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In-Depth Q&A with Doctor Buffy.
(as it appeared in Voyage Phoenix Magazine, 2021)
Buffy, we appreciate you taking the time to share your story with us today. Where does your story begin?
As the president and founder of IPCWell, I have a passion for mitigating infectious diseases through a data-driven approach. Even before the pandemic, I realized how serious infections disproportionately impact vulnerable populations. COVID-19, in my view, merely sheds light on the systemic challenge of infection prevention and control and its adverse impact on patient care.
During the COVID-19 pandemic, IPCWell has taken a “boots on the ground” approach to support healthcare facilities such as nursing homes across the nation, doing in-person, deep-dive assessments to offer immediate support to healthcare workers on the frontlines. I have traveled around the country to long-term care facilities to assess, train, and educate with humor, vigor, and empathy. I have developed practical tools, led training and “train the trainer” programs, provided ongoing support to IPC teams, and co-created the “LTC playbook” for Doctors Without Borders infection control support for early use in hard-hit areas of Detroit and Houston.
When I am not on-site, I participate in and offer my expertise to other national projects such as Project Echo, a hub-and-spoke knowledge-sharing network to support NH leadership during COVID-19, developing content for IPC curriculum, conducting virtual clinics on infection control EPIC and Emergency Preparedness Infection Control disaster programs, providing infection prevention and control support to the Havasupai Native American tribe, and supporting the CDC/White House Vaccinate America Forum. I also provide subject matter expertise to federal, state, and local public health entities and healthcare professionals nationwide. I offer data-driven, targeted, quality improvement solutions aimed to mitigate healthcare-acquired and community-acquired infectious diseases in all healthcare settings including but not limited to Acute Care Hospitals, Long-term Acute Care Hospitals (LTACH), Long-term Care Facilities (LTCF), Acute Surgical Centers (ASC), and Outpatient healthcare settings.
In 2016, I participated in a national pilot study that supported nursing home’s enrollment into the Centers for Disease Control and Prevention’s National Healthcare and Safety Network (NHSN) and report Clostridioides difficile infection, otherwise known as CDIFF. Alongside my colleagues, we worked with four states supporting over 500 nursing homes. Working intimately with these facilities, we were amazed at the lack of infection prevention and control, or “IPC”, infrastructure, and training.
One of the takeaways was that the person responsible for IPC had many other roles and that the actual time devoted to these practices was very little, sometimes only a few hours each week. Learning that there are 380,000 deaths associated with serious infections in nursing homes every year and that over one thousand people are dying every day in nursing homes due to infections, I sprung into action and became Board Certified in Infection Control and started Lloyd-Krejci Consulting, which is now IPCWell.
Would you say it’s been a smooth road, and if not what are some of the biggest challenges you’ve faced along the way?
In the beginning, my ambition included enrolling nursing homes into the CDC’s national database to transition IPC programs to be more data-driven. I knew the more we could measure infections, the clearer the challenges were, therefore the more effective our interventions would be. What I discovered was that the facilities weren’t ready and needed basic support. We refocused our efforts on the fundamentals and found the facilities receptive to the support that began at “Step 1.” They found incredible value in our comprehensive approach because this is what had been missing from public health initiatives.
Called to action, in the spring of 2018, I left my cushy corporate job with health insurance and a 401K to dedicate myself full time to bringing awareness to this preventable problem. I reached out to hundreds of nursing homes, corporate leaders, and federal decision-makers and said, “There is a problem here, and I can help you with it.” It felt like being on the Titanic and knowing the iceberg was just ahead. Very few were interested in what I had to say. Thinking perhaps that spreading the message alone was the problem, my husband quit his job and joined me in the outreach effort.
Believing in our cause so deeply and recognizing the magnitude of the problem, we innocently thought that facilities would be jumping to get on board as long as we explicitly conveyed the solution to solving the problem.
In reality, after a year of making hundreds of phone calls, sending thousands of emails, conducting dozens of free webinars, and presenting in conferences across the country, only seven nursing homes listened and hired us to help them improve their infection control program. The government response wasn’t much better. I presented a detailed plan to the Long-term Care CMS team on how to reduce resident harms and deaths due to infectious diseases with no follow-up or action steps to move forward.
So why now? Why bring this issue forward?
In November 2020, a fellow colleague of mine urged me to tell the story of what I was witnessing in nursing homes nationwide during the COVID-19 pandemic. Nursing homes have often been cast as villains and blamed for the horrendous care that they provide, however, this simply is not true and is only a sensationalized portrayal of a broken healthcare system that is in desperate need of repair. The stories have all been the same. Lack of support, lack of understanding, and a governmental approach that includes a system of bullying, fines, and punishment that dictate every change in this healthcare setting.
