Newbie Academy: From Struggling to Structured

An Infection Preventionist (IP), whom we’ll call Newbie, was hired by the local hospital health system in 2005. Newbie had no previous hospital-based infection prevention and control (IPC) experience but was young, energetic, self-assured, and highly motivated to learn. She loved a good challenge, but how hard could it be, really? Infection preventionists (IPs) just stand around and watch people wash their hands, right?

The honeymoon onboarding phase went reasonably well; Newbie was assigned to Kathy, a mentor and a seasoned IP. Newbie followed Kathy around on the hospital units, accompanied her to meetings, watched her teach staff how to don and doff personal protective equipment, and, of course, assisted her by holding the clipboard while she completed hand hygiene audits. Hospital life was grand, and the job was somewhat easy, so long as Kathy was around to identify and put out all the IPC-related “fires”. This IPC thing was light work, thought Newbie.

After just two weeks, to Newbie’s surprise, Kathy decided it was time to loosen the reigns and let Newbie “run point”. Kathy took a two-week vacation, leaving Newbie to captain the department! A day or two went by, and it didn’t take long to see that Newbie was beyond the IPC onboarding phase and was instead considering jumping overboard. Within one week of being left to sink or swim, Newbie felt like she was steering an out-of-control vessel. There was no shortage of IPC issues. Hand washing observations became the last thing on Newbie’s to-do list. Much larger and pressing events met Newbie every day, and she began to panic.

Newbie realized that her on-the-job training was insufficient. How was Newbie supposed to know what to do with a water leak in the oncology ward, a norovirus outbreak on the inpatient rehabilitation unit, lice infestation among the patients and staff on behavioral health, uncooperative surgeons wanting to know why the temperature and humidity were too high in Operating Room #6, a positive legionella sample from the facility’s water cooling tower, three new cases of C. difficile on the medical/surgical unit, and an expectant mother in labor with an active TB infection (who refused to wear a mask). How would Newie know what to do when the EVS staff called to complain that they couldn’t breathe when they were using the new hospital-approved disinfectant? How should Newbie respond to an influx of six pediatric patients in the ER who all had GI symptoms and who all reported recently having swum in the local lake?

And who does Newbie contact if the health department won’t answer the phone at 4:30 on a Friday afternoon to alert them of the potential enteric pathogen outbreak? Newbie didn’t even know what an enteric pathogen meant.

Where could Newbie turn for guidance when the chief neurologist called and said that he needed her to contact a medical academic facility who was willing to accept a brain that was likely infected with Creutzfeld-Jakob Disease (CJD)? Oh, and what should sterile processing staff do with the surgical instruments that came in contact with the affected brain? Finally, what should Newbie do with a bug that was mysteriously left in a urine collection container on her desk to prove there were bugs on the pediatric playroom floor?

Okay, so all these events took place in more than a two-week time span, but the events took place, and Newbie was unprepared and overwhelmed. How do I know? I was Newbie. I was that young, naive, ill- prepared, yet super motivated IP. I was willing to take the bull by the horns and take on any issue that dared to come my way. I took each unknown situation and quickly researched evidence-based practices, guidelines, regulations, and recommendations. I was flying by the seat of my pants, but I was flying, and more importantly, I was learning. I was learning how to operate under pressure, exert leadership, and use my resources wisely.But what would the story look like if I was not a motivated, challenge-driven IP? What if I let myself sink in the IPC-related issues and just counted down the days until my mentor returned? I would have been fired; more importantly, patients and staff could have been harmed. An Infection Preventionist (IP), whom we’ll call Newbie, was hired by the local hospital health system in 2005. Newbie had no previous hospital-based infection prevention and control (IPC) experience but was young, energetic, self-assured, and highly motivated to learn. She loved a good challenge, but how hard could it be, really? Infection preventionists (IPs) just stand around and watch people wash their hands, right?

The honeymoon onboarding phase went reasonably well; Newbie was assigned to Kathy, a mentor and a seasoned IP. Newbie followed Kathy around on the hospital units, accompanied her to meetings, watched her teach staff how to don and doff personal protective equipment, and, of course, assisted her by holding the clipboard while she completed hand hygiene audits. Hospital life was grand, and the job was somewhat easy, so long as Kathy was around to identify and put out all the IPC-related “fires”. This IPC thing was light work, thought Newbie.

After just two weeks, to Newbie’s surprise, Kathy decided it was time to loosen the reigns and let Newbie “run point”. Kathy took a two-week vacation, leaving Newbie to captain the department! A day or two went by, and it didn’t take long to see that Newbie was beyond the IPC onboarding phase and was instead considering jumping overboard. Within one week of being left to sink or swim, Newbie felt like she was steering an out-of-control vessel. There was no shortage of IPC issues. Hand washing observations became the last thing on Newbie’s to-do list. Much larger and pressing events met Newbie every day, and she began to panic.

