Presenting the ICT 2007 Educator of the Year

Empowerment is a nurses most important asset, according to Marcia Ryder, RN, PhD, an infection control educator and ICTs 2007 Educator of the Year. Empowering nurses and practitioners is what I try to do with every presentation I make, says Ryder, of San Mateo, Calif.

A critical care nurse for nearly 20 years, Ryder turned her efforts to researching medical biofilms and healthcare-acquired infections (HAIs) in 1988 shortly before earning her bachelors in nursing from the University of California, Davis. Since then, the mother of two has been presenting her findings on antibiotic-resistant organisms and how to prevent HAIs to nurses and practitioners around the country.

My job is important because people are dying, Ryder says. In terms of healthcare- acquired infections, there is a mortality rate. Right now, the rate of infections and the rate of death related to these infections is one of the leading healthcare problems in the country, and in the world, for that matter.

The other issue, Ryder continues, is that HAIs are preventable almost 100 percent preventable. Basically, this is out of control, but we have every opportunity to change it. So thats kind of been my mission to help research the issues behind the development of HAIs, as well as methods to prevent them, anywhere from technology to education, and to prevent needless loss of life to morbidity caused by HAIs.

Ryder enrolled in the Western Pennsylvania College of Nursings three-year program right out of high school in 1967. Her mother was an operating room (OR) supervisor and her uncle was a surgeon. I lived in the healthcare profession every day. I felt very adept to do it. But it doesnt feel like it was that long ago, not at all, she says, laughing. It sounds ugly!

After working as a critical care nurse in Pennsylvania and Florida for almost a decade, Ryder says she experienced what most nurses do. At one point I left because of burn-out, she says. Critical care nurses work very hard and face life and death on a daily basis, and eventually it plays on your emotions and your attitude.

Ryder briefly left nursing to work as a veterinarian, which took her to California and UC-Davis. I developed a small animal ICU. But the last year I was there, I ended up literally working for minimum wage. The grant I had was discontinued, and it was one of the most disappointing things.

She then turned her attention to working as a nutrition support nurse specialist at UC-Davis Medical Center. Little did she know at the time, but it would lead Ryder to teaching nearly three-dozen infection control courses a year.

As a nutrition support nurse specialist, I literally saw patients die because of catheter-related bloodstream infections. And being the inquisitive, inquiring person that I am I was meant to be a true scientist I wanted to know why this was happening and what we were going to do to prevent it, Ryder says. I saw it happen over and over, and it seemed so needless to me. Patients in the critical care unit were plugging along and doing better, and all of a sudden theyre gone because theyre septic from their catheter.

Shes very compassionate and extremely thorough, says Cindy Crosby, vice president of clinical affairs for Medi-Flex, and a longtime friend and colleague. Marcia is a true detective, finding out the problems and finding out how to implement changes to prevent or improve on the situation. To watch Marcia in a presentation, its amazing to listen to the passion that she delivers her lectures with and the amount of energy thats generated within the room. Shes definitely a leader.

Ryder says it was one gastrointestinal surgeon at UC-Davis Medical Center who pushed her to search for answers: Dr. Bruce Wolfe.

He truly inspired me, she says. I went back to school, did my bachelors, masters and doctorate all in a row.

Ryder says shes also been inspired in her career by Capt. Walter Scott, PhD, at the Center for Device Evaluation FDA; Dr. Mary Engler, RN, PhD, in the Department of Physiological Nursing at UC-San Francisco; and Bill Costerton, PhD, the current director of the Center for Biofilms at the University of Southern California.

While pursuing her degrees, Ryder explored how bacteria were attached to medical devices and was alarmed as are her students these days by what she discovered.

We realized that bacteria were able to form biofilms on any medical device and even in tissues. And, in fact, almost all chronic infectious diseases are biofilm diseases. About 65 percent of all infections seen by infectious disease physicians are biofilm-related, Ryder says. So this was a whole new revelation in the world of microbiology. This was never understood before that most organisms on the Earth in any nucleus environment live in biofilm and not as individual isolated cells. That has sort of turned the world in microbiology, and theres very expensive research undergoing in all areas where biofilm becomes important, whether its in industry or in oil or in the medical world, and certainly in the dental world, because we know that all dental carries are biofilms. So it was my goal to advance the science and get a better understanding of how biofilms cause morbidity and mortality, partly related to medical devices and transplanting over into healthcare acquired infections.

If you think about it, the major HAIs are urinary tract infections, ventilator-associated pneumonia, catheter-related bloodstream infections, and surgical site infections, Ryder adds. Well, three of those involve a medical device. Those are all biofilms as the source of those infections. Thats where my research was focused and remains to be focused in that area, looking for preventative measures or treatment and diagnostic measures to deal with biofilm infections.

