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Anticipate and prevent

Education plays a big role in the job of nurse epidemiologists in hospitals, too. Joan Golden, RN, CIC, supervises infection control at three hospitals in Provo, Utah.

Her biggest job is to prevent infections that occur after a patient enters the hospital. Hospitals are in a double bind when it comes to infection. Often, patients arrive sick and weak, and once inside the hospital, their bodies are opened up and filled with foreign objects.

All of these factors increase the chance of infection.

Golden examines the numerous processes within the hospital. She compiles statistics, tracks infections, creates policies to prevent infections, and educates staff.

“I think infection control 24-7,” she said. “I am infection control.”

The biggest culprits of infection in a hospital are aspiration, tubing contamination (both caused by the patient’s own body), and the hands of caregivers, she said.

A cluster of infections might point toward hospital procedure as the root of the problem, which leads to “fingerprinting” of the organisms, which may lead to an outbreak investigation.

Sometimes, a source cannot be found, she said.

“Magically, infections go down and you may not be able to determine a cause at all,” she said. Other times, something as simple as contaminated water or a product recall is behind the outbreak.

Golden does not wait for outbreaks to institute infection control measures. She has implemented silver-coated catheter lines to cut down on catheter-associated urinary tract infections. She has encouraged the use of alcohol hand sanitizers and chlorhexidine gluconate for skin prep. She asks health care workers inserting lines to wear masks, as advised by the CDC.

Since the terrorist attacks of 2001, many hospital infection control specialists also have played a role in developing plans for bioterrorist attacks.

Golden works in teams that include employees of state health departments, emergency response services, and other hospitals.

This spring, the local health department will have a mock outbreak of hepatitis A, she said. The hospital will help orchestrate the administration of a real vaccine to see how fast a prophylactic vaccine can be disseminated to the population.

Golden’s nursing background helps her in her job with infection control, she said.

“The nurse is probably more in tune to hospital policy development and compliance,” Golden said. “The physician might be more in tune with a disease and its process.”

Kurth would like to see more programs that educate nurses in epidemiology like the two her university offers. Kurth said the University of Washington is the only program in the country that offers a master’s degree for infectious disease and infection nursing control.

“I think we’re playing catch-up with infrastructure to meet that need,” she said.

The specialty has no formal learning track, and a recent increase in emerging and reemerging infectious diseases will make the field all the more important, Kurth said.

“We need more options for training,” she said. “Infectious diseases are not going away. Nature will keep throwing these things at us.”

Contact Heather World at h_world@yahoo.com.