Newbie realized that her on-the-job training was insufficient. How was Newbie supposed to know what to do with a water leak in the oncology ward, a norovirus outbreak on the inpatient rehabilitation unit, lice infestation among the patients and staff on behavioral health, uncooperative surgeons wanting to know why the temperature and humidity were too high in Operating Room #6, a positive legionella sample from the facility’s water cooling tower, three new cases of C. difficile on the medical/surgical unit, and an expectant mother in labor with an active TB infection (who refused to wear a mask). How would Newie know what to do when the EVS staff called to complain that they couldn’t breathe when they were using the new hospital-approved disinfectant? How should Newbie respond to an influx of six pediatric patients in the ER who all had GI symptoms and who all reported recently having swum in the local lake?

And who does Newbie contact if the health department won’t answer the phone at 4:30 on a Friday afternoon to alert them of the potential enteric pathogen outbreak? Newbie didn’t even know what an enteric pathogen meant.

Where could Newbie turn for guidance when the chief neurologist called and said that he needed her to contact a medical academic facility who was willing to accept a brain that was likely infected with Creutzfeld-Jakob Disease (CJD)? Oh, and what should sterile processing staff do with the surgical instruments that came in contact with the affected brain? Finally, what should Newbie do with a bug that was mysteriously left in a urine collection container on her desk to prove there were bugs on the pediatric playroom floor?

Okay, so all these events took place in more than a two-week time span, but the events took place, and Newbie was unprepared and overwhelmed. How do I know? I was Newbie. I was that young, naive, ill-prepared, yet super motivated IP. I was willing to take the bull by the horns and take on any issue that dared to come my way. I took each unknown situation and quickly researched evidence-based practices, guidelines, regulations, and recommendations. I was flying by the seat of my pants, but I was flying, and more importantly, I was learning. I was learning how to operate under pressure, exert leadership, and use my resources wisely. But what would the story look like if I was not a motivated, challenge-driven IP? What if I let myself sink in the IPC-related issues and just counted down the days until my mentor returned? I would have been fired; more importantly, patients and staff could have been harmed. An Infection Preventionist (IP), whom we’ll call Newbie, was hired by the local hospital health system in 2005. Newbie had no previous hospital-based infection prevention and control (IPC) experience but was young, energetic, self-assured, and highly motivated to learn. She loved a good challenge, but how hard could it be, really? Infection preventionists (IPs) just stand around and watch people wash their hands, right?

The honeymoon onboarding phase went reasonably well; Newbie was assigned to Kathy, a mentor and a seasoned IP. Newbie followed Kathy around on the hospital units, accompanied her to meetings, watched her teach staff how to don and doff personal protective equipment, and, of course, assisted her by holding the clipboard while she completed hand hygiene audits. Hospital life was grand, and the job was somewhat easy, so long as Kathy was around to identify and put out all the IPC-related “fires”. This IPC thing was light work, thought Newbie.

After just two weeks, to Newbie’s surprise, Kathy decided it was time to loosen the reigns and let Newbie “run point”. Kathy took a two-week vacation, leaving Newbie to captain the department! A day or two went by, and it didn’t take long to see that Newbie was beyond the IPC onboarding phase and was instead considering jumping overboard. Within one week of being left to sink or swim, Newbie felt like she was steering an out-of-control vessel. There was no shortage of IPC issues. Hand washing observations became the last thing on Newbie’s to-do list. Much larger and pressing events met Newbie every day, and she began to panic.

Newbie realized that her on-the-job training was insufficient. How was Newbie supposed to know what to do with a water leak in the oncology ward, a norovirus outbreak on the inpatient rehabilitation unit, lice infestation among the patients and staff on behavioral health, uncooperative surgeons wanting to know why the temperature and humidity were too high in Operating Room #6, a positive legionella sample from the facility’s water cooling tower, three new cases of C. difficile on the medical/surgical unit, and an expectant mother in labor with an active TB infection (who refused to wear a mask), How would Newie know what to do when the EVS staff called to complain that they couldn’t breathe when they were using the new hospital-approved disinfectant? How should Newbie respond to an influx of six pediatric patients in the ER who all had GI symptoms and who all reported recently having swum in the local lake?

And who does Newbie contact if the health department won’t answer the phone at 4:30 on a Friday afternoon to alert them of the potential enteric pathogen outbreak? Newbie didn’t even know what an enteric pathogen meant. Where could Newbie turn for guidance when the chief neurologist called and said that he needed her to contact a medical academic facility who was willing to accept a brain that was likely infected with Creutzfeld-Jakob Disease (CJD)? Oh, and what should sterile processing staff do with the surgical instruments that came in contact with the affected brain? Finally, what should Newbie do with a bug that was mysteriously left in a urine collection container on her desk to prove there were bugs on the pediatric playroom floor?

