29 minute read
The need for infection preventionists has never been greater. What can hospitals and healthcare systems do to appropriately staff those positions?
from REP JULY 21
COVID Fatigue and the Infection Preventionist
The need for infection preventionists has never been greater. What can hospitals and healthcare systems do to appropriately staff those positions?
Linda Dickey, RN, MPH, CIC, FAPIC,
Dickey Consulting LLC, has been an infection preventionist for more than 25 years. In that time, “we’ve never been in a situation where we have either reused or extended the use of personal protective equipment, certainly on the scale that we’ve had to do with COVID,” she said. Dickey is president-elect of the Association for Professionals in Infection Control and Prevention (APIC).
In the past, that reuse or extended use was simply not done as a fundamental tenant of infection prevention. Single-use items were used once and thrown away. Yet reuse and extended use was a situation that nearly every healthcare provider found themselves in amid the early days of the pandemic.
“We all realized when we ran into the supply chain issues that it made us think differently about how reserves are handled,” she said. “And it made us think more about the cost of that, because, obviously, there was warehouse space and holding a lot of supplies to consider, versus just-intime inventory. COVID taught us all that we can’t always expect to have something readily available.”
Because there were so many interruptions in the supply chain, infection preventionists had to be nimble and work closely with supply chain partners. “We probably worked more closely with them than we ever did before,” Dickey said, whether it
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was examining personal protective equipment options, cleaning and disinfection options, or even options related to some types of services. “Not that we didn’t work closely with our supply chain partners before, but it made it abundantly clear that we are joined at the hip to try to solve these problems because they are quite vexing. COVID has been extremely challenging to our supply chain partners. It put them front and center in terms of trying to manage the availability of various types of products, hand in hand with maintaining safety.”
The beginning of the pandemic was extremely difficult for infection preventionists, Dickey said, because the guidance coming out was so fast, and so evolving. “Not only were people involved in epidemiology and infection prevention trying to calm fears and maintain patient care and answer questions, but we were doing it in the context of not necessarily having all the information that we would have known had the pandemic been further down the road. So, I think everyone in the whole world literally was working somewhat in a vacuum, learning about COVID-19,
Linda Dickey Robin Carver
its transmission, what the options were for safe and effective care, and what the options were for actual treatment for these patients.”
Many infection preventionists worked around the clock, either extending workweek hours or fielding calls on the weekend. Dickey said for her, those extended hours started in late January and continued throughout the year. She didn’t have her first day off until Mother’s Day. “Our leadership was phenomenal, and our supply chain leader was over-the-top phenomenal and still is,” she said. “But we constantly had to find time to communicate with each other and develop communications that went out to the organization and make sure that we were all on the same page. That takes time, and thoughtfulness. And so, I think a lot of infection preventionists probably experienced that level of intensity for quite some time.”
Even off the clock, infection preventionists were still fielding questions from family or friends about COVID-19. “They were reaching out and asking, ‘Can you give us any more information?’ ‘What does this mean?’ ‘What should we be able to do that’s safe?’ So, you not only experienced the stress on the professional side of your life, but your personal side as well,” Dickey said. “It’s been a marathon.
Extended fatigue
Infection preventionists have been planning and preparing for pandemics for years, said Robin Carver, RN, MSN, CIC, vice president, member engagement at Premier Inc. “I don’t think anybody could have been fully prepared for what we experienced, because even as we wrote plans, and participated in drills, you never know truly what’s going to hit you.”
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Now with COVID cases on the decline, many infection preventionists are admitting that they are exhausted. Fatigue has set in.
“The impact to infection preventionists as a profession has been pretty profound over the last year,” said Carver. “We talk a lot about the front-line care providers, because they were the ones there day in and day out. But the IPs were also right there, day in and day out. And many of the IPs that I work with on a consistent basis have said, ‘I’m so exhausted. I have to be on call, or I have to be at the hospital 24 hours a day, seven days a week, because there are so many questions.’” And the impact of the various organisms on different body systems.”
