Betsy Hackman, director of infection control for Emory Hospitals, with an image of the H5N1 avian flu virus. In March, Hackman attended a World Health Organization meeting in Switzerland to finalize the early containment protocol for the group's pandemic influenza plan.

Sixteen years ago, Betsy Hackman, RN, CIC, had little idea what she was getting into when she took a job in infection control at Crawford Long Hospital in Atlanta. In 1990, hospitals were concerned with HIV/AIDS and tuberculosis. Severe acute respiratory syndrome and the H5N1 (avian flu) virus had yet to appear on the scene.

"I was a cardiac-care nurse, but I had a 1-year-old child and a husband who traveled and [I] was having trouble being on call," Hackman said. "I had a friend in infection control who was moving, and asked if I'd consider the job.

"I took the job, but the .rst day I wouldn't even answer the phone, because I knew I didn't know enough to answer anyone's questions."

Hackman soon discovered that infection control of.cers are on call all the time and needed to be concerned with everything related to health care.

"You never know day-to-day what you'll be doing. Patients in hospitals today are sicker than ever and have things wrong with them that they wouldn't have survived 10 years ago," she said.

Hackman learned quickly. She joined the Association for Professionals in Infection Control and Epidemiology, adopted some of its members as her mentors, studied hard and took the national exam to become certified.

"The more you get exposed to this field, the more you realize what you didn't know, and how much responsibility it is," Hackman said.

Today, as director of infection control for Emory Hospitals, she heads a staff that maintains surveillance, sets and reviews policy and procedures, and must constantly report infections and control measures to a large number of public health authorities. As part of the hospital's leadership, she sits in on committees, including new product evaluations.

"Infection control is a huge challenge in hospitals today, but I'm fortunate to have some of the smartest people in the business right down the street, at the CDC (Centers for Disease Control and Prevention)," she said. "Some of those people are on staff here, as well. We just finished writing Emory's avian flu control plan and had to face some really hard questions."

The avian influenza strain H5N1 has infected poultry and wild fowl in at least 49 countries. The virus has spread to humans on a limited basis, mostly to people working with chickens.

"It hasn't yet spread from humans to humans, but that is what world health of.cials fear - a human influenza pandemic," Hackman said.

A human influenza pandemic is caused by a virus that is new to humans. Historically, the impact of influenza pandemics has ranged from mild to severe. Health officials are monitoring the H5N1 virus closely, knowing that it could mutate to become easily transmissible to humans, where the mortality rate is high.

"That would trigger a pandemic," Hackman explained.

Many have predicted an international disaster. "The aim is to prevent it," she said.

In March, Hackman was asked to take her hospital infection control experience and knowledge to a World Health Organization meeting in Geneva.

Hackman, along with two experts from the CDC, represented the United States and worked with 67 other health care representatives from countries around the world to make the WHO Pandemic In�uenza Plan operational.

Hackman was one of three nurses at the meeting, and before the trip, Marla Salmon, dean of Emory's Nell Hodgson Woodruff School of Nursing, appointed her an Academic Fellow of the Lillian Carter Center for International Nursing.

.It was an awesome honor and I was so grateful to have had this international exposure,. Hackman said.

Hackman worked with doctors from China and Brazil on the Public Health Measures for Containment and Control section of the plan. She focused on infection control measures for health care facilities.

Although containing a pandemic at its source has never been tried, evidence is mounting that it may be possible. Theoretical models have been published.

It would take coordinated action focused on a small area within days of the emergence of a new virus. Success would be dependent on early detection of the virus, swift mobilization of resources and compliance by the target population.

"Our meeting focused on three areas: logistics, surveillance and health measures needed to accomplish those goals," Hackman said.

Having just written Emory's plan, Hackman was able to bring to the table infection control recommendations for health care facilities that would help protect front line workers, as well as the community at large.

"I know I served a purpose there and people seemed so appreciative of the work we did," she said. "I came away thinking that it was pretty important to have someone doing my job in hospitals."