The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit www.apic.org/ambulatorynewsletter. To learn more about APIC, visit www.apic.org.
I'll wager that you've had some pretty amazing experiences in your professional life, right? Like you, I've had the opportunity to participate in and to witness some truly "ah-ha" moments. It's important to recall those past experiences as we accept the new and seemingly ever-changing challenges in our current environment. Here are some of the most pressing roadblocks to infection prevention and a few thoughts that might be helpful as you lead your own organization forward.
1. Apathy within. Lack of senior leader or medical staff involvement in an organization's infection prevention program is a challenge. Just as problematic is the lack of infection prevention awareness of your own non-clinician staff. Why not work with senior leadership and human resources to review your organization's job descriptions, its orientation templates and future training schedules to ensure that each role contains the appropriate infection prevention training and involvement to keep your patients and staff safe?
2. Not using your QI program and its results to lobby for your infection prevention needs. Use a quality improvement (QI) study to provide evidence of improvement in care, to demonstrate financial implications and rewards, and to highlight the direct and indirect "costs" of not being fully engaged in infection prevention. Start small – prioritize your known situations and use your QI program to demonstrate a position or success. Plan carefully on how to present your findings; always have the end goal in mind. Not long ago I witnessed a newly-assigned ambulatory care infection preventionist (IP) successfully use his recent past investigation of an adverse incident to demonstrate the need for an extra hour a week dedicated to the organization's infection prevention program.
3. Lack of knowledge of community, state and federal requirements. There's a lot to do; recruit some help! Prioritize and when it's appropriate, delegate to others, such as to those who are currently uninvolved (Hint – see #1 above). For example, the Occupational Health and Safety Administration's Needlestick Prevention Act is clear in its direction; staff end users should be involved in the annual evaluation of safer devices that might be available. Could a nonclinical staff member assist you in organizing the products to be evaluated that you and your vendor might have identified?
4. Not using local Department of Health resources. In all likelihood, there are various resources available from your local or county Department of Health (DOH). These public servants have knowledge of the overall health status of your community and have ready access to the most current references. Make and retain a networking connection within your local DOH and you'll be better prepared when pertussis or tuberculosis (TB) makes an appearance in your community.
5. Not keeping current on nationally-recognized guidelines and recommended practices. Adopting evidence-based guidelines and recommendations as your organization's own can inform appropriate patient care practices on a daily basis. Take note that guidelines and recommended practices are subject to change as new evidence is made known. Make certain you have an open information pathway to receive notification when updates are issued. Membership in a professional organization such as APIC has many benefits that include keeping abreast of the most current infection prevention guidelines and best practices.
6. Disregard for orientation and training. Whether by overt choice or through error of oversight, orientation and training sometimes are minimized, shortened, or skimmed through. Sometimes those "more experienced" new staff members seem to demonstrate competence and are easily pressed into early duty or seen as ready for full role responsibilities. Have a formal orientation program in place and use testing and task demonstration to move new members through your organization's infection prevention program. If your organization is subject to survey by an accrediting body or a state agency, ensure that initial orientation, annual retraining, and other educational and performance documentation is present and well-organized within each employee's record.
7. Department rounds: Always scheduled or never scheduled? It's a good idea to consider doing both scheduled and nonscheduled department/unit visits. Tuesdays at 2 pm is great, but add in some random walkabouts. While you are visiting and observing, turn the time into a teaching moment by engaging those around you in conversation about what you are observing and why. Here's an interesting tip that was shared with me recently–while performing surveillance activities, an IP used her cell phone camera to gather evidence of overflowing hazardous "red bag" waste and projected that photo image at the following morning's impromptu staff meeting to gain improved compliance.
8. Absent or incomplete monitoring logs. Ensure the equipment you NEED is the equipment you actually HAVE. This is one part of advance planning for a smooth workday. Preventive maintenance and active monitoring of the use, care and condition of your medical devices is paramount to your effort. Create a simple electronic spreadsheet of your equipment, listed vertically, with the days of the month listed horizontally. Review and update the spreadsheet for equipment retired or added. Then print the list once a month, inserting the responsible staff assigned to the task (per day, week or month) to ensure that the equipment is being monitored and any issues relating to equipment are addressed. Or post or circulate the list and allow your staff to self-assign. Remember to delegate when it's appropriate; perhaps with appropriate training, your non-clinical staff could assist with monitoring non-critical logs.
9. The policy is in place, but rarely followed. Most high-performing healthcare organizations perform regularly-scheduled drills. Make those drills pertinent to your unique setting. When a policy is present but seldom is required to be followed, the result may be that staff aren't able to effectively respond when called to action. Consider planning an emergency drill around a scenario that might actually occur. For example, a rare and potentially fatal malignant hyperthermia reaction to a medication unfolds at your ASC. Or a patient arrives with not-yet-diagnosed but now suspected active TB at your community care clinic. In these examples, will your staff know how to respond? Hint –if you previously made that local DOH networking connection (#4), you would know that your communicable disease management policy is current and you would feel confident in helping your staff drill through the scenario of the arrival of that fictitious TB patient.
10. Not making your program interesting, challenging or meaningful. Perhaps one of the biggest challenges today is maintaining one's forward momentum. In the delivery of healthcare services to our patients, many assignments arrive in a sudden and unforeseen manner. Because of this, it may be difficult to remain focused on your program's activities, especially if this infection prevention assignment is new to you or to your organization. Commit to scheduled appointments with yourself so that time is set aside for your important infection prevention work. The infection prevention work you do will make a difference!
The Accreditation Association for Ambulatory Health Care, also known as AAAHC or the Accreditation Association, is a private, non-profit organization formed in 1979. It is the preeminent leader in developing standards to advance and promote patient safety, quality and value for ambulatory healthcare through peer-based accreditation processes, education and research. Accreditation is awarded to organizations that are found to be in compliance with the Accreditation Association standards.
The Accreditation Association currently accredits over 4,600 organizations in a wide variety of ambulatory health care settings, including ambulatory and surgery centers, managed care organizations, as well as Indian and student health centers, among others. With a single focus on the ambulatory care community, the Accreditation Association offers organizations a cost-effective, flexible and collaborative approach to accreditation. Visit www.aaahc.org to learn more.
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