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Navigating Challenges in Healthcare Epidemiology · The SHEA Podcast

• 0:08
  SPEAKER_02: Welcome to Shay's podcast.
• 0:10
  SPEAKER_02: I'm Dr.
• 0:11
  SPEAKER_02: Katie Pasaretti.
• 0:12
  SPEAKER_02: I'm the Chief Infection Prevention Officer for the Advocate Healthcare System and a clinical professor at Atrium Health Wake Forest University School of Medicine.
• 0:23
  SPEAKER_02: I also am fortunate enough to chair Shay's Community Hospital Epidemiology and Stewardship Committee, and I sit on the board of trustees for Shay for this year.
• 0:33
  SPEAKER_02: I'm extremely excited to serve as today's moderator for a podcast looking at the role of the hospital epidemiologist and the similarities and differences that you might see in the role across different settings, ranging from community to predominantly academic.
• 0:52
  SPEAKER_02: Before we get started, I'd like to introduce you to today's speakers.
• 0:56
  SPEAKER_02: First, I want to introduce Dr.
• 0:58
  SPEAKER_02: Erica Chinoy.
• 1:00
  SPEAKER_02: She's the Chief of Infection Control for Mass General Brigham and associate professor at the Harvard School of Medicine.
• 1:06
  SPEAKER_02: Our second attendee today is Dr.
• 1:09
  SPEAKER_02: Louann Bruno Mursa.
• 1:11
  SPEAKER_02: She is the Senior Medical Director of Infection Prevention and Health System Epidemiology, the Division Chief of Infectious Diseases at Cambridge Health Alliance, and also an assistant professor at Harvard.
• 1:24
  SPEAKER_02: We're super very excited to hear about the perspectives from these two very, very talented leaders in infection prevention and hospital epidemiology.
• 1:34
  SPEAKER_02: I am going to let them tell a little bit more about their roles for kind of context for y'all as we're talking through the role of hospital epidemiologists and in different settings.
• 1:46
  SPEAKER_02: So for the first one, I will start out with Luann.
• 1:49
  SPEAKER_02: If you don't mind kind of introducing yourself beyond kind of your credentials and whatnot, what setting do you work in?
• 1:56
  SPEAKER_02: What kind of work do you do as it relates to infection prevention and hospital epidemiology?
• 2:02
  SPEAKER_00: Thanks, Katie.
• 2:04
  SPEAKER_00: I am Luann Bruno Murtha.
• 2:06
  SPEAKER_00: I'm the senior medical director of medical of infection prevention and control at Cambridge Health Alliance.
• 2:12
  SPEAKER_00: Cambridge Health Alliance is a safety network organization.
• 2:17
  SPEAKER_00: We have two acute care hospitals and one pediatric behavioral health hospital.
• 2:25
  SPEAKER_00: We have an urgent care center, two emergency departments, and 15 ambulatory care clinics.
• 2:32
  SPEAKER_00: And my responsibility is to oversee all the infection prevention and control activities for the organization.
• 2:39
  SPEAKER_00: I have two infection preventionists that work alongside me.
• 2:43
  SPEAKER_00: And we have a great team of quality and safety staff that also lend their support since we are a lean team.
• 2:53
  SPEAKER_00: I also wear the hat of Division Chief for Infectious Diseases, as well as co-chair all our antimicrobial stewardship activities for the organization.
• 3:03
  SPEAKER_00: And lastly, I do have an appointment at Harvard.
• 3:06
  SPEAKER_00: Thanks, Katie.
• 3:08
  SPEAKER_02: Yeah, thank you.
• 3:09
  SPEAKER_02: So a lot of different different responsibilities and different settings that you're you're working in in your area.
• 3:15
  SPEAKER_02: Very helpful.
• 3:16
  SPEAKER_02: And Dr.
• 3:16
  SPEAKER_02: Chinoy, same question for you.
• 3:19
  SPEAKER_01: Thanks, Katie.
• 3:20
  SPEAKER_01: So as you mentioned, I'm the chief of infection control for our system, Mass General Brigham.
• 3:24
  SPEAKER_01: This is a relatively new job.
• 3:26
  SPEAKER_01: I've only been in it for a little over a year.
• 3:28
  SPEAKER_01: And Mass General Brigham, just to give some context, as Luann did for Cambridge Health Alliance, Mass General Brigham has two AMCs, academic medical centers, multiple community hospitals, four post-acute care facilities, including a long-term care.
• 3:43
  SPEAKER_01: It has a growing hospital at home and a very large home care program and hundreds of ambulatory clinics across Massachusetts and New Hampshire.