Infection preventionists as a profession are very close to retirement age. “The last survey that I saw indicated 55% of infection preventionists were at retirement age, which will leave us a huge gap,” Carver said.
In fact, Carver has worked with several health systems over the last few months who have said they need help finding an infection preventionist because they can’t adequately staff the position. “The reality is they’re just not out there. So, as we see people that have decided at the end of this pandemic that they can’t do this again,
Indeed, hospitals and health systems have relied on their infection preventionists to answer an onslaught of questions. How do we isolate patients? Can we reuse this medical equipment? Can we co-room patients together, and what’s the risk associated with that? How do we get the right air filtration in place?
Infection preventionists have oversight into all those things in a hospital system, said Carver. “We think about them often as just the people that report hospital acquired infections or do hand hygiene policing. But they have to be experts across the board in things like ventilation, sterilization and disinfection of the environment and of medical devices. and don’t want to do this anymore, they’re either leaving the profession for other options or they’re retiring.”
Filling the gaps
The role of infection preventionist, and who has filled that role, is evolving. In the past, most infection preventionists started as nurses. They may have transferred from some other role into the infection prevention role. “For a long time, I think that was a qualifier of industry hiring practices,” Carver said.
Over the last decade, infection prevention has been moving into different disciplines. More people entering the role of infection preventionist may have an epidemiology, public health or a laboratory background. “I know a few IPs that are respiratory therapists by training,” Carver said. “We’re really trying to broaden what is the definition of an infection preventionist.”
A lot of health systems are also trying to tier their approach to infection prevention, Carver said. “If you think about it, just one part of what we do is surveillance – looking at lab results and determining in the clinical presentation, do they meet the definition of an infection? A lot of health systems are saying they can use a less experienced staff member for that.”
As a result, some health systems have created a role called an epi tech, which might be someone that’s not a nurse or does not have a higher-level clinical background, to fill the role of surveillance. The epi tech may transition up to an infection preventionist. “They’ve created tiers in their departments,” Carver said. “It also helps anytime you have that ladder of progression for people in our profession, certainly helps capture their attention.”
Salary is another lever for infection prevention. When hiring infection preventionists, infection prevention department leaders are competing against things like case management positions, where the employee can work 7 a.m. to 3 p.m., or they can work on the weekend and grab a weekend differential. But in today’s environment, infection preventionists have almost a 24/7 role. There are days they will have to be on call, late hours if an incident happens. They’re constantly having to figure out how to protect the staff or patients.
“So, if you’re going to choose, you’re probably going to choose the role that pays a little bit more, and you’re there 7 a.m. to 3 p.m. and then turn around and go home. The other factor a lot of organizations
have been looking at is market salary. What do we need to do to really compete and get good talent in infection prevention roles?”
Infection prevention is a very specialized discipline. There is a lot of education and preparation that goes into it, Carver said. “When you have a shortage of infection preventionists, that means if you have an IP or two that’s left in your department, they of course have to pick up more. It means that they have to be pretty dedicated to the regulatory reporting that has to happen.”
CMS takes data from NHSN and calculates payments or penalties based on that in the value-based purchasing program. So, if a hospital is limited in the number of infection preventionists it has available, that means the reporting has to be their focus. “You have to make sure that the data gets in so you’re not penalized.”
A shortage of infection preventionists means the hospital may lose the monitoring that needs to happen in the clinical area. “You lose the expertise of that person being able to guide practice changes at the bedside,” Carver said. “You lose that person monitoring the environment to make sure that you know things are being cleaned appropriately, that operating rooms are being turned over correctly. You lose that oversight when you’re very limited and the only thing they can do is pay attention to the regulatory reporting programs. And how long are they going to stay in that position, if all they do is sit in the office and go through data and report it to the government?”
A pathway to more IPs
In late March, APIC announced their intention to create an infection prevention and control curriculum for colleges and universities. APIC’s IP Academic Pathway marks the first national effort to link undergraduate and graduate programs to the field of infection prevention and control, ultimately leading to certification in infection prevention and control. into a higher education institution’s course of study through their undergraduate, graduate, and continuing education programs.
