Working the System
Deborah Farrell, RN, BSN, CIC, CNOR
Tuba City Regional Health Care Corp
Tuba City, Arizona
The world in which Deborah Farrell practices infection prevention is vastly different from that of her colleagues who work in modern medical centers. Hers is a life of infections and diseases on an American Indian reservation, within the 73-bed Tuba City Regional Healthcare Corporation, an extremely rural Government controlled facility located in Tuba City, Arizona.
Deborah, or "Deb" as she calls herself, has been an RN since 1979 and an infection preventionist since 1995, "when the hospital I was working for didn’t pass the The Joint Commission inspection so I was assigned half time infection control, half-time RN duty."
Her surroundings are so rural that some of her patients "live 30 miles or more down dirt roads, and the nearest hospital outside of ours is 85 miles away. We’re an Indian Health Service which is in the process of weaning itself from government control and becoming a community hospital."
Because of the extreme rural conditions and because so much of the Navajo reservation serving Navajo, Hopi and Paiute Indians has no electricity or running water, "many wounds are washed in water that is carried in 55 gallon drums." The Hopi lands are among the oldest continuously inhabited reservations in the U.S. Their walls are made of rock; there’s no running water, no electricity or other modern conveniences.
So how has she been able to make such a difference in her hospital’s bloodstream infection rate, dropping it from 16.13 infections per 1,000 line days to 5.9, and ventilator-associated pneumonia rates from 43.75 infections per 1,000 ventilator days to an average of 6 to 7.35?
"I’m lucky because here at this hospital, if infection control says it’s so, it’s God’s truth. Infection control is seen as a value program, equivalent to a senior management position which carries a lot of weight," she said. "I’d like to see hospitals apply this status to other IPs throughout the country, rather than being looked at as the ugly step sister. IPs save a lot of money for their facilities…this should be recognized."
"You can’t have a good infection prevention program unless the entire hospital buys into it," she said. "In this case, the hospital did the good work and I got the calendar credit for it."