Country Mouse Goes to the City

After some time away, I went back about 6 months ago.   I had been working in a post-acute setting, helping a former director set up a good program.  When I accomplished that, I decided to move on.  Imagine my surprise to hear a recruiter tell me I was “not a competitive candidate” for a job in acute care since my last position was in post-acute. My job search took much longer than I expected, and I suspect this was part of the issue.  

It is unfortunate that hiring managers are often unfamiliar with the actual work of infection control.  Skills in one setting are nearly entirely transferable to another setting.  One doesn’t immediately lose all of their past knowledge when they haven’t used it in a couple of years.  Maybe you need to brush up on some things, but resources are readily available. I haven’t driven to Pennsylvania in a decade, but I know which direction to go, and I know where to find a map.  I didn’t forget how to drive, and I won’t end up in Toronto.

I was also looking for part-time work, which appears to be an infection control unicorn. I don’t know why employers don’t offer part-time positions in this field around here.  So I took a full-time job at a mid-sized academic medical center-- a little different from the community hospitals, rehabilitation, and psychiatric settings I was used to, but I wanted to work with other people.  I’d almost always worked by myself in the past.  It’s been quite a change in some ways, but there are really no infection control things that are different.  What I learned from working alone for many years is, well, everything.

Being the sole practitioner is a bit like being the country doctor.  They deliver babies, set broken arms, treat coughs and stomach pains, provide palliative and end of life care, and everything in between.  Same with the country ICP.  I’ve given thousands of flu shots as I’ve worked with Employee Health in the past.  This year, I gave none: we’ve got a department that manages that.  I’ve taken all that vax data, sorted it (sometimes by hand on paper), to enter into NHSN.  Not here: they’ve got a fancy employee scanner machine that uploads all that.  I’ve planted and read hundreds of TB skin tests, but now we use blood tests. In the past, I’ve answered dozens of phone calls from staff about their own symptoms, an infection their mom had, or a rash on their child.  Not here. Not one.

Once upon a time, I did lots of education: orientation sessions for new employees, covering BBP and tuberculosis, demonstrating PPE, talking about the failure rate of exam gloves, and using good hand hygiene. Every other Monday, for 40 minutes, for years.  I did small group sessions with the new medical residents, talking about our IC policies and infection-related quality metrics.  I met with new nurses and new nursing aides each month for an hour to review precautions, specimen collection and diagnostic stewardship, and appropriate infection documentation.  Not here: other people do all that.  Too bad, it was a nice opportunity to meet staff and build relationships.

Elsewhere, I went to nursing staff meetings to talk about new initiatives and policies.  Now, everything is delivered through an education department. I don’t really talk to staff directly.  I used to work on process improvement projects from the annual risk assessment. I’d research them, develop them, engage other leaders, and move forward.  Now, if I want to initiate something, I need to review it with a lot of people.  Policies go to many committees.  Things take a very long time. In the big hospital, infection control projects are going on in other areas, and nobody asks for help from us.  Sometimes we find out later about departmental initiatives.

I used to manage all of my own PI data (and some other departments’ data, like antibiotic stewardship), and present it at half a dozen meetings--regulatory preparedness, process improvement, clinical operations, environment of care, safety and emergency management, etc.  Here, we have a data analyst to manage most of that, and the doctors present everything at meetings. You might be wondering what it is I do all day now: Surveillance, lots of electronic surveillance.  Thousands of surgical cases, dozens of potential device-related infections. I’ve gained about 8 pounds in 7 months sitting at my desk. Some days, I never leave the office.

But what I do have is other people. Most importantly, they are people who know infection control. I don’t have an ID physician who comes to the monthly meeting and is never seen again.  I have FIVE ID docs who work in the hospital, all day long.  And I have a hospital epidemiologist, who is a walking encyclopedia of every piece of infection prevention and control knowledge written since the beginning of time.  I could call any one of them, at any time, and they’ll have something thoughtful to say about an issue.  They have an ID case conference each month, where they discuss interesting things.  The microbiology staff and the pharmacy staff join in, and it’s a very nice learning environment.

When there was an outbreak of something in the past (food illness, TB exposure, influenza), I’d call the health department, fax all the records, call or interview patients (have you ever done a food illness investigation? Brutal: 5 pages of food--have you eaten any sausage? Bratwurst? Knockwurst? Weisswurst? Kielbasa? Chorizo? Hot dogs? Chinese sausage? Chicken sausage? Breakfast sausage? How about cheese?), create any internal messaging, help set up a phone line, and work 18 hours some days.   