Okay, so all these events took place in more than a two-week time span, but the events took place, and Newbie was unprepared and overwhelmed. How do I know? I was Newbie. I was that young, naive, ill-prepared, yet super motivated IP. I was willing to take the bull by the horns and take on any issue that dared to come my way. I took each unknown situation and quickly researched evidence-based practices, guidelines, regulations, and recommendations. I was flying by the seat of my pants, but I was flying, and more importantly, I was learning. I was learning how to operate under pressure, exert leadership, and use my resources wisely. But what would the story look like if I was not a motivated, challenge-driven IP? What if I let myself sink in the IPC-related issues and just counted down the days until my mentor returned? I would have been fired; more importantly, patients and staff could have been harmed.

So, how is it that we expect Newbie’s (like I once was) to be adequately prepared to handle all the IPC-related situations that might come along? If you’ve worked in IPC, it doesn’t take long to know that every day is a different adventure. You go into the office with a to-do list that never gets done and leave wondering where the day went. You never know what the next situation will present, but you do know that there are people counting on you to make the best decision to protect patients and staff. It is your duty and call to be the best IP you can be. Research has shown that most IPs learn by self-teaching and learning on the job. In fact, a study published in AJIC (2017) found that 31%-65 % of IPs reported that at least one or more of the major IPC competency topics were either self-taught or learned on the job: Identification of Infectious Disease Processes (31%), Surveillance and Epidemiologic Investigation (34%), Preventing/Controlling Transmission of Infectious Agents (32%), Employee/Occupational Health (65%), Management and Communication (53%), Education and Research (39%), Environment of Care (57%), Cleaning, Sterilization, Disinfection and Asepsis (39%) (Kalp, Marx, Davis, 2017). Are self-teaching and learning-on-the-job approaches the most efficient and effective ways to train our newbie IPs? There is arguable value in self-teaching and on-the-job training, but those approaches leave so much to variation and pure chance. For example, what if the IP didn’t have the initiative to seek out the information? What if the assigned mentor is not motivated to train the newbie? What if the on-the-job training is as good as learning the bad habits and shortcuts from previous IPs in that role? Since each day is so different, it is important that an IP has a structured and methodical opportunity to learn, practice, and process the many required competencies of infection prevention and control practice within the healthcare setting.

IPs no longer need to rely solely on self-teaching and on-the-job training. In the past decade, several higher educational institutions have recognized the need for and the value of structured infection prevention and control education. Various types of infection prevention and control academic programs are now available to current and future IPs. The academic programs range from certificate programs and minor degrees to master’s level programs. Each was purposefully created to meet the needs of our current and future IP generation.

I’ve come a long way from my first newbie IP experience, but it is from that experience that I am passionate about teaching and training the next generation of IPs in a structured, methodical manner. I recognize that adult learners benefit from various structured ways of teaching to retain IP knowledge and put it into practice. I have the privilege to co-direct Drexel University’s Dornsife School of Public Health’s Infection Prevention and Control Academic Program. I create and teach infection prevention and control courses that will prepare students to work in the IPC field. Through the evidence-based course work, peer interactions, and problem-based learning opportunities, students can learn about healthcare-associated infections, explain public health reporting requirements, identify infection prevention and control strategies in healthcare settings, understand prevention practices related to maintaining a safe and clean healthcare environment, and develop leadership skills necessary to infection prevention and control administration. Courses such as Epidemiology, Disease Outbreak Investigations, Environment of Care, Surveillance of Healthcare Associated Infections, Healthcare Safety, Industrial Hygiene, Microbes in Public Health Practice, Public Health, and Biostatistics are a sampling of the potential courses in which current and future IPs can engage. By participating in these courses, students can work through IPC-specific case-based scenarios, experience peer-to-peer interaction and feedback, and learn from clinical professors who have dedicated their entire careers to infection prevention and control. In hindsight, I wish that the IPC academic training opportunity had been available to me, but fortunately, I was goal-driven and had many mentors over my career who pushed me and challenged me to be the best IP possible. I am grateful for the mentorship experience. The good news is that the opportunity to learn infection prevention and control is available, and with some programs online, there is a widening availability to rural-based IPs. I encourage you to explore the various programs to expand your role and understanding of infection prevention and control.

Reference
Kalp, E., Marx, J.,& Davis, J., (2017) Understanding the current state of infection preventionists through competency, role, and activity self-assessment. American Journal of Infection Control (45) 589-96.