A Day In The Life Of An APIC Board Member

Some of you will know that as a recreational hobby I am a keen cyclist. (the photo above is 16 of my fellow team members and myself at 6am this morning as we headed out for 2 and a half hour ride thorugh the rainforest). It’s a sport that I was encouraged to take up since moving to the Gold Coast, in southern Queensland, Australia in 2004. There have been a ton of fantastic physical benefits that I’ve enjoyed since taking up riding –fitness, flexibility, agility, balance and mindfulness. More importantly I’ve learnt an enormous amount about the value of teamwork. So in this posting I want to spend some time describing the team dynamics and explaining how my cycling experiences have helped me develop a  deeper appreciation for APIC and the many teams that contribute.

OK back to the bike. When I started out riding I knew nothing and I had no skill and no fitness. Within 2-days of riding a big clunky wide-wheeled recreational bike to the local coffee shop I spotted a flock of lycra-wearing cyclists. They each had a strange swagger as they headed up to the counter to order their coffees. (I later learnt the fine art of walking in cleated cycling shoes – I also learnt how failing to “click out” of your shoes at a traffic light invariably leads to a fall and some serious grazes, as well as hurt pride).

These same lycra-wearers invited my partner and I to join their table and after a few weeks of coffee they’d offered advice about trading in our bikes and upgrading. We did exactly that and so with thinner wheels and lighter frames  on our new hybrid bikes, (ie half mountain bike half road bike) we started to increase the frequency of our rides and the distance we covered. In those early days a 20-30 minute ride was about all we could muster but the whole time our cycling friends encouraged us, offering handy hints and providing critique of our cycling work. No-one ever laughed at us or made fun of us, rather they just kept telling us how good it was to ride, what beautiful adventures were just around the corner and importantly how everything we did in that year was setting us up for the next.

In February 2006 my father passed away somewhat unexpectedly and his death was a huge wake-up call to me. It made me realise that life is short and precious, that good health and physical activity matter and that his gene pool was not fabulous. To celebrate his life we upgraded to racing bikes. These are the ones that have rams horn handlebars and very thin wheels and even lighter frames. All the while our lycra friends were cheering us on. On lighter bikes and with some increased fitness we had a better chance of being part of the team and so we started riding more and more in groups or “packs” as they are more commonly called here. Tuesday, Thursday, Saturday and Sunday mornings we headed out – up hills, over bridges, through rainforest, along the beach, across the river, down the freeway, on the plane – you name it, our bikes took us there.

A wonderful new world opened up to us and as it did we realised how important it was to be part of a team. When you are riding in a pack it’s critical that you keep an eye on the rider ahead, you stay close so you can be pulled along in their draught but not so close that you “clip their wheel” and cause an accident. You also have to place your faith in the leader of the pack. The leader is the person out the front of the pack. Their job is to set the pace so that everyone can keep up and maintain a forward direction. The leader also keeps their eyes wide open, scanning the environment for oncoming traffic and scouring the road for pieces of debris and fallen trees obstacles such as potholes or glass.

The leader follows the signs – when they say STOP the pack STOPs, when the path is clear and it’s safe the leader calls “CLEAR”. The pack places their faith in the leader and they each follow but cautiously they also scan their environment and reaffirm the leader’s calls to those that follow behind them. Best of all in any good ride the person leading the pack changes, that’s how you avoid fatigue and how you develop up the leadership skills of novices. New leaders have to earn the trust and the respect of the pack.

A thoughtful leader doesn’t change the pace unless the environment calls for it. The new leader may lead in their own style but they always read the signs of the environment knowing that their main task is to deliver the pack safely back to the end of the ride which is often a coffee shop. A good leader also knows when they are fatiguing and asks for support and to be relieved. They rely on the pack for feedback and for inspiration.

If the pack is well lead the wheels turn well. The ride is smooth and the scenery absorbed. The rides can be exhilarating and action packed, they can also be calm and relaxing. Usually the pack negotiates the agreed pace at the beginning of the ride and that’s what the pack sticks too. If any member of the pack experiences difficulty such as a flat tyre or a wobbly seat a call goes up “flat tyre, stopping” – it reverberates back to the last rider and the pack stops their ride only beginning when the comfort and safety of all riders is assured. Throughout the ride pack members call “all on” and subtly you check to see that all who started out the ride are keeping up. If not the leader reviews the pace and gives everyone a chance to re-group.

