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By John Roark
Education is the primary tool ofinfection control practitioners (ICPs), says Maureen Zilles, RN, nurseepidemiologist at Pascack Valley Hospital, Montvale, N.J. What we do, we doby working through others, she says. Hands-on support that staff andcaregivers need in order to prevent healthcare-associated infections reallycomes from us. We have to be able to imbue them with the principles andpractices that will keep everybody safe.
A gerentological nurse practitioner by education, Zilles spent13 years in long-term care, and 10 years in ambulatory care. She made the leapto infection control four years ago.
Our institution was looking to replace an infection controlpractitioner who left, Zilles recalls, who worked at Bergen Regional MedicalCenter in Paramus, N.J. for 27 years before making the move to Pascack ValleyHospital in May 2003. One of the frustrations of this work is there are notenough capable ICPs. They looked all around to find someone with experience.Failing that, they decided they could train someone. The individual who was ouroriginal infection control person, who was trained by Centers for DiseaseControl (CDC) and had worked at it for 25 years, trained me. Thats the way ithappens for a lot of people. You come into it without having had priorexperience. Some people come from nursing, some people come from laboratorysciences, and some people come from public health.
From the start, Zilles realized how vast the world ofinfection control really is; a world, she says, which continues to expand. SinceI became an ICP, the flu pandemic was a new threat on the horizon, bioterrorismattacks with anthrax and smallpox, construction risks and the need for infectioncontrol risk assessment for construction and renovation projects became issues.Then came safe needle legislation.
West Nile virus wasnt around when I started, and itsjust so commonplace that no one even thinks about it as new anymore. SARS,monkeypox, multi-drug resistant organisms and the public focus onhealthcare-associated infections have also come into the spotlight. Therewasnt really any focus in the mind of the public about the infection dangersin the hospital, she says.
Transitioning from the large scale Bergen Regional whichis licensed for 1,200 beds to the decidedly more intimate Pascack Valley licensed for 291 beds brought Zilles the realization that size doesntmatter. Pascack is much more active, even though its small, she says,Which brings me to see that the public is not truly going to be able tocompare infection rates between one hospital and another. Its like theyrelooking for a cookie cutter some recipe for how to figure out where thesafest hospital is to be. But the patient population in every hospital isdifferent, and the services that hospitals offer are different, so the potentialrisks are totally different. Its apples to oranges to grapefruits to pears.What the legislators are trying to accomplish and what the public really wantsis not anything that theyre going to be able to get.
What makes Zilles tick? Health promotion is probably thething Im most passionate about, and it comes from all those years inlong-term care, and all those years in ambulatory care, she says. If yourenot always thinking of prevention, then youre not maximizing the potential ofyour immune system. On the back of my handouts for general orientation isinformation on personal wellness, and we never, never get to talk about it. Itell my students that theyve got to take that home and put it in the bathroom where everybody in the family is goingto read it. And I hope that they do.
I really want to make sure that patients who are in thehospital are helped, not hindered on their road to recovery, she continues.I think that people dont realize how much of a setback can occur when youfind yourself in an acute-care setting. You dont have to be a prestigious,large institution to have good techniques and good, caring staff. But withoutthose things, no matter where you are, your patients are in trouble.
Infection control is very diverse, says Zilles, and researchand educating bring great rewards. One of the things that Ive never hadany problems with in infection control is finding a new topic, she says. Ikeep a little book I call Infection Control in the News. I pass it aroundto my students as Im talking to them. I always can find articles fresh offthe headlines that will give me an infectious agent to talk about. There will always be questions that people have about certainsituations that theyre aware of. I try to weave that into whatever Imtalking about as far as chain of infection is concerned.
When it comes to education, Zilles is very hands-on.Having tools to use makes the experience more memorable and effective, she says.Hand hygiene is definitely a challenge. I take the waterless hand sanitizerwith me to the class, I put a little squirt in everybodys hand, even if theyveused it many times before, so that they can see the product that we use here.They can see how it feels, that it leaves their hands soft, and they wont bereluctant to try it when they need it.
