 Hi, everybody. This is Donna Prosser, Chief Clinical Officer with the Patient Safety Amendment Foundation. We're here today to talk about infection prevention and the impact on health worker safety. And joining us today is Dr. Christine Listerna. Dr. Listerna is the Regional Director of Infection Prevention and Control and the Heroes Program at Kaiser Permanente. Welcome, Christine. Thanks so much for joining us. Thank you. I'm very excited to be here and talk about infection prevention. Great. I wonder if you could start by telling us a little bit about your background. Yes. I'm an Infection Preventionist. I am a critical care nurse by background. I am currently the Director of Regional Infection Prevention here in Northern California, as you said. We support 21 medical centers across our region. We provide resources, leadership, consultation, and a lot of support, especially during the pandemic. Also under me is a program that helps our medical centers prevent happy or are pressure ulcers and falls. Great. Well, let's go ahead and get started then. I know we got a lot to talk about today. So tell us, start with, you know, what is a comprehensive infection prevention program and what impact does that have on health worker safety? Right. So, you know, a comprehensive infection prevention program is actually, in my mind, quite simple. The primary goal of any infection prevention program, whether you're in a hospital or, you know, a community healthcare setting is primarily to prevent infections occurring in your setting. And that is infection to patients. First of all, that's usually what we think about when we think about infection prevention and healthcare setting and also infections to our employees or healthcare workers. So there are many components or critical components of infection prevention program. And here in the United States, you know, we go by the CDC recommendations on what those are. And a critical element of that is worker safety or healthcare workers safety, patient safety, obviously, environmental safety is another one. Education being a very, very critical component of it. And in the last, I want to say 10 years, and this is very, very true today with what we're experiencing is a focus on emerging infectious diseases, which is what we're doing with the pandemic. So that is a nutshell what a comprehensive basic infection prevention program is in a healthcare setting. Great. And so for those organizations that maybe don't have some of those protocols in place, what are, you know, what are some of the general protocols that hospitals today should have? Yeah. No, thankfully, the protocols are quite accessible and available. In United States, for instance, CDC has a very comprehensive guidance or guidelines and recommendations when it comes to infection prevention protocols in a healthcare setting. And at the international level, obviously, the World Health Organization have quite similar and quite comprehensive infection prevention protocols as well available to healthcare settings. So, you know, you talk about the protocols and I want to think I'm thinking about the basic infection prevention programs or procedures that should be in place in any infection prevention program. I said that twice. You know, standard precautions being one of those, and I can talk about that in detail, transmission based precautions, you know, when we know what kind of disease we are dealing with and we know how it's being transmitted. There is vaccination or immunization program, both for patients and for employees. And then management of harm. And when I talk about harm in this context, I'm talking about exposures to infection diseases. So whether it's the patients or the healthcare workers being exposed to the diseases and how we manage them and how we support them. And of course, you know, again, I want to say education, healthcare worker education and patient education. So those are to me the main components, kind of the foundational elements of an infection prevention program, regardless of where you're at in the world. So with, you know, with that list that you just shared with us, I'm thinking of my 30 years in nursing. I mean, it feels like we've been talking about this for a long time. I wonder if you can tell us, you know, shed a little bit of light on what are the typical gaps that you see between these best practices that we know, and what's actually happening on the front line? Yeah. You know, I actually was thinking about this before our interview. And I want to start by saying that there is always a discrepancy between policy on paper and actual practice. And when we ask why, you know, for instance, a frontline worker, whether it's a nurse or an environmental staff or a physician, why they're not doing what they're supposed to be doing, the common answer is that they did not know that they were supposed to be doing this. And we kind of take that for granted. I think we're all guilty when we're doing auditing or adherence monitoring that, you know, this is just a usual kind of trying to explain a way of behavior. No, I did not know it. But when you do ask them probing questions, you do find out that they in fact don't know it. And it could be as basic as hand hygiene. It is surprising to me how we've been talking about hand hygiene or how to properly clean your hands, you know, from the very beginning. And we assume that healthcare workers know this by heart, but it's not true. And simple things like hand hygiene is not quite simple at all when you're applying it at your own work at the frontline. So I think knowledge or lack of knowledge of lack of understanding of technical aspects of anything cannot be taken for granted. So that's why I keep reiterating education. The other thing that is a reason for gaps is that the policy or the protocols as written, while it looks good in paper, is not quite practical or applicable when actually being applied. And when you're working with an actual patient in a real life environment, we find that we always have to adjust our policy and our procedure and expectations once a lot of people start implementing the policy. Because we are working with people and people are just not perfect. So they can have a policy. So they always find a way of making adjustments for a policy to be applied in their own environment and their own practice. And I'm finding that's okay as long as it's safe and it can be done. So the discrepancy between knowledge, between practice and the policies I think are the main gaps that we observe why there are gaps in compliance when it comes to infection prevention protocols. Wow, that's a really great point. I think we can pretty much apply back to everything. Yeah, it's one of our core principles that we believe for hospitals is we got to make it really easy for the frontline to know what to do. Otherwise they're not going to do the right thing. Yeah, and the other thing too that we forget, it just made me think of something is