Building Momentum in Infection Prevention

By Jennie Mayfield, BSN, MPH, CIC

As many of you know, recent studies have shown that infection rates are lower than previously estimated. The “Multistate Point-Prevalence Survey of Health Care-Associated Infections” published in the March 27 edition of the New England Journal of Medicine (NEJM) found that on any given day, 1 in 25 inpatients in the U.S. have at least one healthcare-associated infection (HAI). In addition, about 75,000 patients who have an HAI will die during hospitalization.

While the current estimates of infections are lower than previous estimates, it is hard to draw direct conclusions from these comparisons because of the differences in patient populations studied, changes in surveillance definitions of HAIs, and varied data collection methods.  However, what is clear is that there is still much work to be done.

Infection preventionists (IPs) should not view these data as an opportunity to catch our collective breath; rather, we need to view this as a mile marker and continue our momentum toward eliminating HAIs.

It Takes a Team
If we want to maintain this momentum, we cannot go it alone. Thanks to our work tackling device-related infections, such as central line-associated bloodstream infections (CLABSIs), we have learned that we are part of a larger team. And that means involving our partners in healthcare-bedside staff, environmental services, ancillary healthcare staff, medical directors, administrators, physicians and surgeons-from the start. 

Previously, for example with CLABSI, IPs would develop education and tools, present them to the staff and hope that they’d use them. And sometimes they would, or, unfortunately, sometimes they would not. Over time, what we learned was this approach was not uniformly successful.  We continued to struggle with CLABSI rates higher than we knew we could achieve for much longer than necessary. Looking back, we now know if we had involved our partners, i.e., “what do you need from us?” instead of telling them how to implement a given intervention, we might have achieved buy-in and seen reductions in infection rates sooner.

Shifting from Drivers to Facilitators
The IP mentality has historically been to be the owner and driver of infection prevention and control processes in health facilities, but it’s time to shift our attitude to take on a more collaborative and consultative role.

This requires articulating the goal of decreasing infections, and then asking the frontline teams what they need from us to accomplish that. We need to say, “Here’s the goal, and here are the basic parameters. You decide how to get there and tell me how I can help you.” Healthcare workers want to provide good, safe patient care. We need to let them figure out the details that make sense to them and fit into their workflow.

While infection prevention is extremely important, we also need to remember that it is one of many patient safety goals competing for the attention of frontline staff, along with medication errors, falls, and the prevention of decubitus ulcers.

"Culture Eats Process for Breakfast"
At the International Federation of Infection Control meeting in Malta in March, I was fascinated by a presentation given by Dr. Michael Gardam, an infectious diseases specialist in Toronto. He used a quote that we’ve all heard before, but this time, it really resonated with me: “Culture eats process for breakfast.” In the past, we have given our units a process, but the unit culture may have chewed it up and spit it out. Instead, we need to say, “Do it any way you want. We don’t care, as long as we achieve our goal.” And then position ourselves as someone who can help them achieve that goal.

Dr. Gardam used the example of child rearing. Every parent the world over could probably agree on a minimum set of expectations for raising children, for example, all children need food, clothing and shelter. Beyond that, everyone has their own parenting style. Though the steps they take may differ, the goal is the same: to raise happy, healthy children.

To continue to make progress to reach healthcare without infection, we need to work as a team and rally together with frontline caregivers to develop processes that will work for them. It does not have to be the same for everybody. The reality is – one size does not fit all. Every unit has its own culture.

Infection prevention is not about me or you – the IPs. It’s about the staff implementing it day in and day out. Our job is to provide them minimum criteria (e.g., make sure no one is breaking the seal on the Foley catheter, scrub the hub before every line access, and other evidenced-based recommendations). How they go about putting these steps into practice is up to them.

We have spent a lot of time and effort pushing infection prevention efforts toward our bedside colleagues, but it’s time to stop pushing and help our frontline caregivers own their infection prevention programs and truly move the needle toward fewer HAIs.

Jennie Mayfield, BSN, MPH, CIC, is the 2014 APIC president.