Sharps safety is another cornerstone of infection control. I do more specifically for the departments that handlesharps, like nursing, she says. I like to have a collection of items thatwe use at the hospital and make sure that everyone can try them and becomecomfortable with them. In this day and age, people have many jobs. Most nurseshave more than one; they work in different organizations, and they use differentequipment. They may think when theyre discontinuing an IV that they know whatthat device is, but then when they get it out of the patients arm, and have alook at it; it may not be what they thought it was. If they dont activate thesafety features right away, they risk a stick for themselves and the people whohandle the waste after us. I like to have stuff that I can practice with, andlet them use and see and play with and waste.
Zilles list of professional accomplishments at PascackValley is a testament to her productivity and success. She has raised theawareness of infection control within the facility by revitalizing fit testing,expanding the roles of the infection control committee to include regularreports on preventing healthcare-associated infections; she has championedprograms on SARS, respiratory etiquette, bioterrorism, and fit testing. Sheparticipated in the development of the hospitals smallpox preparedness plan,which was submitted to the state and rewarded with funding. She is active notonly teaching, but in surveillance, policy and performance improvement as well.
Delivering the Message
It all adds up to a lot on her plate. Zilles has quicklybecome a familiar figure at Pascack Valley Hospital, toting her rolling suitcasefull of the tools of her trade. The hospital is a 24-hour-a-day,seven-days-a-week place, and Im one person, she says. In somesituations, hospitals have intranet and a lot of educational programs online.When I came into this situation, they didnt have a real live person doing theannual updates. They have a booklet called The Essentials, which coversall of the mandatory subjects. You read it all and then take a test at the end.Thats very good for paper compliance, because you can demonstrate to anyonewho inspects all of this education, because you have all of these competencytests. But its so dry.
I find that the live presentation is much, much moremeaningful, she continues. I usually begin by promising my audiencethat Im not going to tell them anything that that they already know, becausethey tend to zone out. All I am going to do is take the information that theyhave at the base of their skull at the occipital lobe, and put it right up inthe front, right between their eyes. If it isnt in the very front of theirmind, theyre not going to have it at their fingertips when they need it. Of course, one of the challenges is that its at the momentwhen they need the information they youre not there.
Im not above being silly or dressing up or singingsongs, telling jokes or having anecdotes, Zilles explains. When youve been a nurse for almost 30 years, you have lots and lots of those. When youweave them into the situation it makes it much more memorable. Of course, in some situations, games and the prizes dontwork. You have to be careful how you do it otherwise its demeaning, says Zilles. Its hard, because most of the time, youraudience is very mixed. I did a class for physicians, and I was very nervous. Inmy previous job I had a very strong hospital epidemiologist who handled thephysician education at their grand rounds meeting. There isnt that kind ofperson in my situation now, so it fell to me to do. With them I used PowerPoint.I gave them information that was specific to their areas of practice, where thisparticular institution is in respect to nosocomial infection rates and how wecant use misdata to compare our surgical sites. I spoke to them on what Ithought were their issues. I think that thats really the key to making thiswork.
The Hard Part
While Zilles is passionate about what she does and finds herwork deeply rewarding, she cites two points of challenge in infection control.This field has grown has so tremendously, but the number of people that areinvolved in the work has stayed very much the same, she says. I am notunique in being an only infection control practitioner in a facility. The jobthat I do is just so much larger than it ever was before. Its a 24/7 place,youre trying to keep up with people who are not there when you are there, soyoure coming in all kinds of hours. Its every persons job to be aninfection control practitioner. The challenge is to instill that in everyone, tomake them see that they each play a role.
Hospitals give a lot of lip service to how importantinfection control is, but its not a revenue-generating area, Zillescontinues. Cost efficiencies are difficult to see, they dont haveany staffing concerns the one or two people that they hire come in every daylike theyre supposed to. Infection control doesnt dominate an organizationspriority list. And few resources are really allocated to doing this job notpersonnel, not support services, not technology.
The second challenge is that theres no easy way to learnthis; its kind of an apprenticeship, she says. Our very first practitioners were trained by theCenters for Disease Control and Prevention (CDC), and they went out to theirstates and they formed the Association for Professionals in Infection Controland Epidemiology (APIC). They trained their colleagues. APIC is a very strong organizationnationwide in New Jersey we have two chapters, we have many very activeinfection control practitioners who are out teaching and doing consulting work.They form the nucleus of the faculty that teaches the APIC courses to thosepeople like me who come into it without any background. But theyre not university-affiliated there are nocollege education credits for this. There arent even good textbooks. There are microbiology and epidemiology textbooks, but thereare no good textbooks that put all of this together. The two basic texts from APIC are huge, and they written in anoutline form, so theyre difficult to learn from. I would like to see beforethese practitioners go over the horizon theyre all getting ready toretire that they form a nucleus of experts, affiliate with a university, andmake this really an academic way of preparing someone instead of anapprenticeship.
