Infection Preventionist Boot Camp, essentials for the beginner infection preventionist

by Peggy Luebbert, MS, MT(ASCP), CIC, CHSP and Ron Stoker, MS

As the two of us have worked on the Infection Preventionist Boot Camp, we were excited to be able to share the variety of resources available to assist new infection preventionists in their work.

Mentoring

When we asked members of our local chapters of the Association for Professionals in Infection Control and Epidemiology (APIC) what resources they regularly used, one member came up to me and said that the resource she most uses is her mentor! It hit me like a lead balloon about how right she is. The number one best resource you can ever get is to find a good mentor. I would recommend one at your place of employment to help with working through issues specific to your workplace and one in your professional organizations such as your local APIC chapter. Mentoring brings value to everyone involved in its practice: protégés, mentors and the organization(s) for which they work.

Let’s start with some definitions. Protégés have an opportunity to gain wisdom from someone who has traveled the path before them. Mentors have an opportunity to invest themselves in someone who seeks information that they can offer. The organization has the opportunity to share and spread its acquired learning and know-how. In some organizations this is called tribal knowledge—the information is acquired by long-term employees that might not be known by recently joined employees.
In addition to those who are directly involved in its practice, mentoring also helps the community at large because it fosters an environment in which people work together and assist one another in their drive to become better skilled, more intelligent individuals. Together we are all sharing, solving and succeeding.

When I first checked into changing jobs years ago into infection prevention, I called a microbiology friend of mine and picked his brain about the job. He first laughed and said, “are you crazy? You are a chemist, you don’t know the difference between staph and strep and you want to do what?” Ha … but then he said that I would be great at the job since I enjoyed education and motivation and those were two important parts of this job. Since that day, more than 20 years ago, I have regularly called him and shared stories, concerns and issues. He does the same. I teach him what is going on in the nursing units and he keeps me up on the lab activities. It has become a perfect mentoring situation that has turned into a lasting professional relationship.

Finding a good mentor can often be difficult, if not almost impossible as good mentors are normally very good at their work, thus they already have high demands for their skills and time, thus they might be reluctant to take on a new protègè. Yet as the “Levinson’s Eras Model of Adult Development” shows, most want to help as young adults normally seek to establish meaningful relationships, while middle-aged adults want to make an impact on the generation that follows them (Levinson, Darrow, Klein, Levinson, McKee, 1978).

To increase your chances, it sometimes helps to be specific about what you want from a mentor. The more certain you are about your needs, the more likely you will find a mentor to meet those needs. For example, when selecting a mentor it helps to do some probing (pick their brains). Not: “Will you be my mentor?” But rather: “Sue, if you have some time available soon, could you explain to me the difference between colonization and infections?” or “Dan, if you have some spare time, could you explain the …”

Most people, especially those with the instinct to be a mentor, will respond favorably to such requests. In addition, they have probably learned from others, thus will encourage and support others who want to learn from them. If they respond in a favorable manner, then ask another question. This might or might not lead to having that person become your fulltime mentor, but in any case, it will increase your knowledge and skills. Some people might only give a two-minute lecture, but they should be impressed with your curiosity, even if they do not say so.

This targeting of expertise will also guide you toward the specific area or function so that others may possibly help you to identify a potential mentor. In addition, consulting with managers, human resource specialists, and peers can be helpful in identifying a possible mentor.

In addition, once you have gained expertise in one or more areas, then consider returning the favor by mentoring others, even if it is for a short-term special project—for one of the best ways to learn is to teach others.

It is just as important to talk about what your mentor wants and needs from the relationship as it is to discuss your needs as a protégé. Approach that individual and ask if they would consider being your mentor in a specific area of expertise. Depending on the individual, and your current relationship, your proposal will vary in the amount of detail and how it is delivered. At the very least, let them know why you selected them and what you hope to learn from your association with them. If appropriate for the specific individual, you can also discuss the amount of time to be committed and what you will contribute to the relationship.

• Strive for mutual benefits. The relationship should be defined from the beginning as mutually beneficial. Each participant has committed to the relationship by choice. Each should openly share his or her goals for the relationship and work collaboratively to help achieve them.
• Agree on confidentiality. Maintaining an environment of confidentiality is a critical component in building trust between the participants. Without a mutually understood ability to speak freely as the situation warrants, the relationship is unlikely to reach its full potential.
• Commit to honesty. The participants should be willing to candidly share what they expect to gain from the relationship and their vision for getting there. They should be prepared to offer frank feedback as appropriate, even if the feedback is critical.
• Listen and learn. Mutual benefit and honesty can only be achieved when both members feel their viewpoints are heard and respected. Mentors, especially, need to remember that the relationship is not primarily about them. Lead by example. Actions create the most lasting impression.

