By Betsy Todd, MPH, RN, CIC, AJN clinical editor
At the 42nd annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC), held in late June in Nashville, experts from around the world shared information and insights aimed at infection preventionists but of interest to nurses in many practice settings.
APIC president Mary Lou Manning, PhD, CRNP, CIC, FAAN, opened the first plenary with the observation that to be presented with an unending series of challenges is the “new normal” in infection control and prevention. Collaboration is more important than ever in health care, she said, and “there is strength in our combined efforts.”
Cathryn Murphy, PhD, RN, CIC, in accepting APIC’s highest infection prevention award, added that trust, friendship, and passion are essential if these efforts are to succeed.
‘I’m not at Ground Zero. I’m in Dallas.’ The highlight of the opening session was a fascinating conversation with key U.S. players in the Ebola crisis. Seema Yasmin, MD, a former CDC Epidemic Intelligence Service officer and now a staff writer at the Dallas Morning News, described how hard it had been to convey accurate information in the midst of rising public hysteria in the U.S.
As an epidemiologist, Yasmin became an interview subject as well as reporter. She recalled that, after months of worrying about colleagues at risk in West Africa, a reporter asked her, “How does it feel to be at Ebola Ground Zero?” Her reply: “I’m not at Ground Zero. I’m in Dallas.”
Later in the conference, Dr. Yasmin reminded the audience that every disaster drill should include a “public information” component and warned that “misinformation spreads much quicker than a virus” in today’s media environment, adding that we “can’t repeat the same [accurate, informative] message often enough.”
Practice drills vs. the real thing. Philip W. Smith, MD, medical director of the Biocontainment Unit at the University of Nebraska Medical Center, described the unit staff’s experiences in treating Ebola. UNMC’s special unit was built more than 10 years ago after the devastating SARS outbreak in Canada that left 33 dead, including several health care workers. Until Ebola cases arrived in the U.S., the unit had been used for training and occasional patient overflow. Dr. Smith emphasized that, even while the unit was not being used, their mantra was “drill, drill, drill” to ensure that staff would function expertly when this specialty care was needed.
Then, in August of 2014, “Suddenly, nine years of drills had to be translated into reality, and there was not much room for error.” He spoke of how inserting a central line while wearing three pairs of gloves, a face shield, and maximal personal protective equipment (PPE) topped by a sterile gown was a very different challenge from repeated practice runs of the same procedure.
Dr. Smith also noted that the transport of patients with Ebola—airlifting from West Africa, ambulance transport, and movement through the hospital to the unit—was “enormously complex and time-consuming.” A special incident command structure was set up just for transport, in addition to the main hospital incident command center.
A horizontal culture was also vital to their work. “There was no hierarchy,” he said. Cultivating a “classless society,” staff developed a strong sense of team under stressful conditions where they were responsible for each other’s safety.
Nonhierarchical work habits stayed with staff after the unit was closed and they returned to their regular assignments. However, when they continued to make “best practice” suggestions to coworkers, they were met with anger and pushback instead of the thanks and cooperation that had been the norm in the Biocontainment Unit.
How are we going to systematize it? Michael Bell, MD, deputy director of the CDC’s Division of Healthcare Quality Promotion, made the point that we have to get PPE right every time, for every patient, whether we’re protecting ourselves and others from Ebola virus or protecting the coronary artery bypass patient in the next room from MRSA. “How are we going to systematize doing it right, going forward?” He suggested that hospitals might consider the periodic addition of “an extra pair of eyes” to observe PPE use on the unit in order to nudge staff into optimal PPE habits. Dr. Bell added that staff need to know why particular tasks or steps in each process are essential.
Although it may not be practical or necessary to observe PPE donning and doffing every time we suit up for MDROs or other “routine” isolation, Dr. Smith suggested that a unit could periodically incorporate mini-drills into a day’s work, in which staff pair up and observe each other’s donning and doffing practices. And checklists should not be reserved for Ebola; they can be posted on the isolation cart or room door, serving as regular reminders to suit up correctly every time.
A wake-up call for office practices, ambulatory sites. Russell N. Olmstead, MPH, CIC, director of infection prevention and control for Trinity Health, sees Ebola as a wake-up call for ambulatory sites and office practices. He too encouraged staff to find ways to systematize practices, so that even in the busiest EDs or ambulatory settings triage always includes questions about fever and travel history.
As Dr. Bell noted in closing, “The next influenza epidemic is around the corner.”