As the Ebola virus lands closer to home, it has been disappointing to watch the hype, inaccuracies and blame circulating in various media on what continues as a yet-to-be controlled humanitarian and health crisis in West Africa. Those who have been aware of this evolving issue, such as many well-trained, conscientious infection prevention professionals around the country, know this disease has been threatening the West African countries of Liberia, Sierra Leone and Guinea with increasing magnitude since March of this year, taking the lives of far too many West Africans over the last 7+ months. As a result, Ebola abroad, and now for the first time in the US, is also a very dynamic situation, like much in healthcare. As such, responsible healthcare journalists, weekend warrior bloggers or persons with a Twitter account might want to take into account that as more is learned, protocols and best practices will, as expected, evolve.
An excellent Infectious Disease (ID) blog sharing good information about Ebola is Controversies in Hospital Infection Prevention, hosted by three ID physicians from the University of Iowa: Mike Edmond MD, MPH, MPA, Chief Quality Officer, Eli Perencevich MD, and Dan Diekema MD, Director, Infectious Disease. In July, Edmond (@Mike_Edmond) posted, Ebola Hemorrhagic Fever: A Primer, which contains foundational information about the virus, much of which is based on CDC Ebola interim guidances, that are also evolving. And to put Ebola in a more realistic perspective and take away some of its horror film power, it is a very slow-moving infectious disease per Eli Perencevich MD (@eliowa), who writes in an October 9th post, Traveling with Ebola is not traveling with influenza:
The…most important difference between the current Ebola outbreak and the 2009 H1N1 pandemic is that Ebola is very slow-moving….the first case of Ebola is thought to have occurred 307 days ago on December 6th in a two-year old boy. Since that time there have been an estimated 8,032 cases …If you compare a similar 307-day period for 2009 H1N1, April 12, 2009 to February 12, 2010 CDC estimated between 42 million and 86 million cases occurred in the US with a mid-level estimate of 59 million people infected…7300 times more cases of H1N1 using the mid-level estimate
Fast Company staff writer, Rebecca Greenfield (@rzgreenfield), in Ebola Deeply is the Only Place You Should Be Getting Ebola News, directs those in search of Ebola related content without the hype, turn to the single source news website, Ebola Deeply, started by Lara Setrakian (@Lara) a former ABC News and Bloomberg reporter. After clicking onto the site, readers are immediately drawn to the NYTimes video story by video journalist, Ben C Solomon, also embedded below. The story shows what life is like on the streets of Monrovia for Gordon, a Liberian Ebola ambulance driver, separated from his family as a safety precaution for over five months. What he describes sounds like going to war against an invisible opponent, with limited armor and safe harbors. Certainly in a resource rich country like ours, we should be able to handle what courageous true front line Ebola warriors are fighting with much less.
While healthy critique of those charged to create solutions in the US provides a good check and balance, it’s disappointing to watch the finger pointing that rears up in such a well-resourced, educated country, especially as those in West Africa have far less time to discuss and instead are using that energy to improvise and stay alive while caring for their thousands of ill patients vs our limited number of cases to date. In fact, more people died in the last week due to all medical harm in the US than to an outlier of an infectious disease like Ebola. To add even greater perspective, a recent New York Times article by Elisabeth Rosenthal MD, For Ebola Health Workers Risks and Duty Collide, closes with the following:
…Meanwhile, Dr. Cooke said she has tremendous admiration for the doctors in West Africa: “It’s been inspiring to hear African health care workers saying ‘I’m a doctor, these are my people. There’s no choice.’ It’s a fundamental reminder of what it means to be an M.D.”