• 3:53
  SPEAKER_01: We also have specialty hospitals, including a freestanding psychiatric facility, McLean, as well as the Mass Ioneer and a workforce of over 80,000 employees.
• 4:04
  SPEAKER_01: But prior to this role, I was working at MassGeneral, where I've basically been since I came here as an intern and resident and fellow.
• 4:12
  SPEAKER_01: And right now we're recruiting for medical directors of infection control.
• 4:15
  SPEAKER_01: So I'm serving both roles right now.
• 4:17
  SPEAKER_01: So I'm in the midst of the day-to-day infection control work at MGH and doing the work for the system.
• 4:23
  SPEAKER_01: It's different from Luann.
• 4:25
  SPEAKER_01: I do not do any stewardship.
• 4:27
  SPEAKER_01: Stewardship is separated out from infection control, at least at the AMCs and at a system level, it's not part of the infection control portfolio.
• 4:34
  SPEAKER_01: And I don't have an administrative role in my infectious diseases division here at MGH.
• 4:40
  SPEAKER_01: Awesome.
• 4:41
  SPEAKER_02: Very helpful.
• 4:41
  SPEAKER_02: So I heard a lot of similarities and a good number of differences in your all's job description.
• 4:46
  SPEAKER_02: So that was super helpful.
• 4:47
  SPEAKER_02: Dr.
• 4:48
  SPEAKER_02: Bruno Murtha, just for context, how long have you been doing your role?
• 4:52
  SPEAKER_02: Just as we're kind of going through the questions and whatnot?
• 4:55
  SPEAKER_00: So in my role as the infection prevention medical director and now senior medical director, I've been at this for 20 years doing that, more than 30 years for antimicrobial sewer chip activities.
• 5:09
  SPEAKER_02: Awesome.
• 5:09
  SPEAKER_02: That's helpful context.
• 5:10
  SPEAKER_02: Thank you so much.
• 5:11
  SPEAKER_02: So next, just wanted to ask both of you starting out with Dr.
• 5:14
  SPEAKER_02: Shinoy, what kind of training did you have along your path to where you are now in hospital epidemiology, your current role?
• 5:22
  SPEAKER_02: You know, how did you how did you find your way here?
• 5:25
  SPEAKER_01: So I got really into infection control as a junior resident.
• 5:30
  SPEAKER_01: I knew I was going into ID, but the world of infection control kind of presented itself to me when I started getting interested in patients on various forms of precautions and how that affected hospital operations.
• 5:42
  SPEAKER_01: And so during my fellowship here, which was an extended fellowship to do research, I basically plopped myself down in the infection control unit and never really left.
• 5:52
  SPEAKER_01: I had the good fortune of being office mates with a very experienced uh infection preventionist who I credit with teaching me so much, and then also pointing me in the direction of a lot of resources.
• 6:03
  SPEAKER_01: So I've definitely used many resources from Shay, attending um sessions at ID Week related to infection prevention, reading a ton, getting into the weeds around guidelines, using the compendium in its initial, you know, the 2014 and then the most recent one.
• 6:20
  SPEAKER_01: So I basically would say have learned on the job.
• 6:24
  SPEAKER_01: Um, I think the second thing that's really helped me in terms of training is that uh several years ago, after having learned on the job and wanting to offer more of a structured training program for fellows who are interested, developed a second-year fellowship track.
• 6:38
  SPEAKER_01: And as part of developing that track, I used the K paper on key competencies for infection control leaders and developed a curriculum.
• 6:48
  SPEAKER_01: And so by developing a curriculum and then periodically revising it, I feel like that's another, even though I'm training someone else, it's kind of retraining myself on core concepts and more advanced concepts in infection control.
• 7:01
  SPEAKER_02: Awesome.
• 7:01
  SPEAKER_02: Thank you.
• 7:01
  SPEAKER_02: That was very helpful.
• 7:02
  SPEAKER_02: So I'm hearing a mix of you know, structured training opportunities that are out there, networking, connections that help you along the way, and then the you know, classic medical see one, teach one, do one kind of mindset where you learn as you go at by teaching other people in part.
• 7:19
  SPEAKER_02: So that's that's very helpful, I think, for our listeners.
• 7:22
  SPEAKER_02: Um, Dr.
• 7:23
  SPEAKER_02: Bruno Murtha, same question for you.
• 7:25
  SPEAKER_00: Well, I'd like to say that I'm thrilled that there's now this actually a formal track for ID fellows who are interested in healthcare ET to actually have that training before they complete their fellowship program.
• 7:38
  SPEAKER_00: That's really awesome.
• 7:39
  SPEAKER_00: I wish I had that opportunity.
• 7:41
  SPEAKER_00: But be that as it may, can't turn back.
