Alicia Cole will be the opening speaker at APIC 2018. What was supposed to be a two-day hospital stay for her in 2006, rapidly descended into a two-month battle to save her life from the ravages of severe sepsis and necrotizing fasciitis. Since then, she has fought for system-wide improvement by serving on the California Department of Public Health’s (CDPH) Healthcare-Associated Infection Advisory Committee, and is serving a four-year term on the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB). Her incredible healthcare odyssey is a 10-year case study of the state of healthcare, healthcare-associated infections (HAIs), and patient safety. Prevention Strategist recently spoke with Alicia Cole, who offered a sneak peek of what she plans to discuss during her presentation.
Q: Can you give us a preview of what you will be sharing during your talk at APIC’s Annual Conference?
I’m very excited to be at this year’s APIC conference! The work being done by your membership is so crucial. I’ve experienced care that is the absolute model for what ‘not’ to do if you want a positive outcome: Poorly designed rooms, which unintentionally discourage proper hand hygiene, poor communication between team members, and hospital culture that did not place infection prevention at the top of its priority list. But, I’ve also seen the beauty when great care meets attention to detail, and it’s all wrapped in a palpable commitment to infection prevention and control (IPC). Patients see it. They feel it. This is the case at places like Pacific Hospital of Long Beach, under the leadership of Dr. Alfonso Torres-Cook, or the Ohio Health Bone and Joint Center at Grant Hospital with their awesome team of nurses.
The consistent difference in the experience of outcomes and the quality of care has always been that wherever there was excellence, someone stepped forward and took the lead. Someone — a nurse, the wound care specialist, the hospitalist — led by example, showing that on their shift, in their ward, on their floor, they would not accept anything less than everyone’s absolute best for the patient. It wasn’t always those in traditional leadership roles; in most cases it was the respected co-worker with the infectious passion that instantly transforms the atmosphere.
I think the most important thing I can share is my story and my experience. As a two-time survivor of sepsis and necrotizing fasciitis, with more than 10 years of almost weekly medical treatments, the challenge will be narrowing down what to say. I hope I might inspire those whose life’s work is preventing infections and who know how to do it better than anyone in the facility to “take the lead.” Now more than ever, patients need you!
Q: You got into this field because of your experience as a patient; can you walk us through your journey?
I consider myself a sort of “accidental advocate.” It wasn’t something that I planned or even knew existed. On my bedridden days, I couldn’t sit up at the computer, so on a whim, I ordered a ‘talk-to-type’ program and, laying there with a headset, began blogging and using social media to share my road to recovery with others. I taught myself how to use editing software and began making videos to document the struggles of affected patients.
In just a few months, the MySpace group I created for survivors and families touched by hospital infections and medical errors grew to over 2,500 people. Suddenly, established healthcare organizations from across the country began calling to ask about my “organization!” The defining moment came when I received a call from the Consumers Union Safe Patient Project inviting me as one of their “Power 50” advocates to attend a Patient Safety Summit and Advocates Training. I took a suitcase full of wound care supplies, they flew my sister along to take care of me and a wheelchair per my doctor’s orders. It changed my life! I’d found a family of people who like me were trying to make lemonade out of the worst lemons ever. I learned about advocacy, healthcare policy, and infections 101. I left there knowing that this was my new calling. It was the very reason that God saved me, so that I could use what I’d lived and learned to help save others. As soon as I was well enough, I began going to medical schools and nursing programs to share my story and evangelize for infection prevention.
Q: What did you learn early on that surprised you?
Initially, the sheer numbers and the magnitude of HAIs. I had no idea. Prior to my hospitalization in 2006, I’d never really had any medical care other than my yearly women’s exam. In my ignorance, I just assumed that infections only happened to people who did not keep their cuts and scrapes clean.
It shook me to my core to learn that more than two million other patients in the U.S. had suffered from an agonizing HAI that year, just like me. I realized that they may not all have been as debilitating as mine, but there is no such thing as a non-terrifying infection to a patient who didn’t have it as part of his or her original condition when they entered the hospital. Even more sobering was learning that more than 100,000 of them would not survive. When I began to meet other advocates, I often had a great deal of survivor’s guilt because many of their loved ones who died had fewer infections than me, but their body just couldn’t fight it off. I was filled with both great gratitude and sorrow.