Each of us can look at our lives and recall people who touched it in meaningful and powerful ways. These people offered us guidance, support, wisdom, a safe haven where we could expose our uncertainties and grow as perpetual learners. These people were our mentors, whether we realized it or not.

You might not be able to find mentors to assist with every conceivable area of expertise. As an organization, the Infection Preventionist Boot Camp has come up with a method to assist our participants with emergency mentoring needs as they arise. We have developed a service for our Boot Camp participants where someone is on call 24/7 to assist with help on a specific problem. We have experts with years of experience who can assist you in working through an emergent situation, or developing a process to handle a new issue or dilemma. Our Master Mind group has areas of expertise include:

• Surveillance;
• Occupational Health;
• Intravenous Lines ( PICCs, Ports, Peripheral, etc.);
• Emergency Preparedness;
• Body Fluid Exposures/Safe Sharps;
• Ambulatory Surgery ;
• Sterilization and Disinfection;
• Microbiology/Lab;
• OSHA;
• Joint Commission.

We have received all kinds of questions through this service—remembering the old adage—no question is a stupid question! People seem to like this service since the Master Minds are unbiased and have no relationship with your facility or leadership. We also will have a regular newsletter addressing some of the common questions asked by participants.

Examples of the types of questions that we receive include:

• I just had a patient get stuck with a sharp from an insulin pen that had been used on another patient who is now dismissed. How do I manage this since the source is another patient?
• The practice we are using for transporting “Contact Isolation patients” to X-Ray is cumbersome from the PPE perspective. What is a good way to manage this?

Professional Organizations

Let’s move on to the next set of resources. There are many professional organizations or agencies that have excellent resources to call upon. In this article we will not address accrediting or inspecting agencies. Groups such as the Joint commission, OSHA and CMS deserve their very own articles later in this series.

Association for Professionals in Infection Control and Epidemiology

If we are going to start focusing on professional organizations then we need to start with our own … APIC! Both the national organization as well as your local chapters has to be on the top of your resource shelf for the new IP. On the national level, not only do they educate us with their wonderful regular webinars but they regularly produce evidence-based white papers that assist with specific endeavors. Spend some time each week when you first start discovering their Web sites, products and assistance with regulatory agencies. If you go to apic.org/store there is a listing of products and books that are available. I can’t forget the monthly journal that you can receive as an APIC member. Make sure that you check out all of the excellent evidence-based studies and data.

American Journal of Infection Control

Along with APIC another great source of information is from SHEA, the Society for Healthcare Epidemiology of America. Most infectious disease physicians belong to this group; and some infection preventionists. Even if you don’t belong, it is a great place to find evidence-based guidelines. If you go to their Web site http://www.shea-online.org/ you will note on the left hand side of the Web page a number of good areas to look at including the evidence-based guidelines and the new Compendium of Strategies to Prevent HAIs. SHEA produces the Infection Control and Hospital Epidemiology or what we commonly call ICHE.

Specialty Organizations

There are many specialty organizations that you should participate with including:

• AORN (Association of periOperative Registered Nurses);
• ISIPS  (International Sharps Injury Prevention Society);
• INS ( Infusion Nurses Society);
• ISID ( International Society for Infectious Disease);
• American Thoracic Society (ATS).

We do want to mention a few of these organizations in a little more detail. The Infusion Nurses Society has active local chapters in many states. It is a good inexpensive group to join to keep up with new standards in infusion care. They produce two products of interest for infection preventionist—their Infusion Nursing Standards of Practice and Policies and Procedures for Infusion Nursing to meet these standards. These are two more books of standards that should be on your first shelf of resources.

Infusion Nursing Standards of Practice covers the following areas:

• Nursing Practice;
• Patient Care;
• Documentation;
• Infection and Safety Compliance;
• Infusion Equipment;
• Site Selection and Device Placement;
• Access Device;
• Infusion-related Complications;
• Nonvascular Access Devices;
• Infusion therapies.

Policies and Procedures for Infusion Nursing covers the following areas:

• Patient Care;
• Document;
• IP and Safety;
• Infusion Equipment;
• Site Selection and Catheter Placement;
• Vascular Access Devices;
• Site Care and Maintenance;
• Infusion Related Complications;
• Nursing Interventions;
• Non Vascular Access Devices;
• Infusion Therapies;
• Neonate and Pediatric Infusion Therapy.

International Society for Infectious Disease

Another great organization to assist you would include  the International Society for Infectious Disease (ISID) http://www.isid.org/.

ISID is a good way to keep up with the global issues associated with infections. They have membership again available and also some mailings and blogs that you can participate in without being a member. One e-mail blog I review everyday deals with worldwide outbreaks.

