Infection control

By Maj. Irene Ashker
Air Force Inspection Agency

KIRTLAND AIR FORCE BASE, N.M. -- A microscopic hole in a surgical glove can result in a devastating spread of infectious disease. The same is true with the Infection Control Program itself; the tiniest hole in the program can debilitate an entire medical unit.

Having just returned from the Infection Control Course at Sheppard AFB, Texas, I have a renewed awareness of the importance of this program, not only to the active-duty Air Force, but to the Air Force Reserve and Air National Guard as well. I also gained a much better understanding of what it takes to set up and maintain a useful and fully compliant IC rogram.

A frequently asked question is, "Since the USAFR and ANG units don't provide patient care, why do they need an IC program?" The answer is two-fold.

First, protecting medical unit personnel from the spread of infectious disease caused by factors such as poor hand hygiene or improper use of personal protective equipment (neither of which are solely related to patient care) is a force protection issue with huge impacts on keeping a unit medically ready to fight.

Second, the predominant mission of USAFR and ANG medical units is training. We all know we are supposed to "train the way we fight." Having a solid foundation of IC principles is vital in keeping troops fit and ready in the field and the hospitals they will be called to work in.

The IC Course is more than a wonderful educational opportunity; the course or its equivalent is mandatory. Air Force Instruction 44-108, Infection Control Program (Sept. 10, 2004) mandates that all IC monitors attend within six to 12 months after being appointed. The five-day course, geared for USAFR and ANG units, covers IC principles and the steps that must be taken to be fully compliant with AFIs and other written guidance.

A Commander's Program

Maj. Elaine Dekker, the IC Course supervisor/instructor, reinforces the fact that the IC program is a commander's program and that AFI 44-108 clearly delineates the responsibilities of the medical unit commander.

Paragraph 1.6.3 directs the commander to "provide resources as required to support the implementation of the Annual Infection Control Plan." Paragraphs 1.6.4 and 1.6.5 go on to include "administrative assistance" and "computer and systems support" for the IC Program. "Resources" also include required training, material resources and time allocated to implement the program.

Not Just IC

The IC Program is multi-faceted, spanning all sections of a medical unit, so attention to detail is paramount. It includes not only infection control, but also tuberculosis and blood-borne pathogen exposure control.

A Frequent Finding

In 2004, the IC Program element ranked fourth highest among frequency of findings of all elements on health services inspections (HSIs) conducted by the Air Force Inspection Agency. One of the most common written findings was insufficient executive oversight as evidenced by lacking or nonexistent IC committees/IC review functions. Another was training deficiencies.

A great source of confusion is knowing who is responsible for which component of the program. Traditionally, TB and blood-borne exposure are elements of public health. In units with no public health component, these responsibilities fall to the IC monitor.

Dekker stresses that, in cases in which the unit is associated with an active-duty host, it is essential that ARC units partner with and tap into the host's resources.

How does one run a fully compliant IC program? The recipe for success is clear in the governing AFIs. They describe in detail the requirements for infection control, TB and blood-borne pathogen exposure control plans, and what each must contain along with the required review process for each.

Finally, remember no one is an island. Network with other IC officers and monitors and local IC resources such as nearby active duty bases, public health offices and others.

For further guidance, e-mail Major Dekker at the 383rd Training Squadron, elaine.dekker@sheppard.af.mil, or Major Ashker at the e-mail address at the beginning of this article.

Major Ashker is an inspector with the Medical Operations Directorate, Air Force Inspection Agency. She is a veteran of dozens of HSIs and has served over 17 years as an Air Force nurse.

For more on this topic, these sources have a wealth of information:

• AFI 44-108, Infection Control Program
• AFI 44-108, AFRC Supplement 1, Infection Control Program
• AFI 48-105, Surveillance, Prevention and Control of Disease and Conditions of Public Health and Military Significance
• AFJI (Joint Instruction) 48-110, Immunization and Chemoprophylaxis
• AFI 41-307, Aeromedical Evacuation Patient Considerations and Standards of Care
• AFOSH 48-137, Respiratory Protection Program
• Written guidance as published by:
  • - Centers for Disease Control (CDC)
  • - Occupational Safety and Health Administration (OSHA)