As I explain  my interpretation of a great ride you may see the similarities between being a good and fair APIC leader and a good and fair leader of a group ride. The basic skills and approaches are very similar and while it is infrequent that I ever have the bike handling skills and athletic speed to lead my riding pack I truly hope that my experiences of being lead several times a week will continue to guide me and inspire me as I work towards being the best leader that I can for APIC. I hope that you’ve enjoyed this analogy and if any of you are riders let me know and please feel free to share any tips and tricks.

Here’s to good leaders, strong respectful teams and safe rides in and external to APIC!

 On Saturday evening just passed I had the privilege of attending the inaugural Wise Foundation gala as part of the AVA Annual Meeting in Savannah. The gala was a star-studded event acknowledging the critical contribution of Marcia Wise as a founder and life-long supporter of AVA. Marcia’s contribution to IV nursing over the past 30 or so years has been unwavering. Her commitment and contributions to AVA are salient reminders to all of us working voluntarily to improve member services and offerings through our professional organizations. Back to Saturday night…With a ballroom full of “legends” from the intravenous (IV) community and beyond, I was intrigued to find that there are actually Drs Broviac and Hickman, each being the designer and inventors of the respectively named vascular access catheters. Both gentlemen were humble in their contributions to nursing. You can’t help but wonder how many lives all around the world have been affected or touched by their original work.  Another highlight of the evening was the opportunity to reunite with two firm friends of APIC, Victoria and Armando Nahum. The Nahums are Atlanta-based advocates for best practice healthcare associated infection prevention. Their passion is palpable being based in the very premature death of their son as a result of an HAI. Subsequent to their son’s death Victoria and Armando have worked tirelessly in their lobbying efforts to bring HAIs to the attention of those in prominent places who have additional drive, resources and commitment. Given the similarities in their overarching goals, it was inevitable that the Nahums and APIC would collaborate and most recently this has included the release of the Hand Hygiene DVD developed in association with CDC. This DVD was designed for public education on the importance of hand hygiene and its contribution to HAI elimination. In several sites across the USA the DVD has been implemented as a part of routine patient admission process. What an incredible achievement and an important milestone in APIC’s extended reach and ability to harness the drive and creativity of partners.  The line between internal and external APIC partners narrows every year, a sign of the importance of APIC’s message penetrating around the world and to many communities in different parts of the worlds. Consumers are critical partners for APIC, our strategic partners from medical industry are also as are governments and regulators too.  In future years I suspect APIC’s target audience will be extended and more diverse than now. I look forward to being part of that diversity and learning new ways to do better in the business of HAI elimination. We often think that many hands add many germs, truly, many hands make light work. Given the enormity of the work that awaits us in fighting infections I say let’s welcome folks who share our commitment and our over-arching goals, the Nahums are one fine example and I encourage you to visit their website at www.safecarecampaign.org and think about other like folks that perhaps you know who would add value to your work as an infection preventionist – make them welcome today. From 30,000 feet somewhere between Savvanah and Orlando! Cath

This posting is being thrown out on Wednesday 10th September as I sit at Brisbane airport waiting to board a plane for Los Angeles, on to Atlanta and then ending up in Savannah for 3 days where I am attending the AVA Conference. It will be my first AVA meeting but I notice that the meeting has some great presentations relating to infection including reports from Dr Ruth Carrico, PhD who serves on the APIC Board and Dr Marcia Ryder and eminent researcher into biofilms and a keen contributor to APIC. It will be great to catch up with both of my colleagues. After Savvanah it”s a quick hop on the plane up (I think up) to Orlando where the APIC Board is spending Sunday through Tuesday with invited key opinion leaders at the Fourth APIC Futures Summit. The Annual Futures Summit provides a great opportunity to think-tank and brainstorm ideas that will hopefully build upon APICs 2012 Strategic Plan and also guarantee the best alignment with members and the rapid growth and diversity of Infection Prevention. As Chair of the APIC 2008 Strategic Planning Committee I am excited and enthusiastic about the Summit.  The Summit ends on Tuesday and I will spend 30 hours re-tracing my journey this time flying through Dallas to LA and onto Brisbane. Funnily enough I will miss the day of Wednesday next week all together due to date line and time zone effects. If I counted all the days I’ve missed traveling the Pacific since my early 20’s I think I’d still only be about 25 years old rather than my chronological age, which should never be published on the WWW. So it’s a busy few days for APIC, the Board and the staff from Washington. Their commitment to the organization is outstanding and they make every part of the journey worthwhile. The other great part is catching up with friends old and new, nothing brings APIC members together better than working towards a common goal. I’m hopeful that after this Summit we will have new vigour and vitality for APIC members including some further clarity through very contemporary and smart strategies similar to those we’ve worked with so successfully these past few years. Gotta fly, literally….stay well and keep the comments rolling. I like knowing that at least some of you are enjoying this blog.  Cath “the flying kangaroo” www.qantas.com.au 

