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For your next career move, why not infection control?

For your next career move, why not infection control?

Laboratory reports of methicillin-resistant Staphylococcus aureus, urine colony counts above 100,000/ml, and gram-negative diplococci in cerebrospinal fluid smears share a common denominator --all send up red flags in the mind of an infection control practitioner. This hospital position, which requires much of the same training received by medical technologists, particularly microbiologists, is an advantageous job choice for lab professionals interested in a change of pace.

It is surprising that more laboratorians don't choose to further their careers by entering this relatively new field. In addition to heading an infection control department, earning respectable wages, and keeping regular hours, they would discover a unique way to use their intellect and powers of deduction.

The duties of a hospital ICP, sometimes called an epidemiologist, are extensive. Tracking the source of a cluster of wound infections, spotting a communicable disease before a patient spreads it throughout a unit, and convincing physicians that hand-washing rules apply to them too are just a few examples of the matters and ICP disposes of on any given day.

An infection control practitioner is responsible for monitoring policies and procedures that reduce nosocomial, or hospital-acquired, infections; infection surveillance; reporting communicable diseases to local health officials; employee education; helping to select disinfectants and patient care items; and consulting with the employee health staff to keep hospital workers safe from illness.

Depending on the type of hospital, and average of 2 to 10 per cent of patients will develop an infection they didn't have when they were admitted, and about 6 per cent of them will die as a direct or indirect result. Because of the extent of morbidity, mortality, and expense caused by nosocomial diseases, accrediting agencies require hospitals to have one or more persons in charge of controlling the spread of infection.

About 80 per cent of my work as infection control coordinator at our 524-bed hospital is dedicated to keeping nosocomial disease in check. I am responsible for seeing that patients are in isolation when they should be. I check charts to see if infections are the result of hospitalization and then determine how the infection could have been prevented. I log these observations to construct reports on rates of infection. I try to visit every nursing unit every day, so if personnel have questions I can give them answers or suggestions.

An infection control department can range from one employee, as in my case, to several employees. Others in the hospital support my efforts through membership on the infection control committee, which has representatives from every medical specialty, nursing, nursing quality assurance, risk management, the laboratory, pharmacy, the operating room, and administration.

This committee sets policy and monitors our infection control program. It consults with various hospital departments, such as housekeeping or central services, as the need arises. In addition, physician members can intervene more effectively than I when one of their colleagues creates infection control problems.

All of the hospital's 1,450 employees must receive in-service training on infection control once a year. This is an important aspect of my job. I schedule different lectures for different departments and constantly update employee infection control manuals. Sometimes I also address groups outside the hospital.

Nursing is the traditional route to an ICP job, but laboratorians have successfully bridged the gap between detecting the source of infection at the bench and controlling it throughout the hospital. Since nurses were often the first to recognize the onset of surgical wound infections, pneumonia, or cystitis in their patients and were knowledgeable about the various types of equipment causing many problems, it was natural that they would be in the forefront of disease surveillance. However, with the advent of multiply resistant bacteria, sophisticated serological tests, computerized culture reports, and a mind-boggling array of new antimicrobials, laboratory experience is becoming a definite advantage for infection control personnel.

A microbiology background is desirable. Because of the need to discharge patients more quickly under prospective payment, most infections are cultured. Familiarity with microbiology reports and their interpretation make the ICP's job easier. One of several ways ICPs determine the onset of nosocomial infections in patients is by monitoring culture reports and correlating them with the clinical findings documented by a physician or nurse.

If you are seriously considering a career move and want a post in which your laboratory training and abilities can be used to the fullest extent, infection control may be a logical choice. However, as with any profession, you should possess certain attributes to assure your place as a viable candidate when an infection control opening occurs. From personal experience as a microbiologist who became our hospital's first infection control coordinator, I will outline the three Cs that can help you qualify: classwork, cooperation, and curiosity.

Classwork. Laboratory knowledge, while helpful, is not enough. To be a successful infection control practitioner, you must know about patient care practices, risk factors for patients, disinfection, operating room techniques, respiratory care equipment, reservoirs of infecting agents, and how the hospital's infection control committee functions. The better your foundation in all of these areas, the better your chances of landing the job.

To become a certified ICP, you must work in an infection control capacity for two years, have a degree in one of several sciences, and pass a comprehensive examination given by the certifying board of the Association for Practitioners in Infection Control.

Most long-term practitioners had to learn on the job, often with only a Centers for Disease Control manual as a guide and the Joint Commission on Accreditation of Hospitals inspection as a goad. Even today, unless you have trained in nursing, learning about patient care methods that contribute to infection development will be part of on-the-job training-- you will have to ask questions and absorb as much as you can.

If you don't already know these things, you will quickly learn that a balloon is more likely to be in a patient's bladder than decorating his room, that IV is not always a Roman numeral four, and that housekeepers don't use J-vacs to clean the carpet. The names Foley, Swan-Ganz, Broviac, and Hickman--all types of catheters --will soon be as familiar as Gram or Wright are to laboratory employees.

Sometimes I have to go to nurses and ask again how a particular piece of equipment works. But by doing this I learn what can go wrong and how medical devices can provide ports of entry for bacteria.

