My Specialty

Infection Prevention Nursing, Esperanza Salazar, St. Francis Medical Center

Combating outbreaks and hospital-associated infections

Registered Nurse Esperanza Salazar stands smiling with a badge on and St. Francis Medical Center behind her

Esperanza Salazar, BSN, RN, CIC, HACP
Manager, Infection Prevention
St. Francis Medical Center, Lynwood

How is your team responding to the present COVID-19 outbreak?

My responsibilities change drastically during an outbreak or pandemic like the current COVID-19 crisis. My primary role during an outbreak shifts to hospital preparedness and response to potential cases. I’m on call 24/7.

The most challenging aspect is the ever-changing guidelines from the CDC and other agencies. While those guidelines are necessary to ensure the safety of our healthcare workers, they can create obstacles for leaders and are often stressful for the entire healthcare team. Furthermore, we must often tackle protocols that change overnight, sometimes multiple times a day. This involves reeducating and disseminating information to more than 2,500 employees in a very short period of time.

As an example, our facility organized in-services for staff regarding the level of personal protective equipment (PPE) required to care for suspected or confirmed COVID-19 cases. As soon as our staff were able to complete the education, we had to inform them about the updated guidelines.  It can be hard for staff to accept such changes because reverting to a lower level of protection can leave people feeling unprotected. My team’s credibility as infection preventionists may even be questioned.

How did you become interested in this nursing specialty?

I can honestly say that I was thrown into the infection control specialty (now called infection prevention) about 15 years ago. It all began with sorting labs and assisting the directors of infection control for two different hospitals on days when I was flexed as an LVN. As I continued to work with the IC directors, I developed increased interest in the field of infection prevention. I simply found bacteria, viruses and diseases fascinating.

After a few months, I began to search for courses in infection control in order to take a deeper dive into the field. Additionally, I had the privilege of shadowing my father, as he was heavily involved in the facilities’ disaster planning. At that time, H1N1 was a hot topic, and he was able to guide me through emerging disease trainings.

What’s something you learned that was surprising or unexpected?

At first, I thought infection prevention guidelines were geared only for nursing; boy, was I wrong!  It was fascinating to also learn what roles dietary, engineering/facilities and environmental services play in reducing and preventing infections. As a novice infection preventionist (IP), I had to take a crash course in engineering controls, cleaning and disinfection practices, and accreditation and standards interpretation, as well as the ever-evolving infection definitions. It was definitely overwhelming.

As an infection prevention nurse, what are your general responsibilities?

Where do I begin? In general, my main responsibility is to minimize morbidity and mortality associated with healthcare-associated infections (HAIs) by identifying, monitoring, controlling and preventing the occurrence of infectious diseases within all areas of the healthcare setting and the communities we serve.

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We work very closely with our lab, infectious disease physicians and especially our microbiology department. We also work closely with our clinical pharmacist as part of our antimicrobial stewardship program. This guides us to enforce isolation precautions if needed and report infectious diseases to public health and the National Healthcare Safety Network database (NHSN) for tracking and analysis.

An infection prevention specialist’s responsibilities also include being an educator, evaluator, consultant, influencer, collaborator, mentor, leader and liaison. We review annual risk assessments as mandated by the state and regulatory agencies and then create our annual infection prevention plan and set goals for the upcoming year. for the upcoming year. This includes regular unit rounding to ensure adherence to specific unit-based infection prevention strategies, running statistical HAI analysis, creating performance improvement plans, reviewing policies and aligning them with current evidence-based guidelines.

We also play a leadership role, as we must ensure that we abide by all mandated regulations and recommendations. IPs also consult and influence on many patient safety scenarios, which can include patient device selection, construction, water damage remediation, family and/or visitor issues and environmental concerns. From time to time, we investigate suspected outbreaks.

Please provide a HIPAA-compliant patient story to illustrate the work you do.

Working with patients with an infectious disease poses a lot of challenges. These types of patients are under strict monitoring and guidance from the Department of Public Health, as their diagnosis is a matter of public health. It changes their lives and will continue to have an impact in their future. Also, there continues to be stigma regarding the care of such patients.

