’s not just reading something in an article. You must show them. Every year I do a report to show the number of infections we had the year previous and then show how we decreased them by X amount, and how that translated into potential cost savings. You must explain to them what you have put into place, what has been successful and what has not, and when you begin to build that rapport you begin to build that trust with administration and they begin to see you know what you are talking about. It will be easier to get what you need if they trust you.”