In the Spotlight
Molly Blake
Molly Blake is the Program Director for Regional Infection Prevention and Control (IP&C). She has been in this position since August 2013 and in IP&C for the majority of her career, working in that capacity at both Riverview Health Centre and Health Sciences Centre. Previously, Molly worked as a front-line nurse, delivering bedside care at St. Boniface Hospital and Riverview Health Centre. While the position she currently holds wasn't on her radar when she was in nursing school, Molly acknowledges she's passionate about her work and committed to Infection Prevention and Control and its contribution to patients' safety.
What are your main responsibilities in your current position?
A large part of my role is relationship building, collaborating, and communicating with key IP&C stakeholders, both within the Region, and beyond.
As program director for a regional program where safety is at the core, I work as part of a team to support and guide staff in the development and implementation of evidence based IP&C recommendations with the goal of improving patient safety in all delivery settings. For example, different environments require different IP&C protocols based on transmission risk in that setting . . . what is best practice in the community is different from what is best practice in an acute care facility with specific rationale to support the different approaches.
IP&C is broader than the patient perspective. It's about reducing or preventing transmission. So when a nurse protects patients with IP&C practices like hand hygiene, they also protect themselves - and the people they go home to, because you can take those practices home with you.
What role does IP&C play in health outcomes?
A principle of Routine Practices is that microorganisms can be spread from symptomatic and asymptomatic individuals, in any health care setting - just because you can't see it, doesn't mean it's not there; just because they don't 'look infectious' doesn't mean they aren't.
Influenza, for example, doesn't show for one to three days, but communicability starts one day before symptoms begin. Therefore adhering to Routine Practices, at all times, for all patients, in all health care settings needs to be the foundation to prevent organism transmission during care.
This is why IP&C has to be on people's radar all the time (not just during an outbreak or when it hits the news). It would be great if IP&C practices like hand hygiene were embedded in our healthcare culture so they're as familiar and automatic for people as brushing their teeth, putting on their seatbelt, or putting on a jacket when it is 40 below.
Often one of the barriers to IP&C practices like hand hygiene is that people are not able to immediately and clearly see the impact to the patient and connect the dots to patient outcomes, despite the literature. It's hard to show that because Jo didn't wash his/her hands at 2pm on Thursday prior to suctioning, person X has an E.coli pneumonia a few days later, or that because hand hygiene is exceptional on a unit they have very few healthcare acquired infections attributed to the unit.
Learning the basics of IP&C is really important so people can have a level of comfort with them in their daily practice routine (and they need to be part of your practice routine). This way when something out of the ordinary arises, health care providers are not trying to learn the basics of IP&C in a situation with a significantly heightened level of anxiety. Ebola has highlighted this well.
I've personally seen the impact of IP&C measures. I have a nephew who spent the first month of his life in NICU, where the staff paid particular attention to IP&C measures. He's eight now and cleans his hands better than some adults I've seen. My husband also spent a significant length of time in different hospitals within the WRHA - he experienced excellent IP&C practices (thank you GD6 staff). He also experienced less than stellar practices, and consequently suffered from HAIs (hospital acquired infections) as a result.
What do you want nurses to consider about hand hygiene?
I would ask nurses to consider hand hygiene at all times - whether at work, at home, or at play. Adherence to hand hygiene recommendations is the single most important practice for preventing the transmission of microorganisms in health care, and directly contributes to patient (and staff) safety. When hand hygiene isn't performed as recommended, staff contradicts their own efforts to improve patient health and safety. Follow the 4 Moments for Hand Hygiene; this way you're not taking germs into a person's room with you, eating them with your lunch or taking them home with you.
I would also ask they consider leveraging the benefit of their proximity to the patient to empower patients to do the same. That is, perform hand hygiene to have active roles in their own health. Nurses are in the prime position to educate patients and their families about their role in safety, including hand hygiene. A nurse can let patients know times where it's helpful to clean their own hands, and let them know it's okay to ask their health care provider to clean their hands. This allows people to invest in their own care, and it can positively impact outcomes.
You've spent the majority of your career in IP&C. Why?