“Creating the IP Academic Pathway is a national imperative,” said
“The pandemic has brought to light the tremendous need for trained infection preventionists in our nation’s healthcare facilities,” said APIC CEO Devin Jopp, EdD, MS. “While APIC has a robust competency model and other resources to support professionals already practicing in the field, a clear pathway into infection prevention and control careers does not currently exist for college and university students. Through IP Academic Pathway, APIC plans to create an intentional track for infection prevention certification and degree programs. This will help not only the healthcare field, but also industries like entertainment, hospitality, and travel, which are increasingly hiring infection preventionists.”
An APIC task force will develop the IP Academic Pathway core concepts, which will detail competencies needed to work successfully in infection prevention and control as outlined by the Certification Board of Infection Control and Epidemiology (CBIC). Once developed, the curriculum can be integrated Jopp. “As the leading organization in infection prevention and control, APIC is uniquely positioned to lead this initiative. APIC will be soliciting input from both the infection prevention and higher education communities and seeking university partners that are willing to help design and pilot the new program.”
Dickey said they are seeing the need for infection prevention expertise well beyond the acute healthcare setting. “COVID has shown very clearly that there’s a need for individuals who have this expertise in longterm care, home care and in other types of settings, even if it’s just to advise,” she said.
“There are even industries outside of healthcare that have asked, ‘How do you operationalize some of these infection prevention measures, and what does that look like for my business?’” Dickey continued. APIC wants to help educate people on the role of infection preventionists. “So, I think that there’s actually quite a bright future and a strong future for people that are attracted to infection prevention.”
Cardinal Health’s Robert Rajalingam
Cardinal Health’s president of U.S. sales for medical solutions discusses the company’s commitment to customers, embracing diversity, and facing adversity as a team.
For Robert Rajalingam, there was no ramp up. When
he was appointed president of U.S. sales for Cardinal Health’s medical products and distribution in October 2019, he and his team had to hit the ground running, dealing with the traditional challenges that come with serving a large customer base of both acute and non-acute facilities, as well as a significant recall. Then COVID hit.
“On one hand it’s certainly been a challenge, given we’re all working at a frenetic pace,” Rajalingam said. “I think the last year plus, it’s been the hardest that I and many on my team have worked in our careers. It’s really about knowing your reason, your mission – know your why, as some people use that phrase – for what we’re doing.”
In a recent interview, Repertoire Publisher Scott Adams spoke to Rajalingam about a wide range of topics, including Cardinal Health’s pandemic response, lessons learned, leadership insights and how the distributor plans to celebrate its 50-year anniversary.
Cardinal Health’s Robert Rajalingam
Scott Adams: This past year has had its challenges for all of us. How have you been able to keep your team motivated despite the conflicts, obstacles, back orders – all the things that you had to deal with on a daily basis?
Robert Rajalingam: While we’ve had a lot of challenges and obstacles this year, I think one of the positive aspects was just the heightened sense of mission. What we were doing has been critical. When else in our careers would the front page of whatever news outlet you visit talk about PPE distribution? There’s no doubt that was unheard of as dinner table conversation. I think for the folks on my team – the sales reps but also everyone in operations – there was a real sense of trying to help the customer.
I think beyond that, just tactically, a lot of frequent communication came from me and the rest of our leadership team. Our reps operate pretty independently, and even more so in a virtual environment. Making sure the team heard from our leadership team, and me specifically, was important to let them know we’re on the front lines with them. I talk to customers multiple times a week if not every day. Our team knows that I’m experiencing what they are, and I think that’s been motivating for them.
Adams: For all of your customers, especially on the health system side, you can go on any of their websites and the first thing you see is mission, vision, values. When everybody’s drinking from a fire hose, how do you keep your team focused on what you just described, your mission, vision as an organization and overall values?
