Agent of Change: Q&A with Julie Gerberding

Our core business has not changed. We intend, if anything, to do a better job.’

[Editor’s note: We asked Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention’s division of healthcare quality promotion to comment on the restructuring of the old hospital infections program.]

Q. What role do you see for infection control professionals and hospital epidemiologists in these ongoing changes at the CDC?

A. "Leadership for accomplishing these [CDC goals] requires expertise, experience, and commitment. Certainly, the ICP and the hospital epidemiologists have all three of those credentials. It’s one thing to believe something is important and good to do, and it’s another thing to have the power to make the decisions that will matter. For example, ICPs don’t necessarily make prescribing decisions. We have to be able to include the clinicians and prescribers in the effort. In order to accomplish that, we have to get buy-in from a broader group of people than our traditional constituents."

Q. Could this change the ICP job? Some have suggested they should be given a broader title such as epidemiologist and get more involved in noninfectious adverse outcomes.

A. "There is clearly a spectrum of infection control professionals that are functioning very much in the epidemiology domain; some are very much in quality management, quality promotion — more generically than just infections. And some of them still are in a situation where they are doing much more traditional types of bedside surveillance and so forth. So there is a spectrum of practice, and one should not necessarily eschew the other. But there may be some real opportunities here for enhancing capacity membership [in the profession]."

Q. In an economically strapped health care system facing a nursing shortage, how realistic is your long-term program goal of eliminating health care-acquired infections?

A. "[Patients] want to know Why did I get this infection, what went wrong, and what could have been done to prevent it?’ If you take a more population basis [view] — where you say some infections are OK — that may be fine in terms of the big picture. But that is losing that individual patient in the process. A lot of times, even with a very sick patient who gets a complication, there is something that we can learn. Or at least in retrospect something that we consider that we might do differently next time. So we are kind of creating a system where you examine adverse events — not to assign blame or shame — but rather to ask what can we learn from this that either might have prevented the infection or lead to a better result the next time we are in a similar situation?"

Q. Inclusion of bloodstream infections is being discussed as part of the data collected in patient safety systems. Will that be in the context of a preventable, medical error?

A. "The challenge is to not threaten people with the notion that if an infection does occur, then it is bad or somebody [made an error]. We want to create a healthy environment of learning evaluation without punitive consequences. We are not trying to frame this patient safety issue as an error issue. We recognize that some adverse events are errors and some are not preventable. But [we are] thinking of it more as patient safety, though it is clearly addressing the public issues about medical errors. I would not really want to advertise an error-reporting system. I am much more comfortable with the notion that this is an opportunity to have NNIS-like [surveillance] where we are measuring something in an ongoing way. People can learn from comparing themselves to that measurement standard and strive to consistently lower [their rate] and improve."

Q. Will the CDC still be conducting outbreak investigations and have an epidemiology intelligence service?

A. "Our core business has not changed. We intend, if anything, to do a better job with it."