In 1979 with the Sudden Death of Carole De Mille, Infection Prevention Lost One of Its Pioneers

In 1979 with the sudden death of Carole De Mille, infection prevention lost one of its pioneers. I never had the good fortune of meeting Carole but her work and her efforts in the early days of our profession have had a profound and indelible impact on patients and healthcare workers across the world. As I struggled to find just the right message to convey today I wondered what Carole would think if she could be here with us.

What would she think about how public policy is redefining our core role? What would she think about our proposed name change? What would she think about our strategic pursuit of members with expertise other than pure infection prevention? What would she think about our relationships with medical industry? What would she think about globalisation? What would she think about our rapid and our phenomenal growth? What would she think if she walked in to this room right now and sat down beside you?

So rather than wonder I decided to sit and on behalf of the members and staff of APIC to write a letter to Carole, a simple good old fashioned letter on paper, a letter of openness, a letter of honesty and a letter or gratitude. But of course I can’t deliver this letter to Carole, well not yet anyway and so perhaps the next best thing is to share it with each of you and so here goes......

Dear Carole

Although we never met I wanted to take just a few minutes to introduce myself, to bring you up to date on APIC and to say thank you to you and your friends who so graciously gifted us with the profession of infection prevention.

My name is Cath Murphy and it’s been my privilege to serve APIC in 2010 as its first non-North American President. You would appreciate what a steep learning curve it has been. I know I have not mastered it. I never will, but in my quest I have been blessed by the support, encouragement and loyalty of lifelong APIC friends, trusted mentors, heroes, a stellar staff from headquarters, an army of volunteers, a skilled, wise and strategic Board and a general membership of the world’s most committed, indefatigable and passionate preventers of infection.

I imagine that there is a heaven for old infection preventionists and I know full well that you earned your right to be there. I suspect in many ways it must seem like a direct contrast to the unbearable conditions many of our APIC members report enduring day after day. Yes Carole, it’s tough here in infection prevention in 2010. Around the world and in the United States especially, our members are facing a slew of increasing demands. They tell us how their infection prevention programs have been stripped bare. There just never seems to be enough resources, support, hands or money available to enable them to deliver the services they so desperately want to or to provide the level of care and protection that they know their patients and staff need and expect.

Recently APIC members from Washington DC, Virginia, South Carolina, Ohio, Illinois, Georgia, Texas, California, Asia and Australia haven spoken with me. They really are frustrated. Many are at the end of their tether.They are teetering on the edge of burnout and clearly questioning their willingness to continue in theirrespective roles as infection preventionists. A conversation with a member from California was especially concerning. The member told me of her concerns and in doing so she thanked me for all that APIC has done in providing her with practical tools, resources and education. She recognised and valued how APIC was helping her to interpret the science and apply it at the bedside. As well, she especially appreciated APIC’s advocacy work on Capitol Hill. She recognised APIC’s expertise in crafting, shaping and critiquing infection prevention-related legislation and in advising the many regulatory agencies who now either directly or indirectly impact the nature of services our members are compelled to deliver. As we neared the end of our discussion I asked her a simple question “Do you still enjoy Infection Prevention?”, she paused and reflected before responding “I want to and I need to. I think with APIC’s help I can” So in that resting place for weary infection preventionists Carole can you please reserve spaces for at least 14,000 of us, in due course we’re surely going to need them and I know all of APIC’s members will have earned them. Till then we’re proudly standing tall and strong.

One of the most rewarding aspects of being an APIC leader has been the opportunity to engage with members. It’s enlightening to hear and better understand members’ opinions and viewpoints and I am proud that many members have the courage and passion to express their independent opinions. I am particularly pleased if some of those expressed opinions differ from the Board’s view. The rights to form and express an independent view and to have that view heard and responded to are fundamental rights. The APIC leadership interprets the exercise of those rights by members as signs of a healthy, passionate and thoughtful membership. I am sure that in its early days, as it has been ever since, the reaching of consensus through careful consideration and debate, was a underlying principal upon which APIC was built.