Rajalingam: It’s one thing to have it on a nice PowerPoint slide and mention it, and we certainly do that – but the way that I think our team really internalizes it is through the repetition and reinforcement of what we talk about every day in our staff meetings or all-team calls. For example, when we have a best practice to share, we recognize someone, or one of our reps shares a big customer win, I always try to tie it back to the five key values that we have as an organization. That’s where people start to really see, “OK, this is what Robert and the leadership team are focused on.” It’s a good reminder. Whether it’s best practices, wins, key messages, we’re always trying to incorporate our values consistently through our actions and messaging.
Adams: Do you have a system in place that helps you come up with great ideas within your organization?
Rajalingam: I wish I could say it was as organized as a system, but there are probably a few key principles we follow or ways we operate. One is having a diverse group of employees on our team. I think it starts there, so we avoid that consensus or groupthink. We’ve certainly made great strides toward that, in terms of a really diverse team.
The second one is listening to customers and also observing customers, because there are things they don’t always articulate that you might notice, such as problems they’re encountering. They don’t even think to tell you that it’s a problem, but if you notice it and address it, it’s a way to make their life easier and make their experience working with us better. We’re trying to really put customer experience and customer engagement at the forefront of everything we do – and not just our sales reps, but everyone, whether it’s IT, folks in finance, people who are more peripheral to our customers. We haven’t solved this, but it’s a journey we’re on to put the customer experience at the center of everything we do.
Then the last thing I would say is we did have an internal business case competition that was successful. We had a number of great ideas. We teed up a few different problem areas for our employees, not just our sales reps but our employees across the organization, to engage, partner with people they normally wouldn’t partner with in our organization, and then look at a problem from a different lens. We came out with a good problem – we had more ideas than we could give one first place to. Certainly there was a winner, but we’re moving forward with a few of the ideas that otherwise we wouldn’t have arrived at.
Cardinal Health’s Robert Rajalingam
Adam: What one or two things are you proud of within your organization over the last year?
Rajalingam: There are a couple of things I’d mention. One is seeing the team really accomplish a goal that maybe at the outset was greater than something they thought they could achieve. Making progress toward the goal and doing what was needed on behalf of a customer, whether it was through the pandemic or some of the significant occurrences we had, the team showed up in a big way and I’m very proud of our organization.
For instance, we had a significant gown and pack recall, one of the largest in FDA history by SKUs. We had reps spending nights and weekends for weeks at a time, shoulder to shoulder with customers, right in their inventory rooms and warehouses, working through sorting product and assembling kits. I got notes about reps who were driving for hours on Christmas Day to get product to cases where they were needed. Just seeing that dedication from our sales team, that’s better than any articulation of the mission. Their actions embody that, and it’s really energizing to me and I’m proud of that.
The other item that I’m proud of is our commitment to diversity, which spurs innovation and great thinking on our teams. We’ve been really intentional about that in our organization and my specific team. At an organizational level at Cardinal Health, we’ve closed the gender pay gap. We’re at 99%, essentially closing that gap, which typically is 15 to 20% at other companies.
In my broader organization of over 1,000 people, we’re at about 50/50 male/female, which as you know, in most sales organizations isn’t very typical. Almost 40% of our hires in the last year have been ethnically diverse, and we’ve increased the number or the percent of female leaders and ethnically diverse leaders. For all of those things to happen, it takes our leadership really believing in the potential diversity can create in our organization for good ideas and great performance. It’s great to see that progress over the last year.
Adams: How do you continue to grow and develop as a leader?
Rajalingam: It starts with a mindset and an intentional commitment, so the notion of no matter what role you’re in or title you have, you’re always evolving to be a better leader than you were last week, last month, last year. I like to learn from other leaders. I have mentors and others I talk to, but I also engage with a lot of podcasts and books. There are some podcasts I listen to that are interviews with leaders in other spaces. One I listened to in the last month was Bob Iger, the former CEO and chairman of Disney. How does he develop creativity in his employees? There was another podcast interview with John Brennan, who was the former CIA director. How does he make tough decisions with incomplete information?
