We Need a Revolution

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I’d like to tell you a story about a lady with white hair. At least I think she had white hair. It’s certainly one of the attributes I remember most about her. She was short, she had white hair, and she always had a scowl on her face that seemed to say, “Stay away, I bite.” She carried a clipboard with her everywhere, and her eyes would follow you like a hawk circling prey. She’d scribble furiously on the sheet of paper on the clipboard. And I remember always wondering what she was writing.

I was 20 years old at the time and, somehow, had landed myself a job in the emergency department as an ER and trauma nurse. ER nursing had been my first love, so I was surprised when I found a career that I loved even more. I sometimes wonder what my 13-year-old self would have thought if someone had told her that she would grow up to prevent and control infectious diseases. I don’t know that I would have believed them at the time; I was still convinced that I was going to be a musician. But I digress.

I had no idea what the lady with white hair did at our hospital, but she was absolutely adamant that I wash my hands every time I entered or exited a patient’s room. And that’s another thing—I couldn’t figure out whether she wanted me to wash my hands or use the hand sanitizer. Sometimes I would use the sanitizer, and she’d get mad that I hadn’t washed my hands. Other times I would wash my hands, and she’d remind me that I could have used the hand sanitizer. Because we didn’t know her name, we all endearingly referred to her as “the handwashing lady.” When she arrived on the unit, the charge nurse would send a message to everyone’s phone that read, “The handwashing lady has arrived.” This would cue all of us to make sure we paid attention to washing our hands as we went about our work.

It wasn’t until years later that I would understand exactly what the handwashing lady was doing during her visits to the ER. It dawned on me one day during my first year as an infection preventionist that I was now the handwashing lady. However, the issue is not so much what the handwashing lady was doing and the science behind it, but how she was doing it. What a shame that I didn’t know her name, the importance of her job, or the reason for her visiting the ER. Friends, if I’ve learned anything in my career, it’s that infection prevention is 20% science and 80% implementation of that science. If you want to succeed at preventing and controlling infections, you must master the art of implementation. I know that I washed my hands more because of the lady with the white hair, but my compliance was driven far more by fear than by recognition of the importance of hygiene.

I continue to see this scenario play out as a research nurse and consultant in infection prevention and control. We are trying to help people prevent infections who don’t even know we’re there to help them prevent infections. All they see is a man or a woman with a clipboard, telling them to wash their hands. Obviously, there is a huge disconnect here; something is missing, and that something is in our approach. We’re missing a fundamental understanding of human nature. I’m sure the lady with the white hair meant well, but we didn’t know that. I think she knew whatshe needed us to do to prevent infections, but she didn’t know how to get us to do it. She didn’t take complicated, messy humanity into account.

Take a moment to think about one of your habits and what drives it. Would it be helpful if someone said to you, “Stop doing that. It’s bad for you.” Not really. But why? Because they are not addressing the underlying reason or reasons for that behavior. In health care, we must understand what drives compliance and noncompliance. Is it fear? Convenience? Money? Discomfort? A knowledge gap? Is it politics? Are past experiences influencing current actions? If we want to change behavior, we must recognize that people are complex. We cannot simply tell someone to do or not do something and expect immediate compliance. Instead, we must first understand the human factors that affect the behavior we’re seeking to influence.

My friends, this is why we need a revolution. We know whatwe need to do to prevent infections, but we need to change how we do it. We’re forgetting that to prevent infections we must change the habits, perceptions, and knowledge ingrained in people and institutions. And people are so incredibly complex. I’ve already mentioned this, but I want to emphasize it. People are messy and complicated and confusing. We are filled with fear, insecurities, opinions, and habits. If we want to prevent infections, we must get to know and understand people, not just the science of infection prevention. On the surface, infection prevention and control is just science, but it’s really an art more than a science. The science of preventing infections is merely the tip of the iceberg. Underneath are people—complicated, messy people—and our approach to helping them prevent infections is key.

We need to change that approach. We talk a lot about what people must do: wash the hands, take the medicine, clean the hub, wear the mask. But we need to better understand how to get them to do those things. This is what I like to call “the art of prevention.” In this series of articles, art will meet science. Learning to practice this art requires us to continue learning about science because, regardless of how well one understands people, one must first understand the discipline of infection prevention. We’ll also explore human factors, psychology, and finally—possibly most importantly—personal growth. I know what you’re thinking: “What does personal growth have to do with preventing and controlling infections?” Quite frankly, everything. Infection prevention is not an easy job. To be successful in this career, we must have strong interpersonal skills and be able to handle conflict and defeat, competencies everyone can develop with time and guidance.

I’m eager for you to join me as we explore the complexities of being human in the context of infection prevention and control. My hope is that you’ll grow as a person and as a professional. This month, I want to challenge you to become known. Get out there and introduce yourself as the infection preventionist. Strike up a conversation with the environmental services worker. Tell them your name, make small talk, and share with them why you love what you do. Commit to not being known as “the handwashing person.”

Until next time.