• Membership;
• Register for mailings;
• ProMed Blog at www.promedmail.org/pls/apex/f?p=2400:1000. This outbreak e-mail describes short and sweet some of the outbreaks that are occurring throughout the world. For example, last May there was Ebola virus in bats in Spain and avian influenza in humans in Indonesia. If you think you are having a bad day just read one or two of these summaries and you will instantly feel better!

Occupational Safety and Health Administration

The Occupational Safety and Health Administration (OSHA) is in the business of protecting employees (www.osha.gov). Although we struggle sometimes with all the OSHA requirements, they really are in the business of protecting employees. They also have lots of information for new infection preventionists to help them get started in protecting their employees. One educational avenue is what they call their “fact sheets.” These are basic—easy to read explanations of what is expected from their laws. We will talk a lot more about OSHA and other regulatory agencies an upcoming article on inspections and accreditations.

Agency for Healthcare Research and Quality

Some of the areas that the Agency for Health Research and Quality (AHRQ),

www.ahrq.gov, focus on include the following.

• Evidence-based Practice: including scientific reviews, evidence reports, centers and topics, methodology.
• Outcomes and Effectiveness: medical treatment findings, pharmaceutical therapy, outcomes research.
• Effective Health Care Comparative: clinical effectiveness, pharmaceuticals, devices, healthcare services, consumer and stakeholder input.
• Technology Assessment: new technology reviews, risks and benefits, clinical effectiveness.
• Preventive Services: U.S. Preventive Services Task Force, put prevention into practice screening, counseling, immunizations, chemoprevention.
• Clinical Practice Guidelines: current and archived Clinical Practice Guidelines, beta blockers practice advisory, treating tobacco use and dependence.
• National Guideline Clearinghouse™: comprehensive database of evidence-based clinical practice guidelines and related documents with syntheses and comparisons.

FDA Recalls

The Federal Drug Administration (FDA) Web site, www.fda.gov/Safety/Recalls/default.htm,

includes the most significant product actions over the last five years based on the extent of distribution and the degree of health risk. In this section, you will find a listing of FDA and industry press releases regarding the product recalls.

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) has many wonderful resources that can be used by infection preventionist (www.CDC.gov) including:

• Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis;
• Guidelines for Environmental Infection Control Healthcare Facilities;
• Guidelines for the Prevention of Intravascular Device Related Infections;
• Guideline for Prevention of Surgical Site Infection.

In addition the CDC publishes each week their Morbidity and Mortality Weekly Report (MMWR). It is available on the Web or in hard copy.  It is usually an update on new strategies, new guidelines or a summary of a recent outbreak that the CDC has investigated. It is another great method to keep up on CDC’s activities (www.cdc.gov/mmwr).

National Healthcare Safety Network

The National Healthcare Safety Network (NHSN) is an organization that started a few years ago as “NNIS”  to assist in developing infection definitions and to help benchmark rates of infections based upon a variety of risk factors. Facilities belong to NHSN and submit specific data appropriate for their sites.

Today, NHSN produces an annual data summary that is published by APIC. This summary notes the appropriate definitions today and benchmarks for many, many types of infections.

These are just a few of the many resources available to infection preventionists. In our next article we’ll cover many additional resources.

Peggy Prinz Luebbert, MS, MT(ASCP), CIC, CHSP, is the owner and consultant for Healthcare Interventions Inc., Omaha, Neb. Luebbert, a medical technologist with a master’s degree in pathology, has worked in infection control for more than 20 years, and has published and lectured extensively on a national level. She is certified in infection control and healthcare safety. Most recently, Ms. Luebbert authored the “Third Edition of the Infection Control Compliance Guide.” She is a founder and lecturer for the Infection Preventionist Boot Camp.

Ron Stoker, MS, is the executive director of the International Sharps Injury Prevention Society (ISIPS). He has 29 years experience in the medical device industry as a researcher, marketer, educator, consultant and healthcare worker advocate. He has written more than 200 medical journal articles, primarily on sharps injury prevention, infection control, and hand hygiene. Mr. Stoker has his BS in Pre-Medical Zoology from Brigham Young University, an MS in Bioengineering from the University of Utah and an “honorary doctorate” from the school of hard-knocks. As a result of a surgical mishap he was rendered a quadriplegic in December 2006. Informed that he would never walk again, with tenacity and a “supportive and mean wife,” Mr. Stoker taught himself how to walk again. He says that he walks like an “alcoholic” but is really just a recovering quadriplegic! Mr. Stoker has conducted workshops and Congresses on sharps safety at national and international meetings for the last 10 years. He is a founder and lecturer for the Infection Preventionist Boot Camp Series. For more information contact Mr. Stoker at info@isips.org.