Adams: What are some of the most important attributes you see in successful leaders today?
Rajalingam: I think especially in this current environment, I notice a few things that make leaders successful. One, seeing disruption as an opportunity for improvement or transformation. I think everyone understands that we have more disruption now than at any time in our careers, whether it’s our specific industry, the healthcare supply chain, how we work, etc. We were just talking about virtual versus in-person and how we engage with employees across all different spectrums of diversity. There are so many disruptions happening. I think a leader today must be energized and opportunistic about that, versus scared of it and reluctant to embrace it.
The other characteristic I think about is authenticity as a leader and the ability to inspire. I’ve found more and more that with my team and even leaders I work with, I’m energized when I know more about them as a person, versus just a title and someone you see in a business review-type meeting. Again, I try to be candid with my team as much as different virtual forums allow, so they understand who I am as a person, and that we have lives and families outside of work. I think that makes you more relatable.
This all ties into the inspiration piece. Our CEO was talking to us last week about a letter he got from a board member. He mentioned managers light a fire underneath their people and leaders light a fire within their people.
Adams: On the flip side, what are some dangerous traits you’re seeing in leadership today?
Cardinal Health’s Robert Rajalingam
Rajalingam: Overconfidence or arrogance, confidence without humility and being focused on yourself. One of the reasons I enjoy working at Cardinal Health is that I don’t see a lot of that in our leadership team. If you have a leader that is arrogant, then other folks start to model that behavior because they see that maybe it’s being rewarded. I’ve been in other organizations where that’s been the case in certain teams. It can lead to a sense that the rules don’t apply to you. You’re unaware of blind spots you may have, you make questionable decisions, and you have a lack of respect for your team. All of those things you learn by observation, and I’ve certainly seen that in the past.
Adams: As a leader in a large organization, what are some of the qualities and traits you look for when you’re considering to promote somebody into a leadership role or somebody that’s starting the career path?
Rajalingam: I have a list of a few things – they all start with C. One is just capacity – both intellectual and bandwidth. Are they smart? Can they work hard? That’s almost table stakes, but it’s important.
I also think about curiosity. Are they a continuous learner? Are they always trying to seek out new information?
Another quality is courage, which goes back to your earlier question in terms of are they willing to do the right thing under pressure and voice their opinions. Again, I think that’s really important.
I also consider their competitive fire. Do they have a drive to win, especially in sales? I think you just can’t teach that. That’s something I try to look for in any type of interview or recruiting process.
Then the last two qualities are communication and culture. Can you clearly convey your ideas and influence others? Certainly, most folks who are successful in sales are able to do that, but I think it’s a valued trait in any function. On culture, that’s an intangible one, but I think about whether I would want to sit next to them on a cross-country flight. That’s how I assess culture. If I don’t want to do that, then I probably don’t want to hire them and work with them.
Adams: What was one of the most important risks you took, and why?
Rajalingam: The risk that comes to mind is when I was working in business development at Medtronic and helping the CEO with some different opportunities. The preamble to it is that we had gone through a deal that didn’t work out so well, and through some diligence, we learned we couldn’t scale it up.
The risk I took was in the second opportunity on the deal, there was a lot of consensus. You’ve probably been involved in things like that, where an entire organization from the CEO on down are bullish or gung-ho on a deal. People get deal fever and are ready to do it.
The risk there was I was an associate of business development but was on point with due diligence. I knew that there were some risks to this deal, to this product, that would make it something that would be untenable for us to go forward. The risk was just speaking up on that, in a pretty broad setting with broad leadership present. For someone at that stage in my career, candidly, it was intimidating for me to do. However, I learned to really speak truth to power when maybe that wasn’t the proper thing to do.
It went against the consensus in the room, and it certainly turned out to be a good decision in terms of what happened with that product in different hands. Thankfully we didn’t make that acquisition, but that really taught me to trust my intuition that was informed by facts and just build some confidence. It’s something I always counsel folks on my teams or folks I mentor about. “You’re hired into that role for a reason, and we want to hear what you have to say.”