Here, we had a little outbreak thing.  An executive team member deftly led an emergency meeting.  The communications team created the messaging and notifications, the epi MD spoke to the board of health, nurses notified all affected inpatients, telecommunications set up a big phone bank, and nurse leaders called all the discharged patients, and pharmacy helped secure vaccine while nurses vaccinated anyone who needed it. I wrote the phone script, and went home at 4pm.  I called zero patients. I gave zero vaccines. I spoke to the health department just once. I am definitely not in Kansas anymore.

My past experiences gave me both a broad and deep knowledge of much of the infection control discipline, mostly out of necessity. I’ve worked in a variety of settings, purposely, to gain more skills.  I don’t regret any of it.  I find that my varied experiences have made me much better at this job. And while some may not like my resume of shorter stints, I find that most people who’ve worked at the same place for 30 years have a very narrow and often unmoveable view of how to do something, as they’ve literally never seen any other way.  It’s like never leaving your house. I’ve seen 6 ways to do everything, and can usually see, or at least present, a solution for a certain situation.

There’s so much to see in this field.  Go see it.

Everything is Infection Control. Everything.

Gather round for a story, about all the things that you should know because the people whose job it is to know them don’t always know them.

Our pharmacy director mentions in passing that the state board of pharmacy is coming in to one of our small sites.

“They are here to review the moving of the pharmacy”

Me: We’re moving the pharmacy? [which is just a small, dry storage room with a computer. No mixing.]

Her: Yes, we are swapping the nurses’ medication room with the pharmacy.  Nurses need more space.

Me: How did I not hear about this construction project?

Her: Oh, there’s no construction, just a swap.

Me: The nurses’ med room has to have a sink.  The current pharmacy space doesn’t have a sink.

Her:

Me:

Her: Really? Are you kidding?

Me: Nope, not kidding.  The facilities manager should have known that.

Her: Who says you have to have one?

Me: First, it’s good practice.  You should have one for handwashing, making G-tube slurries, disposing of IV bags.  For patient safety, all med prep should be done in one area---without having to leave the med room for things like water.  From an infection control view, staff should be washing hands immediately before med prep.  From a regulations view, it is definitely in the FGI guidelines, but there might be a different code book we are following.  But even if it’s not in there, I’d want a sink.

Her: mumbling and swearing as this makes a giant mess of a plan that was about to happen in a few days’ time. And she wants proof that this needs to be done.  Many phone calls are then made to many important people.  Nobody is happy. I have turned a furniture-moving event into major plumbing and renovation.

So I call the Facilities Director, who knows nothing about sinks in med rooms, or which guidelines we are following, or about any other AHJs in this matter.  So I ask if I can have access to his FGI guidelines.  Which he doesn’t have.  Seriously, does not own.  He refers me to the International Building Code, which, while applicable, is not useful in this situation. (IBC tells you what gauge of electrical wire or type of cement to use, not interior design and function). 

The guidelines that direct how to design, construct, and renovate healthcare facilities is not in the possession of the person who is in charge of these things. The read-only copy (which I’ve read, and so should you) is available free online, but it can be tedious to search.   So at 7pm, from home, I shell out $200 on my credit card for the applicable edition of the FGI manual.  And share a screenshot of the medication room guidelines with all interested parties.  All plans come to a screeching halt.  And that was my last day on that job, so I have no idea what happened after. (The pharm director was a very conscientious person, so the sink likely happened, or the move didn’t happen.)

Projects planning committees are crucial.  You must be on them.  Projects that nobody thinks are projects are often projects.  This is one of a dozen stories I could tell. 

There is a webinar coming up soon on using the FGI guidelines.  I hope you’ll sign up if you aren’t familiar with them.  You never know when you might need to know how to do someone else’s job for them.

https://www.fgiguidelines.org/aia-fgi-webinar-the-2018-guidelines-how-to-use-and-major-updates/

Respect my authority

There was an article recently that sort of triggered me, and I wanted to talk about it a bit.  It’s about being the only voice in Infection Prevention, and sometimes being frustratingly powerless to make necessary changes for patient safety.  If you work in a large organization, you might not know what I’m talking about.  But I’ve spent most of my time in small places where I am the only voice. It doesn’t happen always, but often enough that it has made me wonder why I do this job.