I am thrilled to formally announce my candidacy for the 2009 APIC Elections.  Growing up in the suburbs of Sydney, Australia in the early sixties I could never have imagined the wonderful and rich life that lay ahead. With good support from a loving family, fantastic partner and precious friends many great opportunities have been available to me. Few are as exciting, challenging and rewarding as the potential opportunity to  work with the APIC members and leaders as an elected President. The APIC Nominating and Awards Committee and Board of Directors have endorsed my candidacy and elections typically begin in early September. As for all elections candiates are faced against each other. In this case whilst I don’t personally know the other candidate, Pat Kulich, we have exchanged several warm e-mails. I wish Pat the very best in her efforts to lead APIC and I celebrate that our organisation is fortunate to have two strong and committed members to select as potential Presidents. Far better than not having enough.  2008 will be an interesting year for electing officials in America. I hope that the APIC election adds to that interest and who knows it could be the year that previous trends are overturned. Are we ready for a non-US APIC President, I sure hope so. For your interest my philosophy and biography as they will appear on the slate are reproduced below. Good voting and best of luck to Pat.

Biographical ProfileAssociate Professor Cathryn L Murphy RN, MPH, PhD, CIC, MRCNA, holds an academic position in the Faculty of Health Services and Medicine, Bond University, Australia. In 1995-96 she was the elected President of the Australian Infection Control Association and subsequently a Founding member of the Asia Pacific Society for Infection Control (APSIC). She is currently serving a second term as the only active non-North American member of the APIC Board. Dr. Murphy’s career highlights include working in the Division of Healthcare Quality and Infection Prevention at the CDC, Georgia, USA in 2000 and for WHO throughout Southeast Asia during the height of the 2003 SARS Outbreak. She managed the largest state government HAI Prevention and Control Program in Australia from 1997 until December 2004 with programmatic responsibility for more than 200 hospitals. She is currently an independent, international consultant. In 2006 WHO invited Cath to join its Infection Control Expert Advisory Network. In 2007, the Australian Commission for Safety and Quality in Healthcare invited her to chair their Infection Control Implementation Committee. This committee is similar in function and reach to the USA’s HICPAC Committee. Widely published, Dr. Murphy is a member of the Editorial Boards of the Australian, American and IFIC Journals of Infection Control. She delivers provocative and powerful presentations with respect, humor and compassion. Personally Cath is a novice but committed tri-athlete. She subscribes to the philosophy “Love what you do and do what you love”, hence her long-term commitment to infection prevention. Her “Life is Good” and she dreams of global infection prevention harmonization.

Philosophy Statement

Although infection prevention drivers and practices vary greatly between countries ICPs around the world face similar opportunities and challenges. Imagine a world where ICPs worked in global harmony. A world where infection prevention success and innovations are celebrated. Where infection prevention frustrations are heard, criticisms acknowledged and improvements introduced. A world where like-organizations cooperate to provide safer care and much needed education. A world where healthcare workers are afforded their rightful protections against infectious disease. A world where governments, payors, corporations and citizens recognize APIC members as the world’s leading source of infection prevention expertise and capacity. As APIC members we can craft and nurture this world. It is the natural progression of an organization whose membership has invested the last forty years in refining our work, progressing our achievements and empowering our profession. As APIC President I will help the membership realize this world domestically in the USA and abroad.

 Having worked as an ICP in several different continents and across a range of settings – clinical, government, academic and commercial, I will continue to bring unique perspectives and new offerings to the APIC table. Moreover I will continue to respect and celebrate APIC’s rich history, the legacies of its previous leaders and the consolidation of its bright future. Most importantly, through cautious leadership and thoughtful succession planning I will endeavor to ensure the APIC organization, its Board and its staff continue to understand and meet the many needs of its current and future members. North American APIC has made a difference. Global APIC can make a bigger difference. Electing Cath Murphy as your first non-North American APIC President is more than just a symbolic gesture. It marks the beginning of a new global era for APIC. Visit www.cmurphy.com.au to learn more about my commitment to the APIC membership. 

