Bombs away

I stepped away for a bit.  I gave plenty of notice, trained a new person, and left my job 6 months ago.  It was a good time for me.  With a little help from Mr.MoneyMustache, I got some perspective, put things in order, and took some time for myself.  

Sometimes you’re too busy to do the job well.  The days can be long, and I was barely keeping up with new regulations and standards.  Reading that I had planned to do later just wasn’t getting done, because by the time I got home I did not want to do more work.  As a salaried employee, it’s often required, and I get that, but something was just missing for me, and I wasn’t enjoying it much anymore. In my time off, I enjoyed summer vacation with my family, went to a 3-day conference that I would never have been able to get to if I was still working, and read through a growing stack of journals and regulations from the comfort of my front porch.  And I picked up a part-time job in the microbiology lab, where I go 2 days a week, and happily punch out after 8 hours.  I needed to put my hands on something real, something that felt like patient care. I also joined the board of my local IC chapter, which I had long wanted to do. But I’ll be back to infection control soon.

I’m still on staff at my old job, just on the periphery, supporting the newbie through any crisis.  And I have a bit of a different perspective watching her work.  She can get overwhelmed by the crises.  You should know that bombs drop on Infection Control on the regular (or irregular. Or regularly irregularly).  You can’t get flustered.  This, too, shall pass.

The key is being prepared.  You need to leave mental room in your workflow and in your stress level for bombs that will drop.  (Great time mgmt piece, here..Almost all pertinent to IC). You will be plugging along, preparing docs for meetings, calculating your hand hygiene, doing new employee orientation every other Monday...and a bomb will drop on your desk.

 A kitchen worker has a positive Hepatitis A test.   Are you kidding me?  Call Employee Health, make sure he’s out and under the care of a physician.  Just get him out of the workplace and figure out the rest after.  Check your patients, is anyone sick?  Call your board of health, if they haven’t called you first, about that positive test.  Nobody is sick. Good.  When did he work last?  Find your guidelines on Hep A--state, local, or CDC.  Who needs to be vaccinated? Anyone? Can pharmacy get vaccine?  Administration wants a huddle about this.  NOW.  

This is a bomb.  It will require you to stay late, write a lot of things down, call a lot of people, wait for them to call you back, provide education, and maybe pretend that it’s totally under control.  Which it will be, in 2 or 3 days.  So hopefully, your mandated data reporting isn’t due tomorrow.  Or your report to the hospital board.  You’ve got to leave yourself a small buffer.  Do not be a procrastinator in this job, because you don’t know when the next crisis will hit.  Sometimes even a little crisis (like falsely positive Hep A tests, which happen a lot) takes a couple of days to sort out.  A major crisis (like staff drug diversion with multiple exposed and infected patients), takes weeks.  

When something super major happens, you can be assured that your state board of health will step in, or a federal authority, heaven forbid.  And you will have support, or you may even be pushed out of the way.  But small bombs are all yours.  If you’re new, or in a small or resource-weak setting, you should have a mentor, or a resource somewhere.  Maybe an ICP from a nearby hospital, someone with a little more experience under their belt, who can point you towards the right guidelines and documents.  Try to make connections at a local conference.  Just be honest, and say, “Hey, I’m all alone at our 12-bed hospital.  Do you think I could give you a call to talk through something if I get a tough situation?”  Hopefully, that person is flattered that you asked, and you get a few phone numbers to keep in your pocket.

It can definitely feel like nobody listens to me when I tell them to wash their hands or document the patient’s stools carefully.  But in a crisis situation, I’ve sat in the C-suite with everyone looking at me for what to do next.  It’s the only time I have a modicum of authority (IC is tons of responsibility, zero authority). The very first step in crisis control is to stop the offending issue immediately, and then head to your office to find your guidelines, review your policy, and make a phone call.  CDC has good resources on the steps of an outbreak investigation, and plenty of disease-specific resources for illness in healthcare settings. (And know that you are not the first person to have faced such an issue before--whether it’s mold in the OR, faulty sterilizers, hepatitis A in food service staff, or flu amongst the patients.)

No matter how new you are, you are still the most knowledgeable person in your facility regarding infection prevention and control.  Put on a confident face (and a decent shirt), and tell what you know, and what you don’t, what your next steps are, and what you need from them.  People are looking to you. And you’re going to do great.

 **Patient notification is the last step in a crisis, when necessary.  Don’t ever notify anyone of anything until you have every last piece of info, and the local health department is on board. It’s a very big deal. Do not attempt any part of patient notification alone.