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that individuals and institutions should persistently and incre- mentally strive to do the best they can do to reduce HAIs and improve patient safety are more likely to achieve acceptance by staff who have varying roles and priorities and numerous other job- related concerns. We also need to recognize that our efforts to reduce anti-
microbial resistance should be tempered with the reality that many of its causes are not amenable to direct intervention by individual doctors, healthcare systems, or government agencies. Burdening clinicians with this responsibility or blaming them when resistance gets worse makes our job harder when we recommend partially effective but still useful changes in policies, protocols, and care practices. Instead, we may have more cre- dibility and impact by focusing on explaining and attempting to address basic principles, the relationships between colonization and subsequent infection, the role of local antibiotic pressure and local emergence of resistance, and the adverse risks of devices. We should endorse Easterby’s recommendation that activists
need to listen to their doubters and resist, as best they can, temptations to lambaste them when their opinions clash with ours. Hospital epidemiologists who occasionally disparage col- leagues who doubt, ignore, or are indifferent to our efforts are more likely to be frustrated than successful. Also, we need to fix “computer models” overly reliant on
flawed surveillance definitions. It is often counterproductive to rely on metrics and outcomes such as C. difficile “lab ID events” that currently cannot reliably distinguish between true infection and colonization or endorsing and using flawed definitions of a catheter-associated bloodstream or urinary tract infection. Many of our colleagues are skeptical becausetheycorrectly realizethat use of these metrics to assess and monitor the impact and efficacy of specific prevention protocols and policies is often misleading.We need to develop surveillance definitions that are clinically accurate; comprehensible to clinicians; and have clear impact on clinical practice, quality, and safety. Otherwise, we will continue to experience the same skepticism and indifference that climate activists encounter when then rely on unintelligible and sometimes inaccurate National Oceanic and Atmospheric Administration climate data. Finally and most importantly: how can hospital epidemiologists
become better salesmen? For starters, we can collectively and individually alter prior behaviors and approaches that have led to failure. We should stop assuming that apathy or ignorance of our physician and nursing colleagues are behind the frequent failure of our protocols, policies, and recommendations. All of us need to
Joseph K. Franz et al
become better versed and trained in the arts of salesmanship, negotiations, active listening, communication and even marketing. Multiple on-line and on-site training programs are available for developing these and standard business and sales skills. Some of us could benefit from hiring a personal coach to provide individual help and feedback. We can also learn by observing and mimicking effective people who understand and are skilled in sales and mar- keting. Our society should be urged to collectively and publicly petition The Centers for Disease Control to revamp or even abandon flawed surveillance definitions. Our society should stop overt or tacit support of the use of inaccurate and flawedmetrics to punish hospitals. We need to realize that many of our prior efforts have failed because we, too, lack “clarity, credibility, and empathy” in dealing with our fellow healthcare brethren. Although effective hospital epidemiologists utilize numerous
other “tools and assets,” such as negotiation and complex stra- tegies requiring flexibility, compromises, relationship building, and priority setting, salesmanship is too often underutilized. But salesmanship alone will never be a panacea. Even if we achieve reasonable competency in the preceding skills and techniques, we will still periodically encounter failure, frustration and dis- appointment. And when these failures and frustrations occur, I advise making our best effort to sustain our focus and retain our optimism and goals while pondering Shakespeare’s famous line: “The fault, dear Brutus, is not in our stars but in ourselves, that we are underlings.”
Acknowledgments. Financial support. No financial support was provided relevant to this article.
Conflicts of interest. The authors reports no conflicts of interest relevant to this article.
References 1. Easterby S. Climate activists are lousy salesman. The Wall Street Journal, April 25, 2016.
2. Price JR, Golubchik T, Coke K, et al. Whole genomic sequencing shows that patient-to-patient transmission rarely accounts for acquisition of Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2014;58:609–618.
3. Eyre DW, Cule M, Wilson DJ, et al. Diverse sources of C. difficile infection on whole-genomic sequencing. N Engl J Med 2013;369:1195–1205.
4. Palmore TN, Henderson DK. Managing transmission of carbapenem- resistant Enterobacteriaceae in healthcare settings: a view from the trenches. Clin Infect Dis 2013;57:1593–1599.
Strict sequestration versus lenient isolation precautions during hematopoietic stem cell transplant: results of a quality initiative
Joseph K. Franz MD1, Alexander R. Coltoff MD1 and Amir S. Steinberg MD2 1Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York and 2Division of Hematology and Oncology, Mount Sinai
Hospital, New York, New York
Author for correspondence: Joseph Franz MD, One Gustave L. Levy Place, Bod 1118, New York, NY 10029. E-mail:
Joseph.franz@
mountsinai.org
Cite this article: Franz Jk. et al. (2018). Strict sequestration versus lenient isolation
precautions during hematopoietic stem cell transplant: results of a quality initiative. Infection Control & Hospital Epidemiology 2018, 39, 1270–1272. doi: 10.1017/ice.2018.203
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
To the Editor—Inpatient bone marrow transplant (BMT) requires long hospitalization on the order of weeks to months. During this time, hematopoietic stem cell transplant (HSCT) recipients are at
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