• 7:44
  SPEAKER_00: Uh, I'm thrilled to say that there are plenty of opportunities to learn this field.
• 7:49
  SPEAKER_00: And I very much learned on the job.
• 7:52
  SPEAKER_00: And when I realized I had the opportunity to take a leadership role in Healthcare Epi, I actually attended the joint CDC training with SHA.
• 8:04
  SPEAKER_00: It's a certificate program that's offered every year at the spring SHA meeting.
• 8:09
  SPEAKER_00: And that really was instrumental in giving me the confidence and the knowledge I needed really to feel confident to address many issues.
• 8:18
  SPEAKER_00: And I continue to address uh to attend the SHA meeting almost every spring.
• 8:24
  SPEAKER_00: And sometimes I go back to those core basic uh presentations just to refresh my memory on uh pertinent uh details and uh skills.
• 8:36
  SPEAKER_00: But also there's a lot of tools that are available and networking.
• 8:40
  SPEAKER_00: I you know, I'm fortunate that I uh practice in the Boston area.
• 8:45
  SPEAKER_00: And then healthcare epies in our state, including Erica, are fantastic at sharing, at networking, and just being there for questions and problems.
• 8:56
  SPEAKER_00: So that's been great.
• 8:57
  SPEAKER_00: And then lastly, the chess group.
• 8:59
  SPEAKER_00: The chess group is a group within Shay, it's community-based uh healthcare epis and antimicrobial store that get together on a quarterly basis and we share our challenges.
• 9:11
  SPEAKER_00: We we brainstorm, we share our tools for overcoming challenges, and that's been really instrumental and very much worthwhile.
• 9:21
  SPEAKER_01: I was just gonna pick up on a couple of things you said, Luann, which really uh resonated with me.
• 9:26
  SPEAKER_01: So, first, the Shea course, I've sat in that course multiple times.
• 9:31
  SPEAKER_01: I've heard the same, like similar lectures over the years, and every single time, maybe it's because I didn't hear it quite the same way the first time, or I have more experience now and can put it into context, I'm always learning.
• 9:44
  SPEAKER_01: And I I really do try to take advantage of sitting in and a most of those, even if I'm not formally taking the course each Shea spring.
• 9:50
  SPEAKER_01: So I think that is an incredible resource, not just once, but multiple times to take advantage of.
• 9:56
  SPEAKER_01: And the second was what you said about the community and reaching out to peers.
• 10:00
  SPEAKER_01: I find that, you know, we in the various environments we have, one of us has probably seen something like what might come across our doorstep and just having someone else to run a case by.
• 10:12
  SPEAKER_01: Um, we don't have time to publish everything we've ever seen, even as interesting as it is, but we do have a lot of institutional memory across our fields.
• 10:21
  SPEAKER_01: And I just think that's really an incredible resource to call onto.
• 10:24
  SPEAKER_01: And cold calling people, we're all very friendly.
• 10:27
  SPEAKER_01: So I might not have actually met someone before, but if they reach out, I'm really um very happy to see if I can be of any assistance.
• 10:35
  SPEAKER_00: And if I could just add on to that, another great resource, at least for us in the state of Massachusetts, is our uh healthcare department.
• 10:43
  SPEAKER_00: Massachusetts Department of Public Health is there.
• 10:46
  SPEAKER_00: And I've reached out to them to work up clusters to do some of the advanced molecular testing that we don't have the capabilities to do at a community-based uh healthcare organization.
• 10:57
  SPEAKER_00: So they've been great partners uh with me, and I've actually even published a few papers alongside of the work that they've done for us.
• 11:06
  SPEAKER_00: So I would strongly encourage all healthcare epies to forge those relationships with their public health partners.
• 11:13
  SPEAKER_02: Yeah, hospital epi, you know, the relationships are everything.
• 11:17
  SPEAKER_02: I think you are constantly learning when you take on this role and dealing with new situation after new situation.
• 11:23
  SPEAKER_02: And, you know, that probably is part of what draws some of us into the field.
• 11:27
  SPEAKER_02: Um, but with that, you know, talking through things with peers, you know, revisiting issues, revisiting education as it applies to a new situation is is always helpful.
• 11:38
  SPEAKER_02: And there are resources out there for people to tap into.
• 11:42
  SPEAKER_02: So thank you both.
• 11:43
  SPEAKER_02: Those were wonderful comments.
• 11:45
  SPEAKER_02: Moving on, you know, it's not all roses sometimes, right?
• 11:49
  SPEAKER_02: So what would you say are your top challenges in your current role?
• 11:54
  SPEAKER_02: And we'll start this one off with Dr.
• 11:56
  SPEAKER_02: Bruno Murtha.
