Latest / Culture Positive: An Infection Prevention Podcast / Before Infection Prevention Had a Name
Transcript
- Ally: I have been an infection preventionist for close to five years and was an infectious disease epidemiologist at the Massachusetts State Health Department prior to working as an infection preventionist. For the last three years, I have been an infection prevention specialist at a trauma level one academic hospital. Interestingly enough, when I was getting my master's in public health at Boston University. I didn't even know infection prevention was a career path for someone like me. For my master's program, I concentrated in epidemiology and biostatistics, and within that focus, I really honed in on infectious diseases. I really enjoyed classes where I was thinking about disease transmission. investigations and ways to mitigate disease. I will be honest with you, I would be happy to never code again in my life, but I am very grateful for biostatisticians. We always need truthful and reliable data, so truly thank you to those who do that work. Getting back to where my passions are, going into governmental work was recommended to me Due to my interest in working on investigations and outbreaks. I have always been a Nancy Drew of sorts, if you will. So working on outbreaks and analyzing patterns really piqued my interest. This is how I ended up at the Massachusetts State Health Department Infectious Disease Bureau. A large chunk of my job was talking to key stakeholders. Whether that was citizens of the community I was working in, a local health department nurse, or even physicians at hospitals. I also started speaking with infection preventionist, which was a job I had never heard of before. I love the idea of being in a hospital setting, so I started to do some research on what exactly infection prevention was and what that could look like as a career. Infection preventionists are dedicated professionals who help create safer healthcare environments for both patients and staff, with backgrounds in nursing, public health, epidemiology, microbiology, and other clinical fields, work is done behind the scenes to reduce the spread of germs and strengthen everyday safety practices. From identifying infection trends through data analysis, educating staff to best practice when it comes to central line maintenance, or even working with environmental services to ensure patient care areas are clean, infection preventionists play a really pivotal role in keeping patients and staff safe. While the concept of trying to mitigate infections has been going on for centuries, a formal career in infection prevention really started in the nineteen fifties in response to a nationwide outbreak that eventually became global. Unfortunately, it was an outbreak of an antibiotic resistance strain of staph aureus that led to both morbidity and mortality. The specific antibiotic it was resistant to was penicillin. And I'm sure you know this, but penicillin is actually considered one of the world's first antibiotics. I'm sure we will discuss antibiotic resistance later in this podcast, but essentially, antibiotic resistance is when bacteria have adapted to survive against medications that were designed to kill them. A long story short, it's not good. The specific strain of Staph aureus 80-81 started to spread rapidly, and outbreaks in hospitals started to pop up globally. Epidemiological studies of this outbreak led to different ways of thinking about hand hygiene, isolating patients with infections, and environmental cleaning. The infection control movement in the United States really took shape in the 1970s when hospitals began recognizing the need for structured approach to preventing a healthcare-associated infection. By the middle of the decade, thousands of hospitals had established what they called infection surveillance and control programs. This marked a major shift towards actual organized prevention efforts. A pivotal moment actually came from a study that's I'm gonna refer to as CENIC. So it's the study on efficacy of nosochomial infection control. And this was conducted by a Center of Disease Control, also known as CDC. And this took place in the mid-1970s. This study provided the first strong evidence that well-designed infection surveillance. and control programs were directly linked in reductions to nosochomial infections, better known today as hospital acquired infections. The study validated the work of early infection control teams and set the foundation for what infection prevention standards look like today in our healthcare system. Hospital-associated infections can occur wherever you receive health care. So we're thinking this can range from a hospital to a long-term care facility. Preventing hospital-acquired infections, also known as HAIs, is truly the foundation of infection prevention and control. There are a group of HAIs that you'll often hear infection preventionists talk about. So I can just go through those really quick and hopefully. At some point we can dive into them more, but what you'll really hear referenced a lot are collabses, and those are central line associated bloodstream infections, cautys, catheter