I have worked in a few different arrangements:

• A mid-sized hospital, with another ICP, and 2 ID physicians who: saw patients, chaired the IC committee, provided consults to colleagues, took call overnight, and were involved in antibiotic usage.
• A small hospital, where I was the only IP.  One ID physician who: covered many facilities on consult and had an outpatient practice, was supportive, but very busy, came to IC committee, but I did all the work.
• A small hospital where I was the only IP. All calls were mine. The ID physician was on consult to the IC program, did not see patients at the facility, employed elsewhere, engaged at quarterly IC committee, but mostly unavailable otherwise.
• A very small hospital where I was a consultant ICP for just a few hours a week.  No ID physician.  All calls were mine. I ran committee, and an MD was present and signed off.

When there is an issue in infection control, and there is no readily available physician or other staff, it is up to me to present the issue and my suggestion for ameliorating it.  I am confident in my knowledge and skills, but frequently this is not enough.  I simply have no authority to implement significant changes without support from administration.

When a CRE patient presents from an outside facility, I gather the key players, and explain current CDC guidance for patient care.  I print fact sheets for patients and staff.  I make myself available on the unit for questions and support. But I cannot implement the recommended staffing changes.  I am told that it isn’t possible for the nurse to have only one patient.  Maybe it’s a budget issue, or a planning issue, or they don’t completely understand the implications of CRE spreading.  But I cannot control it.

When the OR staff reports that a surgeon doesn’t wash his hands due to a skin condition, I approach my boss.  She agrees this is serious.  She arranges a meeting with the surgeon.  He explains his issue.  I grit my teeth while she suggests other options out loud: double gloves, a dermatology consult, different soap.  I explain the standards.  She asks me to see if he has a higher rate of infections in his patients.  The numbers are too small for meaningful comparison.  She takes this as ‘no.’  She tells me we can’t take away his job. He continues to practice.

I find expired skin antiseptics in a supply closet.  I let staff know they need to be thrown away and replaced.  They tell me that then they won’t have any because the secretary does the ordering and she’s off next week.  I ask how they check for expired supplies.  Blank stares.  I find many more.  I have no boss in this small organization.  He left 6 months ago, and they haven’t found a replacement.  Next in line is the CEO.  I do not know who he is, and he likely can’t order supplies.  At the next committee meeting, it’s agreed that someone should be in charge of checking and ordering supplies.  The nurse manager says her staff don’t have time. There is literally no solution anyone can agree to, and I am stunned.

The majority of us in the US are ICPs in small facilities.  It can be very frustrating to be expected to maintain the same standards that large facilities have.  I want everything for my patients--the safest care, according to recommended practice standards.  But in all but one site I have worked in, the IC department didn’t even have its own budget.  Nothing specifically allocated to education, to supplies.  Just a salary, for someone to come in and fill that CMS required role.  And directors who look surprised when you show up holding guidelines and asking for support and action.  Perhaps they hoped I would just sit in the office and tabulate things.  Instead, I sit in the office and document things.  Because when something goes wrong, I will have evidence that I did everything I could within my power to inform those who do have the power.  And it will not be on me.

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.

Look Closely

I recently trained a brand-new ICP.  There’s so much to teach, but if you get a good candidate, it’s easy, because so much of what we do is common sense.  She sometimes came to me after doing rounds, and remarked on something that didn’t look quite right, but she wasn’t sure how to handle it. So before she had read and memorized a thousand pages of infection control reference materials and guidelines and policies, she knew when something wasn’t right.  Infection control gives you new eyes on a place you’ve worked for years.   

The next step after recognizing an issue is knowing where to find the answer.  Does your issue really violate good infection control practices and patient safety? You need to know your resources, but you don't need to memorize every one.  Google is my best friend.  Because the problem you are facing is not likely the first occurrence of said problem in the history of modern healthcare, there is information out there somewhere on it.  Often my search leads directly to one of the published guidelines, and then I don’t have to know exactly which one it is off-hand.  I find the CDC MDRO and Precautions guidelines overlap a lot, and the SHEA compendium overlaps APIC.  So if you are looking for exact wording on your issue without reading through each one, just do an internet search with as many key words as you can.

Over the years, I’ve collected (and I’m sure many ICPs have) a number of photos of things that didn’t look right.

