“I really fell in love with it,” she says. “There are so many different things involved in it. One of my favorite parts is the disease-detective side.”
In that regard, early in her career, Jackson and colleagues solved a Burkholderia cepacia outbreak that led to the national recall of a contaminated product.
“We knew that it was probably a water source, and we were looking for weeks to try to determine where it was coming from,” she says.
Meetings with bedside caregivers and emergency department workers eventually revealed that a new sublingual probe product shipped in non-sterile saline was contaminated by B. cepacia. “Initial investigation by the hospital’s infection control team revealed that nearly all of the patients had been exposed to a sublingual probe indicated for use for monitoring tissue carbon dioxide levels,” the Centers for Disease Control and Prevention reported at the time.1 “Cultures of the buffered saline solution from at least two lots of unopened probes yielded B. cepacia and other gram-negative rods. The manufacturer has issued a voluntary recall.”
Hospital Infection Control & Prevention (HIC) asked Jackson to tell us a little more about herself and the challenges facing infection control in the following interview, which has been edited for length and clarity.
HIC: The APIC conference is coming up on June 26-28 in Orlando as we do this interview. The new president usually gives an opening speech about issues and opportunities. Not to steal your own thunder, but what do you see APIC facing in the near term?
Jackson: I think really one of the very biggest challenges that APIC is addressing is the aging workforce. In our 2020 MEGA survey data, about 66% of the respondents were 46 years of age or older. In addition, 40% were at retirement age, or will be at retirement age in 10 years. In APIC’s strategic plan, we’re really addressing this — what are we going to do to get more people involved? How are we going to retain them?
We’re doing a lot of work on an academic pathway so that people don’t find us by accident, but that they purposefully find us. We’ve already completed an accelerated internship program guide that will help employers to rapidly prepare new infection preventionists. We’re identifying content to go into a master’s degree program. We’re looking at ways to retain talent and establish mentorship programs.
HIC: In this process, there has been some movement to seek out greater racial diversity and draw from non-traditional academic backgrounds.
Jackson: Yes, we know that we’re not a very diverse population. We’re mostly female, non-Hispanic whites with a nursing background. There are other backgrounds that make great infection preventionists. This includes those with a master’s in public health, the microbiology folks, and the med techs. Those are all people who make great infection preventionists. We are working on this whole academic pathway so that people will purposefully find us.
HIC: Another part of this is APIC’s ongoing effort to get the Department of Labor (DOL) to officially recognize infection preventionist as a job and give it some identifying code in all its reports and data.
Jackson: We’re trying to work with the DOL to just even recognize that we exist. I think that will help us with establishing some apprenticeship programs. But to be a recognized apprenticeship program, we need to be in the DOL book. But we’re hopeful because the DOL has assigned someone to us to work on an infection preventionist job category.
HIC: Nurse and healthcare staffing has been a huge issue of late. If you have chronic staff shortages, what does that look like from an infection control standpoint? Are healthcare workers less likely to wash their hands appropriately or to break other infection prevention protocols?
Jackson: Yes, we published a study on that in the American Journal of Infection Control (AJIC) about 10 years ago, by Cimiotti et al.2 They looked at healthcare-associated infection (HAI) data in Pennsylvania, where you have to report almost everything. They looked at the infection data and staffing of hospitals, and did a survey of nurses looking at burnout. In this work, they definitely found an association between nurse staffing and HAIs. There were fewer infections in hospitals where nurses had less patients. Nurse burnout was higher in nurses with heavier caseloads. Those with high burnout may not do hand hygiene and the infection prevention practices like we want them to.
HIC: You worked in some large hospitals; what led to you taking a job as the sole infection preventionist in a small hospital?
Jackson: Partly, this was a little bit selfish in nature, because I can drive out of my garage and be sitting at my desk in nine minutes. I’m more toward the end of my career than the beginning of my career, and that short commute was really appealing. There are certainly things that I love about a small community hospital. I love the small-town feel. It’s also a place where I really feel like I can significantly help them in preventing HAIs.
What’s challenging is trying to do the same things with less resources and less sophistication. It takes me longer to do things because I don’t have a sophisticated electronic medical record where I can search for things easily and spit out reports. The data mining is only as good as the sophistication of the electronic medical record in the beginning, so there’s still a lot of things that I can’t do. I can’t collect reliable denominator information, for instance, on central lines and urinary catheters. Some may think it’s just a small hospital and the patients aren’t as sick, and that is true. But it just takes longer to do tasks because of just the lack of automation, lack of resources, things like that.
HIC: How does this job, dealing mainly with adult patients, differ from pediatric infection control? There is that adage “children are not little adults.”
Jackson: That’s exactly what I was going to say, but some of the principles are the same — the evidence-based bundles are pretty much the same. Some of the things that do make it different is that you are — much more so than in adult hospitals — incorporating the whole family into care plans. With a kid in the hospital, most of the time, the parent is not going to leave. So, you have to consider that in all of your prevention efforts.
[Pediatric patients] are not very good at containing secretions, which makes it difficult. We have playrooms where kids can go, which call for their own unique set of infection prevention strategies. There are a lot of unique things that don’t happen in an adult hospital.
REFERENCES
- Centers for Disease Control and Prevention. Notice to readers: Nosocomial Burkholderia cepacia infections associated with exposure to sublingual probes – Texas, 2004. MMWR Morb Mortal Wkly Rep 2004;53:796.
- Cimiotti JP, Aiken LH, Sloane EM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control 2012;40:486-490.
The president of the Association for Professionals in Infection Control and Epidemiology usually is not tapped from a small community hospital. But Pat Jackson, RN, BSN, CIC, FAPIC, has no lack of experience nor expertise.
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