In 2008 there are more countries with dedicated local and/or national programs designed to reduce or eliminate healthcare associated infections (HAIs) than at any other time in history. Interestingly the global infection control stage is becoming more crowded as non-traditional players including claim infection control expertise at either individual or organisational level. High level campaigns of global magnitude are becoming more common and regional organisations such as the Asia-Pacific Society of Infection Control (APSIC) continue to grow in membership size and influence. Additionally, the WHO has signalled its intention to establish multiple Infection Control Collaborating Centres. More interestingly, some see US-based organisations such as the Association for Practitioners in Infection Control and Hospital Epidemiology (APIC) and the Centers for Disease Control and Prevention (CDC) as continuing to have substantial influence in shaping our profession. Recent provocative US lead initiatives such as the impending change to reimbursement and the promulgation of the title “Infection Preventionist” will inevitably also influence the growth and direction of Australian infection control. I would strongly encourage all Australian ICPs to stay abreast of recent, critical global infection prevention trends and initiatives as well as they will inevitable impact us.      

 The photo on this page with my best mate Dee (far left) and friend Justine (far right) was taken in November 2007 minutes before we competed in the annual Noosa Triathalon. It was my first Olympic distance triathalon and represented a pinnacle of the past 18 months when I radically reviewed my lifestyle and health. There were multiple drivers and compelling circumstances that initiated the lifestyle changes. Throughout it all I have been and continue to be well supported and encouraged by wonderful friends and a great group of fellow fitness enthusiasts who coincidentally happen to be great coffee drinkers. Interestingly, I’ve noticed a direct parallel between increases in my physical fitness and increases in my professional growth and the career opportunities which have presented themselves.

Fighting infections and contributing effectively to a professional association like APIC requires enormous commitment and dedication. Planning is also critically important. Clarifying your vision, determining your mission and setting goals enables you to stay focussed and to gauge the effectiveness with which you are influencing behaviours and contributing to a safer patient care environment. They are critical elements of a succesful Infection Prevention program. Imagine then my amazement when I realised that achieving fitness and a healthy lifestyle and sustaining that lifestyle requires exactly the same skillset. The realisation was blinding and now seems so obvious.

Most days for me start with an exercise session. Typically it’s a ride or a run or a swim. Which activity it is is pre-planned according to a set program devised for me by an expert who also happens to be a great friend and a source of endless inspiration. Surrounding yourself with inspiring people who have expertise different to your own  is another strategy that can help goal achievement. However, just having a program and being inspired is not enough, there comes that critical time each morning when it’s easier and much more tempting to roll over rather than to get up and hit the road or the pool. Staying focussed and staying motivated are good tools to keep you on the path at this point. Just like taking regular exercise, staying focussed on preventing infections is really tough these days especially when healthcare systems all around the world are underresourced and typically understaffed. How do you get around it? Well one way is to just keep thinking of your goals and asking yourself if the work you are doing is consistent with those goals. Does it get you closer or further to them? Being prepared and having contingencies is another good strategy. Think about possibilities. What would you do if all of a sudden the Chief Executive Officer of your hospital who was a long term supporter of your Infection Prevention program announced his/ her retirement? Would your program fold or flourish? If an outbreak of some dreaded disease hit your hospital how would you cope? If you had good contingencies in place you would survive and in planning those contingenices you are setting yourself up for success not failure.

So in these few mixed but hopefully wise words of the day I hope I’ve started you thinking about new ways to increase your Fitness To Fight Infections, it’s probably the biggest Marathon you will ever face. Stay tuned for more updates as the Australian season of Summer sports rolls out! Google Noosa Triathalon 2008 if you have an interest in triathalons, but most importantly - keep up your personal and professional fitness, it’s really really important.   

The July 23rd, 2008 edition of The Sydney Morning Herald (see image above) carried a lead story about the intentions of the New South Wales Health Minister to publically release identifying healthcare associated infections (HAIs) data and rates from NSW Public hospitals. What an incredible piece of news and what far reaching implications it could have for Australian and regional infection prevention.