that we often write policies. And I think a lot of organizations are guilty of this, but especially in a system like ours, for instance, where we have our region, or we even have sometimes higher than that, and then you have medical centers underneath you. We are so serious and devoted to standardization that sometimes we forget that we're actually dealing with 21 medical centers, like thousands of different people. And standardization may have different meanings to different people. And almost always when we don't bring in the front lines at the very beginning, we get what we call drift, which I actually think is okay, because we haven't taken into consideration how a policy or protocol would be applied in real life. And then we're surprised why drift happens. Of course it happened because now it's being readjusted and being applied in real life. So that's fine. So anyway, frontline engagement to me, it's very much a critical element for standardization and what you're saying, reliability. You made me think of that. That's a great point. So for an organization who maybe doesn't know that there is a gap between what the frontline is doing and what the expectations are, what can healthcare leaders do to assess whether or not they have those gaps? Rounding, rounding, rounding. Actually going to the frontline, going to the unit. And auditing is one thing. Okay, we do need to audit. That's part of a formal program. You need to monitor adherence. So you have data and there are some regulatory requirements too for auditing. But when you're actually rounding and watching people do their job and having conversation with them, that's when you find out the gaps. And I think that it's more informative and more reliable than or more important than the information or data that you will get from auditing. When you're actually watching people apply the protocols or implement the policies or the initiatives that you've been sponsoring as a leader and listening to what they're saying, what they're finding, and the questions. And being able to hear what their questions are and you as a leader providing that feedback real time. So rounding is very important. And I've also said engaging the frontline. And what I mean by that is actually bringing in a frontline position or nurses or other ancillary staff into committee work or into oversight group so that you can hear what's happening where the work is actually taking place. So I think these are all like communication engagement in addition to adherence monitoring. So leader rounding to me is very important. And so do you have any other recommendations for what hospitals can do to improve their just their overall infection prevention plan for healthcare workers? Yes, I mentioned education being very important. And creating or supporting your your infection prevention program to have an education plan that takes into consideration the actual needs of the frontline and then supporting that program and supporting the frontline to have access to that education is important. And then the education cannot be just an annual education. It has well you need to have an annual education obviously, but it has to be flexible enough that you can pivot you can kind of change what you're offering depending on the needs of the frontline and depending on what's happening like what we were just talking about before we started the recording all that pivoting that your organization had to do because of the pandemic. So you need to have a program with that kind of flexibility and that can only happen if that's being supported by the leadership and the organization with resources where there's human time. Sometimes always money is quite important. And then letting people know that you know that there's this educational plan there's this educational offerings and giving people time to actually take advantage of the programs is important. And what about health workers themselves do you have any recommendations for what they can do to keep themselves safe from acquiring infection at work? Yeah, you know what really came through during the pandemic is to me individual responsibility. It's kind of ironic that given the accessibility of information nowadays that a lot of our frontline staff chose to be uninformed and I'm saying chose because it's hard to ignore the information that's coming through when it comes to benefit. Now it's kind of hard to navigate you know yourself through this all the information and the changing information that's coming through. But I find that our frontline workers tend to rely on their managers for information or tend to rely on their peers. Well sometimes it's important but trying to do their own research and educating themselves I think is it's not coming naturally to our frontline workers. So I think there is that there has to be an emphasis on individual responsibility when it comes to educating yourself as a healthcare worker as a healthcare professional. Asking your manager questions about policies or procedures that you do not understand making sure that you are asking the questions and escalating them and holding your manager responsible for the answers and making sure you're getting reliable answers. The other thing is holding your peers accountable for their actions and I don't need to audit or call out your co-workers but you know being watchful and watching out for that co-worker. If they're doing something that they're not supposed to be doing being able to call that out and have that conversation. But of course you can only do that if you know what the right thing is. So it is important to know what the right thing is not only for the safety of your patients but also for your own safety and that's very critical during the pandemic. As you said there is no patient safety if there's no healthcare worker safety especially with this pandemic. If you are sick yourself how can you care for your patients? How can you care for your family? So you just kind of contribute to the problems in the community when you do not care for yourself and as healthcare worker you know you are in a high risk environment. So you need to be extra careful than a regular person in the community and of course you need to be extra educated because of the environment that you're in. So individual responsibility when it comes to education and being healthy yourself and being watchful not just for yourself but for your co-workers too are important for our healthcare workers. Well that's a really really great point. I think you're absolutely right and I think as clinicians it is our responsibility to practice by policy but it is the organization's responsibility to make sure the policy is followable. That's right that's right and that makes sense. Right yes exactly that's right. Excellent well Christine thank you so much for joining us today. I really enjoyed talking with you and I hope we can have you back again to talk with us about another topic. Thank you so much for having me today.