As a result of my work with more than 200 nursing homes during the COVID-19 pandemic and over 500 prior to 2020, I wrote a book entitled: Broken: “How the Global Pandemic uncovered a nursing home industry in need of repair and heroic staff fighting for change,” set to be released soon. The book describes challenges within the nursing home industry with infection prevention and control prior to the pandemic, the catastrophic consequences of COVID-19, and what actions are needed to improve the quality of care delivered to this vulnerable population now and into the future. And how to use this dark season to transform the long-term care industry into a supportive healthcare system that provides safer, more reliable care for our loved ones. In an effort to provide you with the most accurate description of the current challenges and the path forward, this book includes interviews from colleagues such as Doctors Without Borders, nursing home administrators, academic researchers, national and international advocacy groups, state licensing agencies, health care workers, and patients.
It is my hope that this book will equip facility staff, corporate facility owners, policymakers and even caregivers and those with loved ones in the care of nursing homes to understand the true nature of the environment and what you can do to advocate for change, not only for your loved ones but for those who follow. For policymakers, I hope my book illustrates the need for swift action to protect our most vulnerable populations, and for those who run these facilities, this is a wake-up call that more must be done right now.
As you know, we’re big fans of IPCWell, what would you like other news media to know?
In the United States, nearly 16,000 nursing homes provide care to over four million people every year. (1.) As our baby boomer generation ages, more and more people will need the care of long-term services. Before the COVID-19 pandemic, long-term care facilities (LTCFs), commonly known as nursing homes, had not had a strong focus on infection control practices. It was no surprise that the Centers for Disease Control and Prevention (CDC) estimated that one to three million severe infections annually were leading to 380,000 deaths (over 1,000 deaths a day).
While these statistics are scary, the most maddening aspect of these numbers is the estimated percentage of preventable infections. Conservative estimates say 40%, while some suggest up to seventy percent of infections are preventable. (2.) Even on the low end, we are talking about saving 400 lives every day. The consequences of not having infection control as a priority are dire.
The mission with IPCWell is clear: To reduce the harms and deaths caused by infections by supporting healthcare facilities with all aspects of infection prevention and control. I could see that each facility faced its own unique challenges, so the support they needed wasn’t broad information, but actionable solutions that addressed specific challenges. IPCWell begins with solutions that are practical and easy to implement, then supports the facility every step of the way toward a robust and sustainable IPC program.
We not only pride ourselves on the expertise we bring but the manner in which we deliver it. We understand the challenges our clients face, and they receive something they haven’t before. Not only do we commit to staff and resident safety above all else, but we also listen and actually hear their challenges so we can provide practical solutions.
What is it going to take for us as citizens and community members to feel comfortable with long-term care? We should not have to cringe and say, “I’ll never go into a nursing home,” because that simply may not be the reality. Now is the time to create change, to have our voices heard. Together, we can assist in shifting the punitive culture to a culture of collaboration and support, a culture that provides the very best opportunity to give residents the care they deserve.
Our clients understand we stand with them as their biggest advocate. They know they can count on us for routine, day-to-day recommendations, or in the middle of an outbreak. We've seen first-hand the heroic staff on the front lines, fighting for change and it is our mission to guide them and help them into a better tomorrow, with as many lives saved as possible.
(1.) National Action Plan to Prevention Health Care-Associated Infections: Road Map to Elimination April 2013 https://health.gov/sites/default/files/2019-09/hai-action-plan-ltcf.pdf
(2.) Infection Control Today, 2017. IC in Care Series: Long-Term Care https://www.infectioncontroltoday.com/view/ic-care-series-long-term-care
What has been the most important lesson you’ve learned along your journey?
We have learned recently that if we are going to make industry-wide meaningful change, the culture must shift from punitive to collaborative and supportive. Far too often during this pandemic, we saw unwarranted culpability landing on facilities doing everything they could to keep their residents safe, yet still being punished for things beyond their control. I plan to use the popularity of my book to speak to organizations, institutions, and policymakers about this important issue.
I remember being on-site one day in a nursing home in Idaho. And hearing a resident crying out in pain. The staff was calming him down. Saying. “I know, buddy. Sorry that you don’t feel good. We are going to get you all cleaned up, my friend.” These are the words that I overheard one early morning while working onsite in a nursing home. Caring is the only way anyone can survive working in this environment.
And then…this is often the consequence in the middle of a COVID-19.
“We thought they (state surveyors) were here to help, but instead they (state surveyors) left us with 54 pages of citations.” – Anonymous Infection Preventionist
Our approach resolves problems, instead of penalizing those doing their best with what they ‘currently have.’