1. Alexander, Mary MA, RN, CRNI(R), CAE

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I have written frequently about improving medication safety as well as healthcare worker safety. Recently, I was offered an opportunity to participate in a statewide effort to address those issues. An interdisciplinary panel was convened to examine the problem of healthcare-associated infections (HAIs-formerly referred to as nosocomial infections), and I was invited to join the panel to put forward the infusion nurse's point of view.

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As is becoming more widely known, among healthcare professionals as well as consumers, HAIs cause hundreds of thousands of deaths, most of which are preventable, and cost billions of dollars each year. Campaigns to improve patient outcomes by reducing infection, such as the Institute for Healthcare Improvement's 100,000 Lives Campaign, have had some success, and healthcare institutions and government health departments have taken note.


In 2006, the state of Massachusetts appropriated $1 million to implement a proactive statewide infection prevention and control program. The Department of Public Health acted quickly, convening the Expert Panel on Healthcare-Associated Infections, under the auspices of the Betsy Lehman Center for Patient Safety and Medical Error Reduction. The panel has been asked to assist in the recommendation of evidence-based best-practice guidelines that will promote patient and healthcare worker safety and improve health outcomes by reducing the risk of acquiring and transmitting healthcare-associated infections. The panel will offer recommendations to the Lehman Center and the Massachusetts Department of Public Health. As Massachusetts is seen as a leader in healthcare policy, these recommendations will likely be studied by other states and the federal government.


Infusion nurses know that infection control and prevention is an important part of their job. Until now, however, healthcare institutions and government health departments have largely disregarded or been unaware of the connection. My invitation to share the infusion nurse's perspective reflects a sea change in thinking about how to prevent HAIs and is a significant step forward in recognizing the infusion nurse as part of the solution.


Pilot projects for standardizing HAI surveillance are being developed. During the first phase of this project, a survey will be created to determine the current infection control practices in acute care hospitals in Massachusetts. The four main categories associated with infection control to be surveyed include prevention, surveillance, reporting, and education as they relate to catheter-related bloodstream infections, surgical-site infections, and ventilator-associated pneumonia. In addition to surveying the practice of clinicians, questions about the support of the executive leadership will be explored. Is there an institutional culture that facilitates the adoption of best practices? Do hospital administrators understand the importance of infection-control surveillance and its relationship to patient outcomes, as well as the financial impact that infection prevention has on patient care? It will also be important to understand the reasons why practitioners are not implementing known best practices and to identify the barriers that make it difficult to incorporate them into practice.


This project reflects issues that INS has promoted for years. The Infusion Nursing Standards of Practice and Policies and Procedures for Infusion Nursing encourage consistency in practice and use of standardized terminology in clinical practice. The importance of staff education in infection control and prevention will be addressed, and methods will be determined to ensure that continued competencies are sustained. Not to be overlooked will be the role of patient education as it relates to infection prevention. This project supports continued research and data gathering so that as systems are evaluated the focus is not only on best practices but also on continuing to improve practice. All of these measures are concepts that infusion nurses integrate in their day-to-day practice.


As this topic comes to the forefront of healthcare issues, it is essential that infusion nurses are part of the conversation. We have much knowledge and experience to offer our patients and colleagues as we continue to dedicate ourselves to improving healthcare.


Mary Alexander, MA, RN, CRNI(R), CAE


INS Chief Executive Officer Editor, Journal ofInfusion Nursing