Adams: Can you tell us about your current goals?
Rajalingam: From a team perspective, certainly our customers have gone through a lot over the last year. It’s been the most challenging on record, with all kinds of activity around PPE and COVID testing and things like that. I think the first one is making sure we acknowledge as a company that the experience for our customers has been difficult. We have self-awareness for that and are really improving and simplifying the customer experience. That is my number-one priority for me and my team – and really our entire business segment – as we’re going forward. We’re launching a messaging campaign, along with a lot of improvements and investments behind that to do exactly that. We’re excited about that.
The other one is on a more qualitative level, and that’s to make sure for myself and my team that we have good balance, and the team is able to understand that what we’re in now is not a sprint, but a marathon. We’re essentially in a new normal. That phrase gets overused certainly, but I believe that’s the reality. I want to ensure that my team is creating that right work-life rhythm. Because when our reps are happy and fulfilled, that translates to what our customers experience.
Cardinal Health’s Robert Rajalingam
Cardinal Health at 50: Service at the Forefront
Cardinal Health as a company is marking its 50th anniversary in 2021, and kicked off a year of giving back in January.
Robert D. Walter was only 25 years old and fresh out of Harvard Business School when he decided to pave his own path. Walter founded the company in 1971 with the purchase of a small grocery wholesaler called Monarch Foods in Columbus, Ohio. He eventually changed the name to Cardinal Foods, in honor of Ohio’s state bird and the mascot of his high school.
After more than 10 years of growth in food distribution, Walter pivoted to pharmaceutical distribution and purchased Bailey Drug in Zanesville, Ohio. That was the first in a series of acquisitions of pharmaceutical distributors that eventually led to an initial public offering on the NASDAQ stock exchange in 1983.
In 1990, Mike Kaufmann, now the Chief Executive Officer of Cardinal Health, joined Walter’s growing team, and then in 1994, the business changed its name to Cardinal Health.
“I have had the great fortune of knowing and working with Bob Walter for 30 years,” Kaufmann said. “He has helped make the company what it is today – a pharmaceutical distributor, a global manufacturer and distributor of medical and lab products and a provider of performance and data solutions for healthcare facilities. Bob also taught me a great deal as a leader – and continues to do so.”
Since its inception, Cardinal Health has continually evolved to meet healthcare’s changing needs. But one thing that has remained constant is a deep
commitment to its customers, partners, employees and communities.
“It is a privilege to be with Cardinal Health today,” Kaufmann said. “We continue to adapt and innovate through a dynamic environment, building upon our scale and heritage in distribution with products and solutions to serve our customers and their patients – now and into the future.”
Walter said, “We built the company on a sustainable foundation – doing business the right way. Not a day goes by that I don’t see evidence of the good work that Cardinal Health does for its customers, partners, employees and communities.”
Robert Rajalingam, president of U.S. sales for medical solutions, said Cardinal Health is commemorating its 50-year anniversary with a year of service. “We’re encouraging employees to actively engage in programs that are important to them in many different areas, including educational initiatives, food drives, improving the environment, ending prescription drug misuse, whatever it might be. Our goal is to record a minimum of 50,000 hours of volunteer service by the end of the year.”
Throughout the year, employees will support causes that mean the most to them across four areas, one for each quarter of the year: equity, our environment, health and hunger.
“We’re purposefully beginning the year with equity-focused service,” Kaufmann said. “Diversity, inclusion and equity are core to who we are at Cardinal Health – we firmly believe that ‘as you are is just right for us.’”
Looking ahead to the next 50 years, Cardinal Health is focused on improving outcomes – for customers, partners, employees and communities. “As we collectively navigate the pandemic, we are dedicated to continuing to fulfill our critical role in the healthcare supply chain, as we work to become healthcare’s most trusted partner,” Kaufmann said.