Probably the best and most recent example of lively debate is that of the Board’s proposal to change APIC’s name to “The Association for the Prevention of Infection. Some of APIC’s members are not in favour of the change.In 2009 we sought advice from our members by way of a vote during the annual elections. The clear majority who voted on the issue favoured the name change but under our rules we missed the needed 66% majority by less than half a percent. In reviewing the results of the 2009 vote the Board noted the message from the majority. As a result we are once again seeking a mandate from the membership by way of a vote on the proposal. The decision to again vote on this issue originated and has been promoted entirely from the Board. We firmly believe that the proposed new name more clearly reflects the organisation’s mission and the core business of our members.

Members have expressed concern that by removing the word “professional” from our title APIC is inadvertently de-emphasising our founding and core membership from the frontlineinfection preventionists. Some members are concerned that without “professional” in our title we expose APIC to the risk of one day being led or influenced by individuals without experience at the frontline. The APIC Board appreciates, understands and has considered this perspective.We refute it nonetheless. Clearly, as with every decision we make, the needs of our members are fundamental. However, the overriding question the Board must and does consistently apply to every decision is not “what does this mean to members” but rather “is this decision the very best one for APIC in terms of pursuing achievement of its strategic goals.” Carol if we honestly review and critique APIC’s achievements since you founded us what becomes blindingly clear is that as an organisation we have unrelentingly pursued the prevention of infection. AS you wanted us to, we have done and will continueto do just that, in ever broadening contexts, in ever expanding settings and in ever evolving formats all around the world. Our ability to bring our unique skills as experienced, skilled and hopefully certified infection preventionists to collectively prevent infection, with more people and in more places than any other organisation is what makes us professional. It makes us special and it helps guide our patients to a safer place.

Our work with people from a range of backgrounds has developed strategically and we have pursued opportunities to work with, learn from and educate consumers, legislators, manufacturers and advocates many of whom have been personally affected by healthcare associated infection. More recently, and especially in the US, a range of self-appointed experts in infection prevention have begun attempts to assert authority, assume prominence and build recognition in regard to their ability to influence the delivery and future direction of infection prevention. For APIC, aligning and working with these groups often brings great opportunities for symbiotic relationships. Relationships that assist our pursuit of the organisation’s strategic goals. However, some of our members understandably perceive the involvement of non-hospital based, non- traditional infection preventionists as a potentialerosion of APIC’s perceived power. In contrast, APIC’s Board encourages our members to view it instead as an injection of diverse views, different perspectives and complementary skills. This injection is evident in changes in APIC’s membership demographics. We are seeing small increases in the proportions of members employed in senior leadership positions, those practicing medicine, those leading Quality and Patient Safety Departmentsand those working in non-hospital settings such as ambulatory care and long-term care. May we continue to warmly welcome these new players and become an even more influential and inclusive body of professionals as a result of the additional expertise they offer. May we be the first and foremost organization they turn to.

Carole, your role as a founder of infection prevention shows us you were a person of great vision. I believe that were you with us now you like us would be grateful for and appreciate the value of APIC’s Strategic Partnership Program. This program was introduced by the 2006 Board of Directors with every subsequent Board considering it a legitimate and innovative way to partner with our peers in medical industry. The program has enabled APIC members to enjoy an extended range of offerings such as webinairs, Elimination Guides and most recently to offer an exciting and unparalleled new suite of comprehensive online learning tools and content in APIC ANYWHERE. Our relationships with industry also afford members the opportunity to inform research and design and to provide valuable user and market insights and feedback.

When you began your career in infection prevention in the late 1970’s the task of preventing infection must have seemed insurmountable. Unlike those of us working towards that goal in 2010 you didn’t have the luxury of a body of evidence. A body of evidence preserved forever in the pages of our Journal, AJIC. A body of evidence that underpins the guidance and directives issued by our peers and friends at the Centers For Disease Control and Prevention. A body of evidence we call upon to help inform our political leaders. A body of evidence that reflects the life works of thousands of researchers, academics, laboratorians and clinicians. A body of evidence that highlights the ongoing need for us to find practical, affordable and sustainable solutions. Increasingly APIC members are appreciating that finding those solutions is not our task alone. It requires collaboration and direct input from at least six stakeholder groups – government, professional associations, medical device manufacturers, health executives, clinicians and patients. In 2010 we recognise the critical importance of APIC’s partnerships with these groups in providing our members the best hope of achieving their collective goal of greater prevention of infection globally.We’re looking forward to travelling that path together.