Exhibit 1:

This is a feeding pump.  Staff let the pediatric patients decorate it with adhesive stickers to make it look it more friendly.   Does it look not-quite-right to you?  It should.  All of that adhesive attracts debris, and you can’t clean adhesive.   In fact, those stickers are debris. Feeding fluids are full of sugars, proteins, and other nutrients that are great for feeding humans and bacteria.  There should not be adhesives on patient care items. Reference: CDC Guideline for Cleaning and Disinfection

Exhibit 2:

This is drinks at the nursing station.  I count 3 from this angle. Along with a personal bag.  We use this counter to put laboratory specimens, patient charts (gross), glcuometers, etc.  It is not a clean area.  Staff should have a clean area for food and drinks in a non-clinical space, and should have a work flow that allows for breaks for their own fluid intake.  This is up to the manager to police and enforce.  I always find more drinks after-hours than during the day.  Reference: OSHA blood borne pathogen standard.

Exhibit 3:

This is an isolation gown, hanging on the doorknob, ready to be worn again…..   Does it look wrong?  If you don’t see dozens of gowns on doorknobs, then one should strike you as an aberrancy, something out of the ordinary.  Isolation gowns are worn once.  They are considered contaminated once worn, and you would not be able to put it on again without recontaminating yourself.  This is wrong. Reference: CDC Guideline for Isolation Precautions.

Exhibit 4:

I didn’t take this photo; an environmental services manager did, and brought it to me.  He said, “Can they leave the ceiling open?” No, they can’t. This is open for work being done in a patient room.  He walked by the room and the door was open, and no worker was nearby.  As the room is empty, it’s likely been cleaned.  Does the Facilities staff know they need to contain debris from the ceiling in a patient area? That a ladder and open tiles shouldn’t be unattended?  Does the nursing staff know that they can’t just push the bed back in there, as the room needs to be cleaned again?   This is the result of poor project planning: Nursing needs to know what work is being done, Facilities needs to know how to do it safely, and everyone, including EVS, needs to be sure the room is clean after.

Exhibit 5:

What’s this?  I wish it was a better pic. But this is several layers of plastic (soft) containment set up during major construction in a hospital.  Is something wrong here?  Why, yes.  I can see the glowing exit sign at the end of the hallway they are working in.  This is 2 layers of containment, both open, gently blowing in the breeze, so that a person on the safe side with a camera can actually see all the way through the demolition area to the other end. Unacceptable. Containment is for containing debris and air contaminants, and protecting patients and staff.  This is doing neither.  This is where you may wield your authority, and tell the contractor to stop work until the containment is fixed.  Speak to your Facilities director immediately, as they are responsible for ensuring contractors are properly trained in infection control measures, and have ultimate responsibility for ensuring it happens.  Reference for both above: CDC Guidelines for Environmental Infection Control in Health Care Facilities

So if you wander about your facility and see something that doesn’t look quite right or something you’ve not seen in other facilities, trust your gut: it’s probably wrong.  Head back to your office, find your reference, and then go correct the problem like the infection-preventing deity you are.

Mind the Gap

The APIC Megasurvey gave us a lot of information about our profession: It’s aging (we are mostly over 50), less than half of us are certified (horrors!).  But what was missing from the survey, that I consider important, is about vacancy.  How many facilities have vacancies they can’t fill? How long are postings open before being filled?  Did the hiring manager get the type of person they advertised for, or did they settle for something less?

In my area, ICPs are becoming harder to find.  I see job postings linger longer.  I hear colleagues are retiring.  I  am leaving my position soon, and gave my employer nearly six months notice, knowing how hard it is to fill the position. We had only one applicant.  A part-time position I had last year called to see if I was interested in returning--the position has been open since I left a year ago.  Smaller facilities struggle, and most US facilities are smaller--2/3rds have less than 200 beds, and 28% have less than 50, according to NHSN data.  And that’s just acute care sites.  There are nursing homes and outpatient clinics and surgery centers and psychiatric facilities--all in need of good infection preventionists, but with a seemingly small pool of qualified talent to draw from.

There is a yawning gap between some people genuinely interested in this career, and the career, because there is not always a way to take one’s suitable education and get a job whilst having no experience.  I don’t believe we have clearly laid out a path into this profession.  We are failing ourselves and our discipline. Yes, there are a few online graduate programs now, but some are MSN programs--only good if you have a BSN.

I met a lovely woman recently, looking for a US ICP job.  She “only” had international experience and couldn’t seem to get a job here.  I say “only” because I would simply die at my good fortune if a multilingual, master’s prepared, well-spoken person applied to my department fresh off a stint implementing an infection control and sanitation program in a resource-poor setting.  THIS is public health, THIS is program planning, THIS requires innovation, THIS is someone I want to talk to.   But she had no US hospital experience, and employers couldn’t see past it.

