infection prevention
By Sue Barnes , RN , CIC , FAPIC
Infection Prevention , Patient Safety and Quality – Which Came First ?
Over the last 50 years , IP & C has evolved and expanded to become a rigorous , complex and essential clinical profession , often not understood by hospital administrators who tend to position these professionals subordinately to the non-clinical departments of quality or patient safety .
The departments of patient safety , quality and infection prevention and control ( IP & C ) all support optimizing healthcare outcomes and are driven by state and federal regulatory requirements . Safety departments aim to prevent or reduce patient injury and harm . Quality departments aim to increase the use of and adherence to evidence-based practices and to improve efficiency . 1 IP & C is separate from , but supportive of , the objectives of both patient quality and patient safety by reducing the risk and rate of healthcare associated infections and controlling outbreaks of infectious disease . 2 IP & C is a scientific field of clinical practice which is grounded in infectious diseases , epidemiology , and health systems science .
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Which Came First ?
The concept of infection prevention and control came first and can be traced back to the work of Ignaz Semmelweis , an obstetrician in the 1800s who championed the importance of handwashing to prevent puerperal ( childbirth ) fever and the associated high incidence of mortality . Unfortunately , as history asserts , Semmelweis was ridiculed and his germ theory was dismissed . 3 The current-day profession of IP & C is instead based on the work of 19th century scientists such as Pasteur , Lister and Koch , and was recognized as a specialty almost a century later in the 1970s . In its early decades , the evolving specialty was led by registered nurses who still remain the single largest group of clinicians within the profession . 4 Once assumed to be inevitable , clinical research in the area of healthcare-associated infections ( HAIs ) has proven that a significant percentage are preventable .
One of the first studies to prove this was the CDC ’ s Study on the Efficacy of Nosocomial Infection Control ( SENIC ) published in 1985 which estimated that 30 percent to 50 percent of HAIs are preventable with effective infection surveillance and control programs . 5 Over the last 50 years , IP & C has evolved and expanded to become a rigorous , complex and essential clinical profession , often not understood by hospital administrators who tend to position these professionals subordinately to the non-clinical departments of quality or patient safety . In hospitals where they report directly to the C-suite ( chief executive officer , chief medical officer , etc .), they are afforded the support and authority to execute their programs expediently , thereby reducing patient morbidity and mortality . 6 When this is not the case , there is often associated under-market compensation , which in addition to the increasing incidence of retiring experienced IP & C professionals , and the ever increasing burden of data reporting , is resulting in an ongoing exodus of IP & C professionals nationwide . 4 In response , the field of IP & C has opened its doors to individuals with public health and laboratory science backgrounds . However , there is no replacement for the registered nurse who has the training and knowledge of the clinical pathophysiology of infection and the physiological details that reveal the dynamic causes of sentinel HAI and outbreaks . 7
The concept of quality improvement in healthcare was introduced in the early 1900s by Ernest Codman , a surgeon who first pioneered the creation of hospital standards and strategies to assess healthcare outcomes . The modern quality movement has since transformed to include creating practice guidelines in addition to ongoing comprehensive assessment of hospitals and healthcare providers . 8 The current day hospital quality departments are typically well-resourced and well-positioned , often reporting directly to the C-suite . 9
The concept of patient safety in healthcare was sparked in the late 1990s , with publication of the Institute of Medicine ( IOM ) report , “ To Err is Human .” This report estimated that as many as 98,000 patients die from preventable errors in U . S . hospitals annually , a statistic which immediately garnered public and legislative attention . 10 Local and national efforts subsequently began to focus on categories of preventable error such as pressure ulcers , patient falls and medication administration errors . This also rapidly led to development of new patient safety certifications , courses and positions in healthcare .