Yes Carole you heard me correctly - APIC in 2010 is global APIC. It is an APIC seriously investing in and shaping the delivery of infection prevention all around the world. Could you have ever imagined the global ramifications of the work of you and your fellow pioneers? Did you ever envision us as an organisation with active members in more than 41 countries? Did you ever think we would have an active Chapter in the Middle East? Did you ever expect AJIC’s Editorial Board to include representatives from France, Malta, Australia, the United Kingdom, Canada, Wales, India, Nigeria, Spain, Switzerland, Argentina, Germany, South Africa, The Netherlands and Taiwan?Working across so many cultures brings unique challenges to APIC, things like differences in language, time zones, cultural norms, healthcare structures, resources and technologies. Those challenges are actually minor compared to the richness that APIC has experienced from the greater involvement with international peers and agencies. In 2010 our members are spreading knowledge and preventing infection all round the world.

Obviously the Internet, e-mail and social networking surfaced after you left us but those mechanisms have really revolutionised the ability of our members to connect, with each other and with the leadership of the organisation irrespective of where that member is located geographically. The Chapter model you introduced remains a cornerstone of APIC. Our Chapters continue to provide a unique and local community for members to share. We recognise that for our International Members the opportunities to meet in person are less frequent and to meet their need to connect we are currently developing a “Virtual” International Chapter which promises to offer them their own unique APIC portal. You see Carole that unique Chapter model has served us well and even decades after its inception it enables APIC to rapidly reach large numbers of infection preventionists in every corner of the globe.Our ability and track record in rapidly distilling and sometimes collecting information for the purposes of sharing and informing are great examplesof APIC’s reach.Remind me in my next letter to tell you about our MRSA and C. Difficile prevalence surveys, our E-news and our APICList. More great examples of how we stay connected and how we continue to excel in an increasingly crowded field.We are APIC EVERYWHERE.

Another way in which we excel is in our sheer volume. Could you have ever fathomed that from its humble beginnings in the early 1970s with membership in the single digits that APIC would grow to almost 14,000 members? APIC’s membership has grown year after year after year but only in the last four years have we seen explosions in our membership and our budget. Coincidentally that budget now peaks at almost 12 million $USD. There is no doubt, several factors influenced that explosive growth. Things like increased media attention, increased regulatoryactivity, increased consumer demand and the like. However to some extent those issues have always been part of our landscape. The one unique and obviously successful difference in the last four years has been the hiring and retention of our CEOand world class staff. No one individual can take credit for APIC’s growth, rightly nor should they. Regardless, Carole without a doubt you would enjoy the opportunity to meet, engage with and work beside APIC’s staff. They work tirelessly to respond to our members’ needs and they advocate on their behalf.Most are not clinicians, they don’t profess to be.They haven’t provided direct clinical care to patients, they dont need to.Carole, what they do is nonetheless special and I know it would please you as it pleases the Board and our members. They share your dream of forty years ago, they embody the principles you graced us with and they put them into action every day. We do too. Some of us do those things well, some of us do those things really well and some of us do those better than the rest of us – the 31 recipients of our Carole De Mille Award have done it best, you showed them how.They followed in your footsteps.

So Carole

I’ve told you lots of stories, I’ve shared my biggest fears,

I’ve done it with great pride but I’m holding back the tears

You now know about your APIC, the one you helped us build.

You’ve heard about its growth, you know it leads the field;

I wonder how you find us? I wonder are you proud?

Should we bask a while in sunlight or cower under cloud?

Have we carried on your passion, your integrity, your direction?

Have we honoured your intention, your vision and your perfection?

Have we been relentless, successful and courageous,

How do you really find us? Well intended or outrageous?

Have we made preventing infectionappealing, perhaps inviting

Would it still attract you, would it be exciting?

Whatever your answer, whatever your view

On behalf of APIC, its members and its crew,

Let, me say it loudly

Carole De Mille rest well, we miss you, and

Thank You

1