And with the arrival and death of an infected patient to a Dallas hospital, and the subsequent infection of two nurses who treated him, many of the existing cracks in our healthcare system are being exposed by the media on the larger stage that is now practicing medicine. In an interview on the Today Show last Thursday, a nurse working at the hospital spoke with Matt Lauer, sharing the need to come forward knowing full well she might lose her job. Not knowing the full story, the fact that this could happen comes as no surprise to those working in healthcare. However, it is important to note we still have one of, if not the, very best systems in the world–cracks and all. A safe healthcare system has a just culture, and when a nurse “voices concern” about his/her own safety, as well as that of patients and colleagues, he/she is heard, even thanked, by those who can fix and address those concerns. Many healthcare organizations across the US are creating environments that welcome this voice, yet others are still far from adopting this culture. While not at all familiar with the culture at this particular hospital, nor the institution’s side of the story, it appears from the Today Show interview this nurse voiced concerns that initially went unaddressed. To this end, we see how failure to embrace elements of a just culture could affect patient and provider safety in real-time. This could be an unfortunate example of a long existing need for greater urgency around culture change in healthcare.
And despite the “he said, she said” or “they should of…” thinking, there are many looking for solutions to stop the outbreak in Africa. In a recent @FastCoExist article, Can Better Design Stop Ebola? How Creative Minds Can Help, Jessica Leber writes:
…On just one day’s notice, almost 200 people crowded an auditorium at Columbia University’s engineering school on a Thursday evening in early October. Engineers, designers, and public health researchers were there to learn and brainstorm, and do so quickly…Columbia isn’t the only institution interested in applying design thinking to the health and humanitarian disaster. On October 9, USAID, partnered with the innovation platform OpenIDEO, the CDC, the Department of Defense and the White House, announced its sixth in a series of “grand challenges for development” focused on crowdsourcing ideas for better tools to fight the virus. Anyone can contribute to the brainstorm, and the government hopes to begin funding the strongest ideas in a more formal challenge competition “in a matter of weeks.”…
Getting to the other side of this real-time test of our infection prevention and containment abilities at home, the hope is that we will rise to the challenge and become that much stronger as a national healthcare system for having gone through the experience. As Edmond writes in a Controversies in Hospital Infection Prevention post on October 14th, Ebola: The Questions Keep Coming:
…the Ebola crisis is challenging us in many ways and will likely continue to do so for quite some time. But perhaps we’ll emerge from this with a more thoughtful approach to patient care that improves safety without sacrificing quality.
Following are thoughts by guest author, Lynne V. Karanfil, RN, MA, CIC, Corporate Director, Infection Prevention, MedStar Health-Corporate Quality & Safety, Faculty Associate|National Center for Human Factors Engineering in Healthcare
Aye maties! Give me your life!
As folks celebrated Talk Like a Pirate Day on 9/19/13, days earlier the CDC posted their own skull and cross-bones. The pirates here are resistant bacteria causing people to lose their lives at a rate of 23,000 a year in the US. How did we become captured by these pirate bacteria? A picture is truly worth a thousand words. We are getting to a point in time that has been predicted. And its scarier than any pirate!
As Wayne Campbell, MD chief of Infectious Diseases at MedStar Union Memorial so eloquently stated at a recent Board meeting:
The emergence of antibiotic resistant bacteria marches on. The most recent iteration is a bacteria common to all humans, Klebsiella pneumoniae. This bacteria may now carry genetic information that allows it to be resistant to the vast majority of antibiotics, and the few antibiotics that remain active are seriously toxic to human kidneys. We are in a bind to safely treat this common bacteria that has emerged after years of antibiotic bombardment made it an impending threat. No antibiotics are currently in the pipeline to help us, and we will have cases in the future of this bacteria being completely untreatable.
If you ever took only a few days worth of an antibiotic or begged your doctor to give you an antibiotic for a disease that isn’t treated with antibiotics, like the flu, then you need to walk the plank! I admit I am guilty. I wanted to get back to work earlier and asked for antibiotics when probably not needed. I was fortunate not to develop C difficile. C difficile causes unrelenting diarrhea and this bacteria is causing havoc in the US, especially in our hospitals. The other is carbapenem-resistant Enterobacteriaceae (CRE), commonly known as resistant Klebsiella or E coli, as Dr. Campbell discussed.
