It’s chaotic, disorderly – and almost impossible to see if something is going wrong.
Now, picture that same pool with eight separate swimming lanes. Everyone is swimming inside the lanes, heading in the same direction and at similar speeds. It’s systematic, methodical. When one person starts swimming in the wrong direction, it’s easier to detect the deviation.
That’s how Tiana Wells describes her job. She’s the lead infection preventionist for the University of Minnesota Medical Center (M Health). Her days are spent preventing, investigating and managing the spread of infections within the health care setting. She puts infection prevention best practices – or swim lanes – in place, so that everyone in the system can follow the same guidelines, from physicians and nurses to cleaning staff and sterilization teams. Her goal? To advance patient safety, improve outcomes and save health care dollars.
Health care-associated infections (HAIs) are a big deal. In fact, HAIs are the most frequent adverse event in health care delivery worldwide, according to the World Health Organization. They can affect patients in any type of setting where they receive care and can also appear after the patient’s been discharged – and they’re often preventable. Types of HAIs can include central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections.
That’s why the job of the infection preventionist is so vital. They perform surveillance for patients with HAIs and promptly implement isolation precautions and manage outbreaks. They monitor infection prevention and control procedures for hospital staff and administration, implement hand-hygiene programs, outline best practices and monitor overall compliance.
The specialty has been around for a long time, and for years, the role was referred to as “infection control professional.” In an effort to elevate this important profession, the title was officially changed to "infection preventionist" in 2008. And with a rising global trend toward preventative care, the role of an infection preventionist is becoming better known.
Tiana didn’t know the role of infection preventionist even existed until she was several years into her career as an operating room and recovery nurse at a different facility. She recalls a woman coming into the operating room with a clipboard and announcing she was there to do an audit on uniforms. “She began telling us that we should be wearing a jacket, and that we can’t wear earrings,” Tiana says. “We all knew that stuff, but no one really held us accountable for it. She told us she’d be back the next day to do hand-hygiene audits, and I immediately wanted to find out more about her job.”
Tiana learned the woman was filling in temporarily for an open infection control nurse position at the hospital. She told Tiana this person is really the hospital system’s detective – someone who looks at a lot of data and works closely with clinical and frontline staff to make sure everyone is doing the right thing to help keep patients safe.
The woman took note of Tiana’s sincere interest in and passion for patient safety protocols and encouraged her to apply for the position. Tiana did, and she got the job.
“She became my mentor and worked side-by-side with me for the next three months,” says Tiana. “She introduced me to the Association for Professionals in Infection Control and Epidemiology (APIC). I took an intensive course on infection prevention, and then I went on to get my board certification – and I’ve been putting my detective skills to work ever since.”
Surveillance of HAIs is the foundation of an infection prevention program, so analyzing and deciphering data is a significant part of Tiana’s day-to-day job. Twenty years ago, infection control professionals would manually go through hundreds of paper lab reports looking for positive cultures to track down the source of an infection. Today, automated surveillance technologies – including data mining and query-based data management – are an essential part of infection prevention activities.
“Software is getting so smart,” says Tiana. “We can tell the system which bad pathogens we want to monitor, and it’s able to pull only the positive cultures with the positive results we want. We are then able to pick up on the slight little deviations or details from the data and identify risks to patients and employees.”
After performing surveillance and monitoring data, making the rounds is Tiana’s top priority. Talking to her staff, engaging with them and finding out what they’re seeing on the frontlines is a fundamental part of her day-to-day job.
Tiana says that a good infection preventionist is rarely at her desk. She does a number of audits at the bedside, in the clinics or in the operating room. At the bedside, she makes sure staff is properly pre-cleaning equipment and audits the cleaning processes. In the operating room, she monitors for cleanliness, hand hygiene and uniform compliance. She examines the rooms where patient equipment and supplies are stored and ensures the clean and dirty equipment are not co-mingling, and she consults on safe injection practices.
“Creating a relationship with our staff and building trust is hugely important in this role,” Tiana says. “I’m not here to tell them how to do their jobs. I’m here to put forward some best practices and help them do their jobs better and more safely – to give them tools and resources that arm them with success.”
Being able to make a change in the frontline staff’s workflow to increase safety for the patient or employee is the impact Tiana sets out to make in her work every single day.
“The work of the frontline staff is not glamorous – they are busting their butts every single day, and then I come in and ask them to add five steps to the process,” says Tiana. “So, I acknowledge that it’s hard, and I assure them that we’re going to make it better, that we’re going to improve patient safety, and we’re going to do it together. When I see a true partnership being built between us, and I know I’m helping to make a difference in patient safety at the frontline staff level, that’s my best day.”
Interested in learning more about the whats, hows and whys of hand hygiene? Check out the resources under Hand Hygiene Links.