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By Kelli M. Donley
Healthcare workers (HCWs) have faced unprecedented healthcare challenges inthe past 12 months. Just when officials thought the American healthcare systemwas safe from variant Creutzfeldt-Jakob disease, a 23-year-old college studentwas diagnosed with the brain-wasting illness. Healthcare officials rushed toensure instrumentation used on such patients did not infect others. Afterpreaching about the necessity of hot water, soap and regimented behavior toprevent nosocomial transmission of disease, the hand- hygiene guidelines updatedby the Centers for Disease Control and Prevention (CDC) now emphasize theimportance of alcohol-based rubs.
However, not all health-related news items caught HCWs off guard. Legislationregarding bioterrorism and nursing retention was anticipated, as were severalleadership appointments to prominent health agencies. Infection control expertJulie Gerberding, MD, MPH, was named as the director of the CDC. Mark B.McClellan, MD, was named commissioner of the Food and Drug Administration (FDA).
Other health topics receiving national attention include: mold in thehealthcare setting, preventing IV catheter-related infections, antimicrobialresistance, OSHA tuberculosis control, smallpox vaccinations, West Nile virus,bronchoscope-related infections and Vancomycin-resistant Staphlococcus aureus,to name a few.
Infection control practitioners (ICPs) are reviewing the industry's progressin 2002 to pick apart areas of improvement and suggest solutions to patch holeswhere experienced nurses and cushy budgets once remained.
EXPERTS PRIORITIZE IC GOALS
William Jarvis, MD, with the Hospital Infection Program at the CDC, agreesthere are a variety of pressing issues facing infection control leadership.
"Downsizing of infection control programs and decreased support,antimicrobial resistance and the nursing shortage resulting in decreasednurse-to-patient ratios, which increase breaks in technique and result in moreinfections and adverse outcomes (are the most pertinent issues facing ICPstoday)," he says.
Lawrence Muscarella, PhD, director of research and development for CustomUltrasonics and editor of The Q-Net Monthly e-zine, says the economics ofhealthcare have shaped the past year and will continue to sculpt the industry.
"One issue of particular concern to ICPs is balancing the growinginterests of the patient against the never-ending reduction in financialresources," he says. "Some healthcare facilities, under pressure toreduce costs, may reassign their ICPs to other responsibilities or terminate theposition altogether. Only after an outbreak or some other infection-relatedadverse event is identified does the facility realize the shortsightedness ofits downsizing and the true value and importance of an ICP. Surveillance and theanalysis of infection-related data are crucial to the detection of outbreaks andto preemptive and quick action. Facilities that place emphasis and properfunding on infection control and its related activities are likely to reduce notonly the risk of patient infection, but also the risk they face of litigation ifinadequate care is provided, resulting in serious patient injury."
Fatal infections drew national attention to sterilization systems and productdesign in 2002. Bronchoscopes were investigated after outbreaks of Pseudomonasaeruginosa infections at Johns Hopkins Medical Center in Baltimore andAllegheny General Hospital in Pittsburgh, Pa. Also, officials at Henry FordHospital in Detroit tested patients for possible hepatitis infection after ICPsnoticed the foam-lined cases housing nasal pharyngoscopes may have beencontaminated.
While vectorborne illness got headline news coverage, those in the industrywere more startled by the first two cases of vancomycin-resistant Staphylococcusaureus (VRSA). The first was reported by the CDC in July. The second, apatient in Pennsylvania, was admitted September 20 with a chronic foot ulcer. Aculture of the wound found S. aureus and later tests determinedvancomycin resistance. As soon as the patient was able, officials from thePennsylvania Department of Health and the CDC moved the patient intohome-healthcare to receive antimicrobial treatment and reduce the possibility oftransmitting VRSA to others.1
PREVIEW OF 2003
With the nursing shortage, a struggling economy and federal cutbacks topublic health systems, the resources to meet the healthcare needs of the UnitedStates may not be available.
Where does Jarvis see the future of healthcare? "In crisis," hesays. "Decreased resources, mergers, financial trouble ..."
Muscarella's view is more optimistic.
"With regard to infection control, I am hopeful that recent reports thatsuggest the risk of patient injury increases with a reduction in the number ofattending nurses will be sufficient to sound an alarm and cause healthcarefacilities to upgrade their infection control capabilities and allocateadditional resources to hire more infection control staff," he says."Those facilities with foresight are bound to understand that infectioncontrol staff contribute to the reduction -- not increase -- of overallhealthcare costs."
ACTION ON CAPITOL HILL
Legislative solutions were presented to ease the national nursing shortage.The Nurse Reinvestment Act, signed into law August 1 by President Bush, has beenhailed as a progressive step. The amendment to the Public Health Service Act wasinitially proposed by Congressman Michael Bilirakis (R-Fla.) in December 2001.The law provides scholarships and loan repayment options to nursing students,gives funding to graduate-level nursing education and supports public serviceannouncements promoting the field.4
Luisa Blue, RN, president of the SEIU Nurse Alliance, the largest union ofnurses nationally, says continued funding is necessary.
"Any measure that will improve recruitment and educational opportunitiesfor nurses is a step in the right direction," she says. "Now we needto take further action to make our hospitals better places to work and receivecare. We don't have a shortage of nurses. We have a shortage of nurses willingto work in hospitals."
Jarvis says the solution to the nursing shortage is to give nurses theopportunity to work with patients, rather than overwhelm them with red tape.
"(We need) improved incentives, including reimbursement," he says."(Nurses should) return to helping patients and have less paperwork."
Blue, who represents more than 110,000 nurses in the United States, saysproviding more resources is beneficial, but not the cure.
"Recruiting new nurses without fixing the underlying problems drivingthem out of the profession is like pouring water into a leaking bucket,"she says. "It's time to cure the diseases -- not just treat thesymptoms."3
Bioterrorism control also received federal funding via legislation in 2002.The Bioterrorism Preparedness Act of 2001 was signed into law by President BushJune 12. The law had been initially introduced by Congressman W.J. Tauzin (R-LA)Dec. 11, 2001. It provides $4.6 billion toward preparing for a bioterrorismattack and funds mental health services in the instance an attack does occur.5Monies will be spent to protect the national food supply, improve the healthsystem's ability to handle a bioterrorism attack, improve federal response to anattack and increase the fight against such attacks at the local state andnational level.6
Jarvis says improving the national healthcare system will require the effortof the government, individual hospital administration, employees andcommunities.
"Hospitals need to spend money on important things, such as patientcare, rather than decorative things, such as fancy lobbies," he says."Administrators who do not do a good job should be removed. Communities andindustry should demand better healthcare. Government should improvereimbursement, but also demand and require better data to show that theresources are resulting in improved patient outcomes. (There should be) lesstalk and PR from regulatory agencies and more decision-making and accreditationbased on data."