Taking antibiotics and using proton pump inhibitors (drugs that reduce acid reflux) are some of the contributing factors that are making C difficile more common than Methicillin-resistant Staphylococcus aureus (MRSA), and now considered an urgent threat to public health in the US.
We all need to do our part! Taking antibiotics only when appropriate, completing the prescribed dose and, if experiencing diarrhea after taking an antibiotic, alerting the prescribing doctor are three weapons we can use to beat back these potentially deadly bacteria. For more information on antibiotic resistant threats, click HERE and head to the CDC website.
Following are thoughts on the value of infection control and prevention by guest author, Lynne V. Karanfil, RN, MA, CIC, Corporate Director, Infection Prevention, MedStar Health-Corporate Quality & Safety, Faculty Associate|National Center for Human Factors Engineering in Healthcare
Joint Commission requires every hospital to have an infection control program. Most of those programs are led by an infection preventionist (IP), formerly called an infection control professional. This person is usually a nurse, microbiologist or epidemiologist, and occasionally a physician who has received additional training in preventing infections.
The Association for Professionals in Infection Control and Epidemiology (APIC) has just celebrated its 40th anniversary. During the annual APIC conference in June, leadership recognized the importance of infection control in hospitals in their opening session. Following are a few highlights from the speaker’s presentations. (For more information on APIC, and for a history of infection prevention, click here to visit their website).
CDC’s Dr Arjun Srinivasan, Associate Director for Healthcare Associated Infection Prevention Programs, Division of Healthcare Quality Promotion indicated it is fine to monitor infection rates but asked, “What do the numbers actually mean, and how do we use those numbers to guide change?” He shared that guiding this change usually falls under the role and responsibility of an infection preventionist. He advised the audience that, “This is the time for infection prevention”, and challenged those leading change to move these efforts forward throughout the next decade. He also talked about the value of Antibiotic Stewardship, sharing that we are quickly running out of effective treatments for resistant organisms. Prevention, he shared, is what remains. Prevention is one tool we can always improve upon, and we need to do whatever we can to prevent these multi-drug resistant organisms from causing harm to patients. That we can’t stand by and watch our patients die from infections we can’t treat, especially when they could have been prevented in the first place.
Denise Murphy, RN, MPH, CIC, and Vice President, Quality and Patient Safety Main Line Health System went on to describe the “people bundles” that can help prevent infections. People bundles are safety behaviors and tools that help enforce these prevention efforts, such as:
- Paying attention to detail
- Speaking up for safety
- Stopping the line
- Empowering members to challenge folks when they are not doing the right thing.
To truly prevent adverse events and infection, we need to study what causes people to make errors, or unable to comply with safety guidelines, she emphasized.
So how are we going to make a hospital stay safer for our patients? We need to take responsibility for our own health, all of us whether patient or caregiver. Every healthcare provider needs to own his or her behavior, and speak up for safety when witnessing anything that could endanger a patient. If you as a patient, or healthcare worker, see a provider that fails to wash his or her hands, or practice hand hygiene, say something! Leaders also need to hold staff accountable.
Each hospital needs a champion to lead this work. We can prevent many infections but we need the infrastructure to do this job well. And as Patti Grant RN, BSN, MS, CIC, current APIC President indicated in her speech at the conference in Ft Lauderdale ……the public needs to demand the presence of infection preventionists in hospitals!
From my perspective, we are doing battle today. Our enemy is healthcare associated infections and the organism that cause these infections. Public enemy #1 is C difficile, an easily transmittable organism that causes unrelenting diarrhea. And then there is the resistant bacteria like carbapenem resistant Enterobacteriaceae, most commonly E. coli and K. pneumonia, that have virtually no treatment and a high mortality for bloodstream infections. To do battle you need appropriate resources, which include knowledgeable people and the right equipment. The time is now to arm our healthcare providers with what they need to prevent these infections altogether.