Although there are few college courses in infection control, alternative training is available. Most large communities have organizations of hospital epidemiologists whose members share problems and solutions. Many groups are affiliated with the APIC, which was founded in 1972 and now has a membership of more than 7,000. The association sponsors an annual weeklong educational seminar as well as area workshops that are held throughout the year.

Other programs may be sponsored by pharmaceutical firms or disinfectant manufacturers. Some of these are free, but even on your own time and at your own expense, you should attend as many sessions as you can.

And read, read, read! This relatively young field has a surprising number of specialty publications. APIC membership includes a subscription to the American Journal of Infection Control. Other pertinent material may be obtained from medical libraries or directly from the Centers for Disease Control. Some textbooks have chapters on controlling infections in hospitals.

And don't forget the lab journals. It is very important to keep up with clinical lab advances, especially in microbiology and serology. You don't want to lose lab skills; they are the tools that will aid you in your career change.

A working knowledge of statistics may give you the edge over many competitors for an epidemiology position. An ICP must produce reports about infection rates using such parameters as patient profiles or patient discharges.

Occasionally you will conduct a special study on patient risk factors or the onset of a certain type of disease, such as urinary tract infections. You will look at patients with Foley (urinary) catheters who developed urinary tract infections, as opposed to patients with UTI who didn't have catheters. Knowing how to use computers to compile statistical reports is another useful skill.

Cooperation. Although an ICP may constitute a one-person department, his or her effectiveness depends on the cooperation of all other employees in the hospital. Begin now, while you are still in the laboratory, to overcome the antagonistic "them' versus "us' attitude that often characterizes relations between lab and nursing personnel.

Be friendly on the phone and in person whenever you talk with nurses. Be helpful when they are in your territory, even if they are seeking a patient's gallstones in the chemistry department or demanding the culture results of a specimen sent down just 20 minutes ago.

Someday, if things go as planned, you may be in their unit seeking information about a patient's pneumonia, and you will want them to remember you with fondness. Nurses who have been treated kindly by you may even volunteer otherwise hard-to-get information: a report on an unsuspected surgical wound infection, for example.

Physicians are another valuable source of information. Ask the ones who come to the lab seeking test results how your findings will aid in diagnosis.

Report significant data quickly. The salmonella report that is called in time may save a patient with abdominal pain from undergoing a barium enema or colonoscopy. Your cooperation at this time may insure help from physicians when you become an epidemiologist.

Become active in hospital affairs, volunteer for committees, and get yourself noticed. Being a member of the infection control committee can be especially helpful. Because a representative from microbiology is required, ask for the assignment if you qualify.

Routine environmental culturing is not recommended these days, but sometimes special studies are required, and your expertise will be valuable to the infection control committee. Such assistance will help make your name familiar when a vacancy occurs in the infection control department.

Don't forget other employees. Controlling the spread of infections requires everyone's cooperation, from the hospital president to the trash collector. A sincere smile and friendly greeting will brighten their day and possibly your future.

Curiosity. The third C, curiosity, is imperative. If you have no interest in test results other than sending them out as quickly as possible so you can get to a coffee break, infection control may not be for you.

An effective ICP must wonder and analyze: What is the significance of resistant Proteus rettgeri in the catheterized urines of two men who shared a room on the urology floor? Whenever you see a strange organism in two patients in the same hospital area, it's time to investigate. Perhaps a nurse taking care of a patient with a Foley catheter inadvertently contaminated the Foley catheter of another patient, thereby transferring the infection. Perhaps both men were residents of a nursing home where this organism was prevalent. Resistant strains build up over time, and these organisms frequently develop in nursing home and other long-term patients, such as quadriplegics or paraplegics who have indwelling catheters.

If you have ever wondered enough about a strange result or an unusual order to find out more, you have the makings of an epidemiologist. Begin now to notice the unusual, to question, and to seek answers.

Once you have culivated the three Cs and your plans to become an ICP come to pass, your chain of command will change. Instead of reporting to the laboratory director, you may report to the director of nursing or of quality assurance. Better yet, your boss may be the hospital administrator, which helps when you need more money in your budget or someone to stand up to a recalcitrant department head who is violating infection control policy.

Don't, of course, sever ties to the laboratory and your former co-workers. Now more than ever, you will need to know overall findings on a specimen from all lab sections. I have a computer link with the laboratory, which makes it easier to assemble data for my reports. I can learn what specimens came in yesterday and what cultures have grown today.

In return for their assistance, you can tell your laboratory friends the significance of their findings in relation to the clinical condition of patients. What was formerly a tube of blood, a brown urine sample, or an unsavory-looking swab takes on new meaning when associated with a desperately ill patient whose recovery depends on accurate and timely lab results.

In infection control, you have hands-on control. If something's really wrong, you can direct a change, with the help of the infection control committee. You can make a definite difference in medical care.
COPYRIGHT 1987 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Title Annotation:epidemiologists
Author:Howie, Joan
Publication:Medical Laboratory Observer
Date:Aug 1, 1987
Words:2121
Previous Article:How to become a better agent for change.
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