What she needed was an internship or mentorship of some kind.  Bigger hospitals or systems can mentor a new person in to the job (grow your own), but smaller sites don’t have anyone to do it, especially if the last ICP is leaving or has already left.  This is really an unfortunate set-up. Hospitals willing to do so could offer a mentorship or internship to interested professionals, as a type of schooling, but it would likely be unpaid, and thus they’d need candidates who could afford to spend several months working with the ICP, full time, for no money.  There aren’t many candidates who could afford to do that.

Also, it seems employers can’t see past the “infection control nurse” title.  You. don’t. need. to. be. a. nurse.   But the hiring manager or director is often NOT an ICP.  They are perhaps the quality manager, the nursing director, the vice president of patient care, and don’t always fully understand what skill set it takes to be successful.  The large number of nurses in any facility clouds one’s view of all of the other professions who have equal, although different, education and skills.  Some nurses are only diploma-educated.  Your respiratory therapists are much more qualified than that nurse. I can see a process management person doing well in this job.  Certainly anyone with epidemiology training can succeed.  It is the process improvement piece that is the bigger part of  this job, much bigger than the nursing piece.   Employers are limiting themselves, and very qualified people are being left out. Employers that can’t fill positions sometimes go to contract agencies.  I’ve looked at these jobs, and most list the position as “RN required.”  And I think, maybe if you changed your requirements, you would have been able to fill the position.  Now you’ve just turfed the problem to someone else.

We need a gap closer.  We need that middle mentorship piece.  We need to educate employers about the position, and what skill sets will be successful. We need to advertise the career.  The APIC Roadmap is great, once you’re in, but we need a map of the path that leads to the road.

This is what we came for

I am here as a resource: to my coworkers, to my professional colleagues, and to anyone in this career.  If I can help you in some way regarding infection prevention and control, then I am happy.   I often say to staff, “If you’ve spent more than 3 minutes on the CDC website, you’ve done too much.  Just call me.  Either I already have the answer or I know where to find it.”  Let me help you; this is why they hired me.

I don’t know everything, not even close. I’m Googling while you’re asking me a question on the phone.  But I know my resources.  You’re looking for a professional connection in your area?  Let me put you in touch with one of my tweeps or the local chapter leadership there.  Your kid has an itchy bottom and the doctor wants you to do something bizarre with a piece of adhesive tape?  Let me explain what they’re looking for and how to get a good sample.   Your patient says the other hospital staff wore gowns when treating him?  Let me call their IC department.  The hand sanitizer bothers your skin? Let me get some other samples for you.

There are certainly days when you feel overwhelmed and underappreciated, but if you continue to build your knowledge, identify your resources, and offer people calm and rational information, they will come to rely on you (in a healthy way).  And that is probably one of the best compliments you can get in this job.  Or in any job.

Here is a blissful little story from my week.  A staff nurse notes a new issue, and brings her concern to her manager.  Her manager sees that there might be an infection concern, and calls me.  She doesn’t even try to solve it, because she knows I am the resource she needs.  I identify the problem, and what we need to fix it.  I could spend hours looking for the solution, but I have something better.  I have a vendor I trust.  I send him an email that explains exactly what I need.*   Do you have a product that meets this need?  Yes.  Yes, he does.  He is my resource.  I know he has the information I need, and I don’t need to spend hours looking for it.  Surround yourself with people like this. His company isn’t our preferred vendor, but he’s my first go-to, because he saves me endless amounts of time.

Today, our solution arrived.**  The manager and I opened the packages, and I did a little dance.  It was everything we hoped for, and exactly what we needed. All the stars aligned, it was a good day, someone needed me and I came through (because someone came through for me).   I feel like I reached a little milestone in my career. It’s bittersweet because I have decided to leave this fabulous job in a few months. I work with great people who do amazing work, but I need a short break, and I’m not sure what’s next for me.  But I wish you days like this in your career, when you feel your value, no matter what your work is.

*[I need to disinfect floors in an outpatient area that has no housekeeping staff.  It needs a long shelf stability because it won’t be used often. It needs a disposable component because there is no laundry service. It must be ready to use because there is no dilution system. It needs to be compact for storage, and must require minimum PPE for handling so staff aren’t at risk mixing or diluting chemicals.]

**We got the Diversey Pace mop and the SmartMix chemicals--which is a fabulous, amazing, genius thing.  I rarely rave about anything.  But this is so exactly perfect for our setting that I’m going to gush over it as only an ICP can about disinfectant products.