Interview with infection control expert Irena Kenneley, PhD

Health care-associated infections (HAI) are a big deal, causing suffering and death for many patients. In this interview, Irena Kenneley, PhD, APRN-BC, CIC and adjunct faculty member at American Sentinel University, describes the problem and the role of infections control professionals.What is an Infection Preventionist or IP?Most Infection Preventionists (IPs) are nurses, physicians, public health professionals, epidemiologists, or medical technologists who:

• Collect, analyze, and interpret health data in order to track infection trends, plan appropriate interventions, measure success, and report relevant data to public health agencies.
• Establish scientifically based infection prevention practices and collaborate with the healthcare team to assure implementation.
• Work to prevent healthcare-associated infections (HAIs) in healthcare facilities by isolating sources of infections and limiting their transmission.
• Educate healthcare personnel and the public about infectious diseases and how to limit their spread.

Many IPs are employed within healthcare institutions and also serve as educators, researchers, consultants, and clinical scientists. The majority of IPs are affiliated with acute care settings. An increasing number practice in ambulatory and outpatient services where they direct programs that protect patients and personnel from Healthcare-Associated Infections (HAIs). IPs also work in long-term care, home health, and other practice settings where infection prevention and control is an increasing area of responsibility for nurses and other healthcare personnel.Is it really necessary to have specialized training or is it ok to use common sense and basic skills?IPs are committed to best practices in infection prevention and control and improved patient care. An appropriately educated IPs also signals to an employer and colleagues that they are committed to professional growth and advancing the practice.A  study in the March issue of the American Journal of Infection Control found that hospitals whose infection prevention and control programs are led by a director who is board certified in infection prevention and control have significantly lower rates of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections than those that are not led by a certified professional. Additionally, news articles are noting the value of education and certificationTo meet the demands of the rapidly expanding field of infection prevention, and equip professionals for the challenges of the future, the Association for Professionals in Infection Control and Prevention (APIC) has created the infection preventionist (IP) competency model. The model outlines the skills needed to advance the infection prevention field and was created to help direct the IP’s professional development at all career stages. Education and Certification are critical stages in the model.Is infection control a bigger issue than it used to be? Why?A team of researchers from the Columbia University School of Nursing surveyed infection prevention and control departments of 203 acute care hospitals in California to determine if there is an association between structure and practices of their programs,  and frequency of infections caused by antibiotic-resistant bacteria. MRSA bloodstream infection data for 91 of these hospitals were analyzed to see if there were factors that were associated with frequency of this infection. Presence of an educated and board certified director and participation in a multifacility performance improvement project were associated with significantly lower MRSA bloodstream infection (BSI) rates. This is one of the first studies that found an association between specific infrastructure elements, patient care practices, and rates of healthcare-associated infections. MRSA is a type of staph bacteria that is resistant to certain antibiotics and can cause serious infections.Why is C. diff so prevalent now? To what extent is this an outpatient v. an inpatient issue?Ninety-seven percent of hospitals in the survey reported some type of screening policy for multidrug-resistant organisms – primarily MRSA – upon patient admission, with the most commonly targeted populations being transfers from nursing homes (77.8%), readmissions within 30 days (75.6%), ICU patients (72.8%), and dialysis patients (63.3%). By contrast, few hospitals reported the use of universal and targeted screening for two other multidrug-resistant organisms: vancomycin-resistant Enterococcus (VRE) and Clostridium difficile (C. difficile).Ninety-four percent of all C. diff infections reported in 2010 were associated with receiving health care, according to the study in the March 9 Morbidity and Mortality Weekly Report. Of those cases, 75% first showed symptoms in nursing home patients or people who recently received care in an outpatient doctor’s office or clinic. Only 25% of infections first presented in hospital patients.Although the proportion of infection onset is relatively low in hospitals, these facilities remain at the core of prevention efforts, because many patients with C. diff are transferred to hospitals for care, which increases the risk of spreading the disease there.What is being done by regulators at the state and federal level to address infection control?State level:

• 27 state laws require public reporting of hospital-acquired infection rates.
• 2 state laws allow confidential reporting of infection rates to state agencies (NE, NV).
• 3 states have voluntary public reporting of infection information (AR, AZ, WI).
• 5 states have study laws on public reporting (AK, GA, IN, NM, NC).
• 13 states and D.C. have no laws on public reporting of hospital infections, though some have bills pending on the matter.
• Of the states that have laws requiring public reporting of hospital-acquired infections, 12 states also have laws requiring the screening and/or reporting of hospital-acquired MRSA rates (CA, CT, IL, MN, NJ, NV, PA, SC, TN, TX, VA, WA).  Three states, MA, ME and NY, have legislation pending on the matter as of this update.

States with pending HAI legislation or no law on reporting

• Georgia – bill died in session in 2008; no new bill introduced on the matter.
• Hawaii – HB2829, Hospital Infection Disclosure Act, passed the Health Committee and the Judiciary in early February 2010; the bill is now in Finance Committee.
• Idaho – bill died in session in 2008; no new bill introduced on the matter.
• Iowa – law on correctional facility infection incidence only; no public reporting of HAI.
• Kansas – bill died in session in 2008; no new bill introduced on the matter.
• Kentucky – bill died in session in 2008; no new bill introduced on the matter.
• Louisiana – has no bill on the matter.
• Michigan – bills died in session in 2008; no new bills introduced on the matter.
• Mississippi – SB2360 died in Senate Public Health & Welfare Committee in 2010.
• Montana – has no bill on the matter.
• North Dakota – has no bill on the matter.
• South Dakota – bill died in session in 2008; no new bill introduced on the matter.
• Wyoming – has no bill on the matter.

Federal Level: FEDERAL CMS TITLE 42 REGULATIOMSConditions for Participation:CMS CoP Interpretive Guidelines for Infection Control state:

• Hospitals must be sanitary
• Have an active infection prevention and control program and someone overseeing it
• Surveillance must be systematic
• Infections must be “logged”
• Leadership must:
• Ensure problems identified by IP are addressed
• Take responsibility for corrective action plans when problems identified

What role do (or should) patients play? Is it reasonable to expect patients to ask their caregivers to wash hands?Patients and family members are a critical part of the healthcare team. They play an important role in preventing infection and staying safe when visiting a healthcare facility and should be educated accordingly. For example, the right of family or patients to ask their clinician to wash their hands.Educational materials supplied by IPs help healthcare consumers understand the important questions to ask their caregivers to stay infection free. They also inform consumers about infection preventionists, dedicated healthcare professionals who work to protect patients from healthcare-associated infections.