The more I learned, the more I also became filled with great anger and disappointment. (Only 1 in 4 providers washes their hands between patients!?) Then, my hospital was cited by the local health department for not reporting my infection to them as mandated by law. When CDPH reviewed the records from the Infectious Disease Department, my infection was not recorded in any of their statistics or documents. It was not discussed on the agenda of any department meetings for the entire two months of my inpatient stay — a fact I find all the more appalling given that one of those months was spent in intensive care, fighting for my life! My infection simply did not exist. I was horrified! Seven surgeries, nine blood transfusions, nine of the strongest antibiotics on the market, almost having my leg amputated, and the people I trusted as my team, memorialized it with invisible ink.
I knew that if this could happen to me that there must be others who also were not counted. W. Edwards Deming, an American statistician and college professor known for his work in the field of quality management said, “You can’t fix what you don’t measure.” I began to include transparency and truly measuring the scope of the infection crisis in our nation as part of my advocacy. I joined forces with advocates Carole and Ty Moss who lost their 15-year-old son, Nile, to healthcare-associated MRSA. In 2009, we co-sponsored two California laws for public reporting of hospital infection rates and mandatory infection prevention education for all health care workers with patient contact (SB158 and SB1058). Together, they are known as “Nile’s Law.”
Q: In your opinion, what do you think needs to be done to address HAIs?
So much can be said on this subject. I think the most urgent, and practical, needs are those which address HAI at the bedside and facility-wide levels. Time and again, hospitals across the country have demonstrated that we already have the knowledge to prevent deaths due to hospital infections. Even without any new scientific breakthroughs.
During a presentation to the PACCARB, a Veterans Administration Health Service representative shared that between 2007-2012, the VA had reduced MRSA infections in its ICUs by 72%, and by 66% in other hospital units. They achieved this through rigorous, consistent, sustained prevention practices that included patient screening programs for MRSA and contact precautions for hospital patients found to be colonized with MRSA. They implemented a comprehensive hand hygiene campaign, which included placement of reminders and ever-present sanitizers in strategic locations.
My father is a Marine and Vietnam Veteran, and on several occasions during his visits to the VA hospital there have been Walmart-style greeters surveying patients as they were leaving the facility: “Did everyone who saw you today wash their hands?” “Did you have to ask them or did they do it automatically?” Real-time surveys, real-time feedback.
They created computerized reminders in the charting software and online infection prevention training. To test the impact, they used frequent measurement and provided continual feedback to the medical staff to reinforce these practices. Through their actions, their allocation of resources, and full-immersion approach, they created a culture that promotes and demands prevention of infections.
In addition to the administration and IPC department, this bold goal was seen as everyone’s responsibility. To ensure accountability and oversight, dedicated employees were enlisted to monitor compliance. Was any of this easy? NO. Was it labor- and resource- intensive? Yes. But if we say, “it’s too much to do,” does that mean patients only deserve infection-free care when the process is easy, convenient, and cheap?
I would also like to see the government create an incentive program for IPC similar to the Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs. These programs provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. I have been using my platform on multiple federal-level committees to recommend that the government create a similar program to reimburse hospitals for the use of innovative, traditional and non-traditional technology, diagnostics, and products to help eliminate the rise of HAIs.
The government is allocating billions for the development of new antibiotics which will take years to go through the pipeline. In the meantime, why not assist hospitals across the country with adopting processes like automatic robotic room disinfection or reimbursement for the purchase of copper or silver antimicrobial coated medical devices, catheters, bedrails, etc., designed to help prevent the growth of microorganisms.
There are many things that can be done to help prevent HAI infections and save lives. But, it takes the desire and will to do it. A commitment needs to be made to allocate financial resources where the ROI is measured by lives saved, not in the profit margins on a balance sheet. It takes bold healthcare professionals who take the lead in their facilities and create prevention champions across all silos – transport, housekeeping, and dietary staff. Patients need infection prevention leaders willing to educate trustees on what’s possible and enlisting them on the facility-wide HAI prevention team. None of it will be easy, but neither is surviving, recovering from, and rebuilding a life after the devastation of an HAI. So, while it’s a daunting task, we owe it to our patients to at least try.