According to Crosby, Ryders research has been invaluable. Thanks to Marcia, biofilm research within the medical industry has just bloomed, Crosby says. We are becoming better clinicians based on her initial research and on the research she still puts out today. Shes stimulated me, Crosby adds. Shes definitely made my life very interesting.

Ryder says she sees that nurses and practitioners she presents these findings to are as surprised by her revelations as she once was. Yes, absolutely, Ryder says. I find a very high level of interest on the part of practitioners in trying to learn this and understand it. It is a really fascinating field. And now the technical capability with microscopy, cortical laser and epiflourescent microscopes has really opened the whole world to really be able to understand and observe what these bacteria are doing. Its been of great interest to all of the folks that I have presented to.

Antibiotic-resistant organisms are a persistent problem leading to morbidity and mortality for patients. Pretty much any of the organisms can become resistant. But when they live and develop in biofilms, then youve got double trouble. Its the multi-resistant bacteria that are causing so many deadly infections in patients.

Ryder says she asks her audiences to use critical thinking and to think outside of the box in order to make significant changes in dealing with HAIs. Practitioners, she says, must understand the scientific principles behind what theyre doing, why the problem exists, how it works and they must translate that into their daily practice.

Medicine and nursing is not a cookbook, Ryder says. Infection control practitioners tend to go in that direction, and its not by their own fault. They are under an enormous amount of pressure and are spread so thin in so many directions. They are forced to be a generalist in everything but a master of nothing.

I think this is why this is so powerful, because Im bringing something to them that they can wrap their arms around.

Absolutely, Crosby agrees. Marcia doesnt stimulate just with data. She gives them a reason to search for data. They walk away thinking about making changes, how to fix or prevent what they were doing. She definitely sparks interest within a room. She has never taken no as an answer, and thats an enormous asset to healthcare, in general.

Ryder explains that bundling procedures is imperative in helping reduce infections and mortality rates.

Medical-device related infections are very, very complicated. The whole premise to prevention is keeping bacteria from having access to the device. There are multiple ways for bacteria to get to the device; for each of those ways its important to have an intervention to keep them out.

Each one of those interventions has got to be scientifically evidenced that that intervention will work, she continues. So a bundle is usually four or five specific things that, if you do them repeatedly, they will certainly minimize your risk if not eliminate the problem.

Ryder emphasizes that evidence-based medicine is mandatory and necessary, and this is what we all try to achieve. 

You have to do the consistent things we know and what works, Ryder says. What we have to do is revert to the best practice, where we take all of the information from whatever level, whether it is observation, experience, or scientific rationale. And, out of all those things together, we need to do whats best for the patient.

Ryder says she values being able to present the power of research most as an IC educator, and be able to take clinical questions and address them and teach practitioners the best methods in being able to solve those problems related to infection.

Craig Johns, a sales representative with California-based Medi-Flex, has been working with Ryder for more than four years now. He says hes always surprised at how easily Ryder takes complex matters and discusses them in an easy-to-understand and practical manner that allows our nations healthcare workers a chance to make quick and crucial changes in their practices.

Marcia has very graphical material in her presentations that is current and up to the minute, Johns says. She has a way with analogies, taking very challenging information and relaying it in layperson terms.

Ryder, whos been married for 23 years, is also a member of the Association for Professionals in Infection Control and Epidemiology (APIC)s Scientific Research Council, a consultant to the Food and Drug Administration (FDA) General Hospital Panel, a past president of the Association for Vascular Access (AVA), a member of the Association for the Advancement of Medical Instrumentation (AAMI) tag committee, and a former member of the FDA Central Venous Catheter Working Group.

Ryder says theres a power of visualization that is crucial to keeping her classes interested in the material.

When a nurse or a physician walks around the hospital, they cant see bacteria. Its out of sight, out of mind. Were fighting an enemy that we cant see, Ryder says. If we can be able to visualize that they are there and what are they doing and what do I need to prevent that, then were better armed with the power to being able to translate that research into knowledge and innovatively create ways to do the prevention.

You cant do much about something that you cant see if you dont understand that its there, Ryder continues. In terms of the audiences, I think a lot of it is just bringing the science to life and having them visualize it and understand it. And I think theres a lot of power in that.

Specifically, Ryder uses PowerPoint presentations, a lot of drawings, cartoons and actual photographs of biofilm bacteria to show her audiences just what it is theyre battling. And then trying to take that science and the research, understand the data and the science behind it, and translate that over to our clinical practice.

If they understand that what were doing is not working, we have to stop doing that and do something different. So you need to understand the science behind it to be more effective.

Ryder says that because of her approach, she finds that few, if any, practitioners are resistant to change.

Its very powerful stuff, she says. One of the biggest things I hear is, Now I get it. And thats when I know Ive been successful. 

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