I'm passionate about IP&C. I believe we truly impact safe patient care. I think I'm doing exactly what I'm supposed to be doing. IP&C sticks our (clean) fingers everywhere and can potentially impact every area of the Region. It requires we know a little bit about everything, from construction to microbiology to reprocessing . . . there's such variety. And collaborative key relationships are required to make sure it all happens. I feel this mix suits me well.
What does a typical day look like?
As mentioned earlier, we have a lot of variety in IP&C, so our days aren't often 'typical'. I guess I could say we 'typically' get involved in a wide variety of issues that could potentially impact patient safety.
Before Ebola, a day would include a lot of relationship and consensus building activities: committee work, attending meetings, responding to inquiries, and collaborating with other disciplines. Part of being collaborative is being respectful of a person's knowledge and expertise. We also work to develop evidence-based recommendations with the goal of ensuring/improving safety, whether it relates to patient care activities, supply use, air exchanges and the environment, waste management, and so on.
Of course, the Ebola preparations made for much longer days but followed the same collaborative IP&C principles!
Can you talk about Ebola preparations?
Good practices for patient safety ultimately are good practices to keep health care providers safe as well. Ebola has certainly helped to highlight this.
IP&C would never recommend something that would put individuals at risk. Of course, we need to consider not only evidence and best practices, but how to apply this in our physical settings.
Along with including information from resources such as the Public Health Agency of Canada, the Centers for Disease Control and Prevention, Médecins Sans Frontières, and others, we've been in the extremely fortunate position to have local expertise that helped inform our PPE protocols. For this we're very grateful. Additionally, we received strong support from regional leadership to institute additional measures, beyond those included in provincial and national guidelines, to practice an abundance of caution and ensure staff and patient safety to the utmost of our abilities.
The Health Sciences Centre had an existing IP&C protocol (from 1996!) for the management of Viral Hemorrhagic Fevers. We started with this and updated it rather than having to start from scratch. We got to know Ebola - how it's transmitted, what personal protective equipment (PPE) is required and how to wear PPE. We spoke with local experts. We worked with other programs/staff/individuals to develop protocols that make sense, work, and protect all. And we continue to improve upon the protocols and processes. We tested pieces of PPE to ensure safety and collaborated with front line staff to ensure the process we were outlining for donning and doffing equipment was workable yet still consistent with IP&C principles. The ICPs have worked diligently with other staff at their sites to help ensure each site is prepared, should a patient present.
There exists a committee of individuals representing different programs who review key information, documents, communication and elements with respect to Ebola. The Region has also worked closely with Manitoba Health to ensure not only are we aligned, but so are the other four health regions.
What are your reflections on nursing?
Nurses are a significant portion of the WRHA workforce, and are in a key position to be able to impact and move forward safety - patient safety, staff safety. We also work in a range of capacities, such as research, direct care, education, and so on, and each of these capacities has a vital role in moving the patient safety agenda forward.
Research helps provide the evidence we use to guide our recommendations. Education helps outline the IP&C recommendations, why they're important, and how to achieve them. Given the proximity and duration of patient interaction, front line nurses have the opportunity to learn about a patient's medical and personal needs. They often have the advantage of insight about patient safety factors. This insight offers a nurse the opportunity to move an agenda forward and advocate for their patient. In order for a nurse to be that patient advocate, they need to feel supported in doing the right thing. Administrative nursing roles can help provide this support.
What gets you out of bed in the morning?
I love my job! And it's great to be a part of the IP&C team.
If I won the lottery, I would slow down but I wouldn't quit my job. I believe what I'm doing is meaningful and can help save people. Regardless of the age of a person, what condition they have, or where they are, adhering to IP&C principles reduces/prevents organism transmission.
What has impacted your nursing practice?
First, my family. Were it not for them, I would not be a nurse.
Then, the two years I worked at Riverview offered a really strong learning foundation upon which to build for the next decade plus at Health Sciences Centre in IP&C. At HSC, there was so much knowledge and experience there, and I had the opportunity to see unique things. It offered great learning, great experience.
Often when people see IP&C coming, they are wary because of the fear more will need to be spent, it will take extra time, and add steps to an already busy day. But IP&C practices are important and have meaning. Our intent is not to make things difficult for staff, but to help provide a safer environment for patients. I have been told when I communicate this to people; they can see I believe in the things I speak about, which can sometimes help when working through challenges or resistance. I think when you believe in what you do, and are passionate about it, people see that and it means something.