Patient Perspectives: A Fresh Take on Infection Prevention


Patient advocate Liz Kruvand brought a fresh perspective to the SHEA Spring 2017 Conference when she discussed her own trials and tribulations with infection prevention in the pediatric hospital setting.

At a session at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, Liz Kruvand, a patient advocate at Children’s Hospital in St. Louis, MO, gave a personal patient perspective that illustrated the importance of involving families and visitors in healthcare-associated infection (HAI) prevention practices.

Kruvand started her presentation with a brief background on Children’s Hospital in St. Louis, saying, “What do we do? We do what’s right for kids.” She then went on to share her experience at the hospital where she experienced HAI-prevention practices on a personal level.

To set the tone and explain some of the “stress and panic” that added to her story, Kruvand said, “My story started in the height of the H1N1 outbreak.” She then shared that her daughter, who was prematurely born at 28 weeks gestation, was diagnosed with methicillin-resistant Staphylococcus aureus (MRSA), four and a half weeks after birth. A “lovely infection prevention sign telling us about PPE [personal protective equipment]” was stuck outside the door to their room.

With the lack of skin-on-skin contact with her baby, Kruvand had had enough. “I went on strike from wearing PPE. I didn’t believe in transmission and cooties and all these wonderful things that I had been told, because I follow proper hand hygiene and I follow all of the rules and regulations that [they] wanted me to do. But guess what? I was a bad influence on the people that don’t.” And so, Kruvand went back to donning the pathogen-repelling gowns. In fact, Kruvand and her family members “spent 55 days wearing yellow gowns.”

The story continued. Kruvand shared that a few weeks before her release, her daughter “suddenly was having trouble breathing; [and] she went on high-flow high-humidity [therapy].” Try as she did to comfort her daughter, Kruvand’s smiles and coos were hidden behind the PPE mask. “She couldn’t see anything of normal facial features that would help calm her. I looked like an alien to her.”

After several skin abscesses, however, the worst was over, “The good news is that we made it out safely, we survived,” said Kruvand. “But for a lifetime I [will] still skin-check my daughter for MRSA.”

Kruvand’s daughter survived the MRSA infection that affected her at just four weeks old and is now 7 years old.

“That is my ‘why.’ That is why I’m here, that is why I partner with you all. It’s why I partner with my hospital; it’s why I call it home,” said Kruvand.

Kruvand is one of the few parents on staff at her hospital where she and fellow parents, “solely represent patients and families.” She added, “We’re all leveraging multiple talents, but the reality is, we’re there advocating for our families.”

As part the Children’s Hospitals’ Solutions for Patient Safety National Children’s Network, it is a tenet of safety strategies at the Children’s Hospital in St. Louis to have family members join the healthcare team. This is to ensure that patients are involved and engaged in HAI prevention. This practice is not without some challenges, though.

Describing what she believes is the biggest struggle in being involved with safety, Kruvand said, “Imagine your child’s life is being held in the hands of a doctor who you don’t know. You see them come in and they don’t [wash their hands]. How do you think it’s going to feel when you turn around and say ‘you’re not touching my kid until you [wash] your hands’? Do you think most people are going to feel comfortable doing that? No. Society and culture in hospitals (right now) is set up to make [a] distinction [between the patient or family and the physician]. Physicians are revered. [The reality may be that] they know way more than I do [about the medical field], but I know a lot more about my daughter than [they] do. And [accepting this is] the premise of real, true partnership.”

And, therein lies the importance of educating and engaging not only the patient but his or her family and visitors, as well. This engagement should not only be in the form of pamphlets and hand-outs. According to Kruvand, although having patient education tips printed on paper is “great,” it should not be the only format available. She suggests moving towards “higher technology,” and trying to relay the message through videos, especially in areas with low English literacy rates. Kruvand encouraged “breaking down barriers and inviting patients and families into this private world of” infection prevention in the hospital setting.

She also suggested creating “fun and engaging” posters that illustrate different precaution designations or proper hand hygiene. “Everything in a kid’s hospital is fun,” she said, and it’s important to have “a clear visual connection for people to know ‘I need to have a mask and gloves’” in one particular area, “and ‘I just need a gown’” in another.

Kruvand then stated that one of the main “fears” linked with “inviting families in” is “losing control and exposing [hospital] problems.” However, she said that families already notice the underlying problems that hospitals may try to keep hidden. For example, families will notice when a hospital is understaffed, “because we can see it on the [frazzled] faces.”

Knowing this, there is no reason to hold back and not involve families in infection prevention strategies across the hospital. Kruvand urges hospital personnel to engage in any and all Family Partner Programs. In addition, she stated that healthcare providers can personalize safety promotion by inviting family members to share their stories.

“You can only teach people if you engage their minds and hearts,” said Kruvand. “Hearts go a lot further; they get passion and engagement at a higher level. People that can see suffering on a family (not that I wish any family has to suffer), will [comply with safety precautions].” Involving families in infection prevention also means including them on safety councils, and having them participate in mock emergency preparedness events.

Kruvand described one mock event at Children’s Hospital in Philadelphia, PA, conducted to help prepare for an Ebola crisis. This hospital was “working on Ebola preparedness [strategies] for all pediatric hospitals,” and had family partners play the roles of being a family at the hospital during an Ebola crisis. With the help of these families, the hospital was able to determine the equipment that would be needed to manage an Ebola crisis, from iPads to televisitation. “You have to figure out alternative ways to engage, but don’t just shut the doors and keep [families] out,” said Kruvand.

At Children’s Hospital in St. Louis, family partners also weigh in on material developed for family education, and are even involved in safety rounding. “The more you engage patients and families the better off these materials will be designed, and the more sustainable your programs will be,” she commented.

Overall, this process is about “finding ‘ready’ patients and families who will be an asset to your hospital’s infection prevention team. These individuals will be the key to advancing patient and family education on infection prevention strategies. Not only do these individuals bring in a fresh perspective to your team, they inspire other families to follow suit.

“Please think of your family advisors as [groups that can do] more than [advise] where flowers go and what paint color should go on the walls. They have amazing insight that you are losing out on if you don’t converse with them,” she concluded.




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