Many of you will be aware of efforts in the US over the past few years where various legislature has been enacted compelling states to submit and publically release their specific HAI data. You may also note that APIC through its leadership, membership and Government Affair’s experts, has continued to raise public and political awareness about HAIs and infection prevention. The APIC website details this recent history well at www.apic.org It is likely that Australian progress will be similar but not identical to our US and British infection prevention peers. However this unfolds I can’t help but recognise that Australian infection prevention is on the cusp of its most recent wave - may it be a great ride.

Below I have copied the content of a recent posting I made to our AICA E-discussion List in relation to this development. Few AICA members have commented but I am sure that each has a response to this initiative.

Since yesterday afternoon two very important infection prevention events have occured. Each will have national impact. The first is the release by the Australian Commission on Safety and Quality on Health Care (ACSQHC) of their Surveillance Report. I have reproduced part of an e-mail sent by the Commission to stakeholders yesterday. I would also strongly encourage AICA members to provide comment to ACSQHC individually and collectively from your state and national perspectives. This is a critical opportunity to influence the future direction of Australian infection prevention efforts.The second event is a frontline story in today’s Sydney Morning Herald where the NSW Minister of Health has responded to the Commission’s publication by indicating that within 3 months NSW will release hospital-identifying healthcare associated infections (HAI) data. Many of you will know that NSW Health has had this information available to it for all public hospitals since January 2003. Whilst there are undoubtably methodological issues which impact the validity and reliability of the NSW data (like every other large HAI data collection system in the world) this is a monumental development.It has the potential to change the way we do business and especially to change the expectations of healthcare consumers. I have closely watched the US public reporting debate unfold since late 2004 and I suspect Australia’s path will be equally challenging. If NSW does release this data routinely every other jurisdiction will likely follow. Our profession is under the microscope well and truly.

On 26th and 27th June I had the distinct pleasure of meeting with old friends and peers at the World Health Organization headquarters in Geneva, Switzerland. The meeting involved invited members of WHO’s Informal Panel of Infection Control Technical Experts and the main work undertaken on those two days was in relation to defining and scoping the core elements of an infection control program and the key role of infection control professionals.

The meeting was incredibly interesting not just from a technical point of view but largely because it involved internal and external representatives from each of the WHO’s Regions. 

I was thrilled to work alongside experts such as Prof. Wing Hong Seto (Hong Kong), Prof Ziad Memish (Saudi Arabia), Dr Mike Bell (CDC USA), Ms Shirley Paton (Canada) and WHO’s Program champions Drs Carmem Pessoa da Silva and Fernando Otazia. As I understand it a Report of the meeting will be forthcoming and once it has official WHO approval I suspect that it will be made publicly available.

As well as the 2 days of hard work the group also managed to enjoy some social down time at the Le Chateau de Penthes which is located close to WHO. In the photo above you will see Dr Bell and me outside of the Geneva School of Diplomacy & International Relations. I will leave it up to you to determine whether Mike and I were guest lecturers or students at the school????? Stay tuned for further stories from Australia and abroad.

Many APIC members ask me how do I manage to contribute to APIC activities and discussions when my base in Australia is at least 14,000 miles from APIC’s head office in Washington, DC. It’s actually much easier than you would imagine. For a start, my day is already more than 12 hours long when the first APIC staff and other Board members begin the same day. For example it’s now almost 7pm here in Queensland and it’s almost 5am the same day in DC. So my Monday in-box is almost empty and ready for all that APIC can throw at it while I rest up.

When I wake up and check my Blackberry I always have enough time to respond to any urgent requests and still make the end of the DC business day. It’s remarkable actually.

Probably the most difficult thing has been having to get up sometimes at 5am to start a 2-hour Board call. Or perhaps even worse has been staying awake to start an all-day conference call meeting in DC which starts at 11pm my time. Thankfully the few times I’ve needed to do that I’ve been up for the challenge and thankfully no-one on the other end gets to see my pyjamas!

Strangely the way that I do business with many of my peers in Australia now is by phone or occasional meeting. The rest of the time e-mails and Blackberries work wonderfully for us. I honestly think that time zones are irrelevant because if you really care about your role on the Board, as all the current Board members, we all make sure where there for when it matters.

That said, it’s always great to meet my Board colleagues face to face and I am excited about that opportunity late next week in Denver.