As an IP, I need to ensure that patients understand their disease process and their disposition, which involves a coordinated approach with the health department, case management and the patient. It can be scary. For example, I had a patient who was being ruled out for tuberculosis. This caused an incredible amount of fear in the patient and in the patient’s family.

Did you pursue any special certifications or training in order to master your current role?

Yes. At first, I began taking online courses though the Association for Professionals in Infection Control (APIC) and the Society for Healthcare Epidemiology of America (SHEA). As I’ve continued to evolve in the IP position, I’ve also taken an ample number of California Department of Public Health (CDPH) trainings.

As I’ve continued to evolve in the IP position, I’ve also taken an ample number of California Department of Public Health (CDPH) trainings.  These self-paced and in-person trainings prepared me to take the five-day APIC Foundations of Infection Prevention course. Let me tell you, they either make you or break you as an IP!

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After a few years as an experienced IP, and after dozens of webinars, courses and firsthand experiences, I passed the Certification Board of Infection Control and Epidemiology (CBIC) comprehensive exam to earn the certification in infection control (CIC) designation.

What are the challenges of infection control in the 21st century?

One of the general challenges for me in this specialty is setting a daily routine or schedule. I get curveballs thrown at me all the time, and I honestly can’t recall the last time I was actually on schedule. Usually, I have to deviate in order to take on 10 different tasks or meetings. That said, this is also what makes infection prevention exciting to me: Every day is a different day.

The other challenging elements are the rapid evolution of technology and the increase in mandatory reporting requirements. We are years past the paper chart stage, which means that infection preventionists can spend a lot of time behind their desks conducting ongoing surveillance, doing research, entering mandated reports, creating reports, etc. It becomes very challenging when you don’t have the staff power to share those responsibilities.

Ultimately, we infection preventionists need to ensure that we don’t lose sight of the patients and the human element. We need to get out there and evaluate patients, monitor patient safety practices such as hand hygiene and adherence to HAI prevention bundles, and interact with colleagues.

What strides do you feel we’ve made in terms of infection control in the last 10 to 20 years?

Numerous strides have been made in infection prevention — too many to list, really. A good example would be the creation and advancement of online HAI surveillance, as well as antimicrobial surveillance and reporting systems paired with EMRs. These all facilitate surveillance and eliminate time-consuming manual methods.

The creation of an HAI program with our local health department has provided an important resource for the prevention, surveillance and reporting of multidrug-resistant organisms (MDROs). Having this resource is crucial to the development and management of any infection prevention program, especially during outbreak investigations and emerging diseases.

Is infection control the same in outpatient and inpatient settings, or are there site-specific issues?

The basic principles are the same. For example, hand hygiene remains the No. 1 method of reducing the risk of transmission of microorganisms in both the inpatient and outpatient settings. The settings begin to deviate from each other when it comes to patient care and surveillance.

In either setting, standard precautious like adherence to hand hygiene standards, consistent use of aseptic techniques, removal of unnecessary invasive devices and complying with HAI-reduction bundle strategies can go a long way in preventing healthcare-associated infections.

If a nurse wants to pursue a career in this specialty, what do they need to know?

I’d first like them to know that infection prevention is a fun and rewarding field! All IPs work very closely together, so we have continuous support from one another.  For anyone interested in pursuing a career as an infection control nurse, know that you will be working with a variety of infectious disease processes, so understanding basic microbiology is very helpful.

Nurses seeking entry into the specialty also need to be aware of the importance of keeping up to date on research and guidelines. IPs are often responsible for disseminating sensitive and evolving information about novel and reemerging diseases or MDROs. Everything else I feel is learned once you join the specialty.

Tell us about your career goals.

I have two additional goals that I would like to pursue: The first one would be to attend graduate school to obtain an MSN degree. In fact, I began my first graduate course this month. Once I obtain my MSN with a specialization as a family nurse practitioner — within the next two or three years, give or take — I’ll explore earning a doctorate in nursing practice.

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at

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