Hospital epi weathers challenge of change
'Our demise has been highly exaggerated'
With recession-driven budget cuts being only the latest example, the field of hospital epidemiology and infection prevention has faced numerous threats and ominous predictions of its impending doom.
"Every time someone has predicted it would be buried because of CQI, safety, or you name it, something has come along to resurrect it," says William Scheckler, MD, hospital epidemiologist emeritus at St. Mary's Hospital in Madison, WI. "I agree with Mark Twain that the story of our demise has been highly exaggerated."
We caught up with one of the true pioneers in hospital epidemiology at his home in Door County WI, where he has been involved in a project taking the oral histories of elderly people who lived in the area long before it became "the Cape Cod of Wisconsin."
Having retired at the end of 2008, Scheckler has been involved in infection prevention in one way or another since its inception. He was the fourth officer appointed to the Epidemic Intelligence Service, serving from 1968-1970 when the Centers for Disease Control and Prevention first founded the "gumshoe" squad that is now famous for its outbreak detections.
From punch cards to Internet
Scheckler also was one of the founders of the CDC's first infection surveillance program, the old "NNIS" system that has now morphed into the National Healthcare Safety Network (NHSN). The NHSN — an Internet-based surveillance system that is increasingly being used for state infection reporting laws — has fairly humble origins.
"We started the NNIS program back in 1969, and the first publication of the data collected from the voluntary hospitals was in January of 1970," he recalls. "We had hospitals sending their infection control data on [paper] line- listing forms. We converted them to IBM punch cards."
The computer has revolutionized surveillance, but there still are lingering problems with matching apples to apples.
"The only way a hospital will be able to compare its own data (over time) — and certainly the only way to compare it to any other hospital — is to make absolutely sure and verify that they are using the same definitions for numerators and denominators," he says. "That's where it gets sticky."
After spending a long career in hospital epidemiology, he sees signs that the field could finally reach its full potential amid a national chorus of outcries to prevent health care- associated infections.
"The golden era will be if the federal government ever really uses the money — which it now looks like it might — to enhance infection control and prevention around the country," he says, "and to support research on what works and what doesn't."
Whether it's the frightening early days of the AIDS epidemic or the first pandemic flu outbreak in four decades, infectious disease events have a way of plunging infection prevention into sudden significance.
"One of the most striking things was the anthrax attack in October 2001 right after 9/11," he says. "Then we had all the national concern about bioterrorism."
Only two years later, SARS swept out of Asia and took the lives of Canadian health care workers treating infected patients. "That's when our colleagues in Toronto told us the biggest problem they had was an insufficient number of physicians and nurses with training in hospital epidemiology and infection prevention," he notes.
Such events have highlighted the importance of health care epidemiology, but also added accumulating responsibilities that make the day-to-day job increasingly challenging. Then comes the latest threat, with this year's version the much anticipated return of H1N1 influenza A.
"Nobody really knows what's going to happen this fall," he says.
With recession-driven budget cuts being only the latest example, the field of hospital epidemiology and infection prevention has faced numerous threats and ominous predictions of its impending doom.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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