associated urinary tract infections, SSI, that would be a surgical site infection, and CDI, that is a C diff infection. So we can get into the specifics on those another time, but Core strategies we maintain to avoid hospital-acquired infections can include but are not limited to proper hand hygiene, number one, personal protective equipment, also known as PPE, antimicrobial stewardship, insertion bundles for invasive devices, thinking those central lines, catheters that were mentioned earlier. and cleanliness of the environment. Roughly one in 31 hospitalized patients in the United States has a hospital-acquired infection. HAIs can cause unnecessary patient harm, increase the length of stay for a patient, and also cost the hospital a good chunk of money. Let's use CLABSI as an example. So remember CLABSI is central line associated infection. So this is when an infection enters the bloodstream via a central venous catheter, also known as a central line. Central lines are flexible tubes that lead to your superior vena cava, aka that big vein that sends blood into your heart. Since this catheter goes into a major vein, it is easy for a nasty bug, even like what was mentioned earlier, staph aureus. To travel into the bloodstream and cause infection. In more serious cases, complications could include septic shock, organ failure, and sometimes unfortunately, even death. It can also lead to extended patient stays. Cleveland Clinic actually reports an average of a 45-day patient stay if a patient needs treatment for a CLAPSI. And the cost for the hospital? The average cost for a Klabsy is around forty-eight thousand dollars. The 1980s brought new levels of responsibility to the field of infection control, with both AIDS epidemic, and antibiotic-resistant microbes. AIDS presented a risk of infection to healthcare providers when providing care for patients. An infection preventionist became a key part in recommendations and best practices to not only keep patients but also healthcare workers safe. Also, our friend Staph Aureus pops up again, but this time Medicilian resilient Staphyreus. I'm terrible at saying these. We can just call it MERSA. Infection control was needed to help with understanding new cases versus colonized cases of MRSA. Recommendations for antibiotic use. Using isolation precautions and the healthcare environment, and the tried and true hand washing. At this time in infection control, the field was, if not entirely, mostly made up of nurses and those with clinical backgrounds. Of note, you might have picked up on me calling the field infection control. During the 1980s and 90s was when there was a real culture shift in calling the field infection prevention. There was a hope to prevent disease spread instead of controlling it. From here on out, I'll refer to the field as what we know it as today, infection prevention. The next big public health event that caused another shift was the COVID-19 pandemic. Due to being such a chaotic time where guidance was being given in real time and sometimes changing due to learning more about COVID itself. Remember how I mentioned not knowing about infection prevention being a job? COVID-19 really pushed the importance of infection prevention in hospital settings. Along with other public health areas, including ambulatory clinics, long-term care facilities, and even cruise ships. A cruise ship has been in the news recently for a hontavirus, and I'm sure you've even heard about the need for passengers to quarantine. The overall increase in needing infection prevention work in our communities has really made the field boom and has also pushed. for different backgrounds outside of nursing into infection prevention work. Like mentioned earlier, the field of infection prevention is now made up of those with nursing backgrounds, but also epidemiology, microbiology, and public health to list a few. I can speak from experience, present-day infection prevention is busy as ever. Infection preventionists are expected to consult on construction occurring at the hospital, knowing when positive versus negative airflow should be used, understanding cleaning and disinfection, along with high-level disinfection when thinking about semicritical instruments. Understanding and speaking to how different pathogens spread, ensuring proper isolations are being followed, I mean it's endless. Every day looks different, and in a future episode, we can dive into a day in the life of infection prevention. Hopefully, the history of infection prevention and a sneak peek into what the work looks like today gives you some insight on the field and maybe even piqued your interest. For our Huddle Corner, a section for some takeaways before signing off, I do want to confirm that I am in fact not a lab rat, and I have never been one working in infectious disease. I also have zero intention of doing that in the future. Also, infection prevention as a career is still very new and has evolved so much since the 1950s. Something else from the nineteen fifties? Our girl Barbie, she also came out in the nineteen fifties. And I would like to start a petition that there should definitely be an infection preventionist Barbie.