Infection Control Today - 04/2003: Fear as "The GreatMotivator"

Fear as "The Great Motivator"

"Ofall the emotions ... fear is the one which is likeliest to get thingsmoving."¹

Smallpox. Anthrax. Chemical terrorism. Airplane attacks. Sniper attacks.

Most of us have experienced these fears at some point over the last 19months, if not consistently, or at least fleetingly. "What if ... "has become a common refrain as legislators scramble to fund antiterroristactions and smallpox vaccinations.

It is unlikely, however, that we have spent even half as much time worryingabout medical errors -- which kill approximately 98,000 people each year.

This statistic in no way diminishes the gravity of the terrorist attacks. Butwe need to be aware of how fear -- which led to improvements in security afterSept. 11 -- can be used in the medical field as well.

3,000 people died on September 11, 2001. Fear of follow-up attacks led toimprovements in security for every public facet of society -- airports, baseballstadiums, shopping malls, convention centers.

Five died of anthrax apparently distributed through the U.S. mail. Fear ofadditional infections led to improved security in mail delivery, not just at thepost office but also at in-house mailrooms for businesses and schools.

Last October, 10 people were killed and three critically injured by twosnipers eventually captured in Washington, D.C. As fear gripped the Washingtonmetro area, people kept their children home from school, stopped fueling uptheir cars, shopping at home improvement stores and walking through parking lotsalone. People became more aware of license plates, white vans and trucks.

In 2002, 254 died of West Nile virus. Millions of Americans in affectedstates, fearing fatal encephalitis, changed their habits to avoid mosquitoes --wearing long sleeves and pants, and staying indoors at dawn and dusk.

No one thus far has died from smallpox or its vaccination. But fear has ledto a federal vaccination program for smallpox. (And fear of complications fromthe vaccine is preventing many healthcare workers from being vaccinated.)

"Fear is the great motivator -- and skill is its offspring. If necessityis the mother of invention, fear is the mother of competence, the mother ofexcellence."²

Regardless of the object of fear -- be it disease, terror or error -- wecannot deny that fear itself is indeed a great catalyst for action. That fear,properly channeled to the appropriate action, can be a positive force for good.

But what actions are appropriate to counter the fear of medical errors?Over-treating (by ordering unnecessary tests and labs) to avoid accusations ofmalpractice is not the answer; it leads only to inefficiency in the medicalsystem. Education, first and foremost, is the appropriate action. In the currentmedical climate -- with the high rates of medical errors and the resultingrising costs of malpractice insurance -- education is fundamental.

• Education about proper diagnoses, tests and procedures.

• Education about correct surgical sites.

• Education about double-checking patient names and prescriptions to ensure the right person is receiving the right medication in the right dosage.

• Education about look-alike or sound-alike medications.

• Education about checking patient records for allergies.

• Education about infections.

• Education about equipment and its proper use and maintenance.

• Education about blood transfusions and organ transplants.

The much-hyped case of Jesica Santillan, who died after receiving aheart-lung transplant from a donor with a non-matching blood type, is a primaryexample of an error that could have been easily prevented. Asking simplequestions about blood type or allergies can literally mean the differencebetween life and death.

Educating healthcare workers to do it the right way, every time, and to askthe right questions, every time, is essential. Knowledge of proper procedures isessential. Knowledge of what not to do is just as important.

So how does one obtain such knowledge? Read the latest journals (don't letthem pile up in the magazine stand at home or on your desk at work). Visithealthcare related Web sites; AORN and APIC consistently provide up-to-dateinfection control-related knowledge. Attend seminars. Take continuing educationcourses -- in-house, online or in the pages of your favorite infection controlmagazine, Infection Control Today.

This month, our Best Practices department addresses an ongoing problem:surgical site infections. According to the Centers for Disease Control, thereare an estimated 500,000 surgical site infections in the U.S. each year, whichequal one-quarter of annual nosocomial infections. The cost -- to both financesand health -- is astronomical. Bonnie Barnard explores the problem in-depth andtells us exactly how to prevent it.

Our continuing education program is designed with you in mind. Upcomingtopics include asepsis, patient safety standards and how to prepare for JCAHOsurveys. If there are topics you'd like us to address in future issues, pleaselet us know. If you have written an educational piece that is relevant to aninfection control course, let us know that, too.

If you have upcoming in-house educational sessions, please feel free todistribute copies of the Best Practices to your "students" for them tosubmit for continuing education credits. The courses are intended for the goodof your employees in the short term; in the long term, they contribute tocontinued health for all of us.

Kathy Dix
Managing Editor
kdix@vpico.com

1. McClellan JL. www.pygalgics.com/F/fear.html
02/28/03

2. Morgenstein, Henry. www.nmc.edu/~hmorgenstein/essays/fear.html 
02/28/03