An Eye on the Future
I think that infection control is a marvelously challengingfield, says Zilles. The person who recruited me told me I would never bebored. Of course, the world didnt turn as fast back in her time as itsturning for me now, but she said, Just when you think youve got a goodhandle on it, something new will come along that youve never heard of before.Shes absolutely right. And of course, with the threat of terrorism, it couldbe something truly disastrous thats new on the scene. But it pulls to mindthe basic principals. Here we are in a flu vaccine shortage, and people are veryconcerned about it. If they never wanted the flu vaccine before, they want itthis year, because they cant have it. What is the way that all of us throughhistory have dealt with the threat of infectious disease? With the simple, basicprincipals: good hand washing, staying home when youre sick, staying awayfrom people who are sick, covering your cough, using tissues its allbasic. So lets not get crazy about this. In fact, it may turn out to be thatthis strain of influenza virus that becomes problematic this winter is not evena strain thats in this flu vaccination. So then we will definitely be back to basics, and all we willhave are our basics. So if you dont promote wellness and keep your immunesystem healthy, and follow these basic principals, you will be susceptible toeverything new world.
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Quitehonestly, I cant remember a time in my life that I havent been excitedabout education, says Debbie Bowling, RN, MSN, CIC, infection controlpractitioner and employee health coordinator at Helen Keller Hospital inSheffield, Ala. A registered nurse with 25 years of nursing experience inmedical-surgical nursing, medical oncology, management, consultation, staffdevelopment, infection control and employee health, Bowling is passionate abouther profession.
I cannot imagine a more rewarding, fulfilling career,Bowling says. The possibility that I can make a difference in a personslife is such an incredible feeling. The Florence Nightingale Pledge, Practicemy profession faithfully, drives me. Whether teaching a new employee aboutimportance of handwashing, or how to use a new safety device that might keepthem safe from a bloodborne pathogen it just overwhelms me that I can dothis. This is what it means to me to practice my professionfaithfully. The pledge I made more than 30 years ago is still real today.
What Bowling most enjoys in preparation for an education eventis exploring the history, or historical perspective of her topics. It fascinates me to look back in time to find out when, forexample, pneumonia was first documented, she says. It is equallyfascinating and fun to find out how it was diagnosed and treated. My audiencesare taken back in time and allowed to follow the timeline that brings them fullcircle to how we diagnose and treat that disease today. I think my fascinationand excitement rubs off on them.
Bowling keeps things interesting by tailoring herpresentations to her audiences. I try to impart relevant facts on theparticular subject I am presenting, and gear those facts to the intellect of theaudience I am addressing, she says. I also like to include handouts forthe participants to follow along, as well as give them something to take awayfrom the meeting. I find that this reinforces pertinent information that I wantthem to recall. I also encourage questions at the end of a session. This partkeeps me on my toes as well as allowing for those who may desire a deeperunderstanding of a particular part of the subject matter to satisfy their thirstfor knowledge.
Focusing on effective means of communicating is anever-changing, ongoing process, Bowling continues. Just a few short yearsago we didnt have the technology we have today. We graduated from achalkboard to an overhead projector, to computer technology with PowerPointpresentations with sound and animation and color.
No. 1 is keeping up with the technology for presenting theinformation. That does not minimize No. 2, though knowing the latestinformation regarding your subject. I also think my effectiveness comes from thefact that I am not just an educator; I am first and foremost a practitioner. Mydaily hands-on experience better prepares me to present and answer questions.
Bowlings deepest satisfaction comes from one-on-onecounseling with employees. I get such joy and a feeling of realaccomplishment when I am able to help someone with a personal question orconcern, she says. Whether that question is in regard to a patient situation,in reference to a family member or personal concern, when they come to me itsays, I believe in you, I trust you and I believe you care about me, myfamily, and our patients. It reaffirms for me that I am practicing myprofession faithfully.
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