• 11:58
  SPEAKER_00: Uh, top challenges, I think, are really getting back to core infection prevention and control basics, especially coming out of the pandemic.
• 12:07
  SPEAKER_00: Uh, there's been an awful lot of staff turnover, and the new staff coming in are not really extremely knowledgeable about our organizational policies and practices and what really matters, the really basic things.
• 12:21
  SPEAKER_00: So that remains an ongoing challenge.
• 12:24
  SPEAKER_00: It seems like our education opportunities, their orientations keep getting condensed.
• 12:29
  SPEAKER_00: And so they're starting out not really fully understanding our policies and procedures.
• 12:35
  SPEAKER_00: So that's one challenge.
• 12:37
  SPEAKER_00: I think another challenge that we're all facing is the financial challenges that healthcare is currently battling, and that presents its own challenges in terms of expanding our staffing to what we really think we need.
• 12:51
  SPEAKER_00: And then probably the third challenge is instilling accountability, right?
• 12:56
  SPEAKER_00: We we don't really, we can't hold staff accountable for us.
• 13:00
  SPEAKER_00: They're we're not their bosses.
• 13:02
  SPEAKER_00: So trying to forge those great relationships with the responsible parties is often challenging.
• 13:08
  SPEAKER_00: So I think those are my greatest challenges.
• 13:11
  SPEAKER_02: Yeah, absolutely.
• 13:12
  SPEAKER_02: All very, very good points and you know, very pertinent to to the audience here.
• 13:17
  SPEAKER_02: Uh, Dr.
• 13:17
  SPEAKER_02: Chinoy, same question for you.
• 13:19
  SPEAKER_01: Well, first I'm shocked that it's not all roses, um, especially on Friday afternoon at 4.59, but we've all been there.
• 13:27
  SPEAKER_01: I totally agree with what Luann is saying.
• 13:29
  SPEAKER_01: I would add a couple things.
• 13:31
  SPEAKER_01: I think standard precautions are just not understood.
• 13:35
  SPEAKER_01: If we really, if our staff knew and understood and lived standard precautions, we would be in a much different place, I think, across the board with HAI prevention and other safety aspects.
• 13:48
  SPEAKER_01: So I think I totally agree with that.
• 13:50
  SPEAKER_01: I think in addition to the turnover, it's really hard to not recognize the amount of burnout concern with well-being across not just all of our staff, but I think our IPC staff as well, who've been through, everyone's been through a very, very intense period.
• 14:07
  SPEAKER_01: And now we're dealing with, as Luann said, a lot of financial pressures, trying to get back to basics.
• 14:13
  SPEAKER_01: And I think that is definitely weighing and making our work challenging.
• 14:17
  SPEAKER_01: In addition to that part of accountability and really trying to make sure that our audiences understand what is the role of IPC, which is as a subject matter expert, troubleshooting, but we can't do the actual prevention at the bedside because we're not at the bedside.
• 14:34
  SPEAKER_01: And so that I think speaks to the accountability part.
• 14:37
  SPEAKER_01: And I and that's I probably a cultural shift to really think of the role of IPC that way and to really understand it.
• 14:44
  SPEAKER_01: So I think there are a lot of challenges.
• 14:46
  SPEAKER_01: And I don't want people to think that it's all challenges because there's also a lot of wonderful things that we can contribute as a field to patient safety and healthcare worker safety.
• 14:55
  SPEAKER_02: Yeah, so hearing a lot of common themes, whether you're in kind of an academically based center or community-based center, there's a lot of overlapping challenges.
• 15:05
  SPEAKER_02: It may show up slightly differently in different settings or be a little bit different, but the common themes are very similar.
• 15:12
  SPEAKER_02: I would say, you know, in my perspective, the community that's supporting infection prevention, the community of healthcare epidemiology, you know, Shays leadership is at a point where it feels even more supportive than it has in the past when you're working through those challenges, you have a good group to lean on.
• 15:32
  SPEAKER_02: So I think those, while those challenges are there, you know, would just kind of echo that there is also, you know, I think we're in a hopeful place.
• 15:40
  SPEAKER_02: And honestly, uh a place where there is more attention to the importance of infection prevention than maybe there has been in the past.
• 15:47
  SPEAKER_02: So thank you both.
• 15:49
  SPEAKER_02: Another question for y'all, and we've kind of hit on this, but if you want to add anything else, you know, hospital epi, infection prevention, infection control, all the things are constantly in evolution.
• 16:00
  SPEAKER_02: You're constantly having challenges that maybe you haven't personally seen before.
• 16:05
  SPEAKER_02: What's your personal support system for working through those challenges?
• 16:09
  SPEAKER_02: Any resources that you want to kind of just reiterate or, you know, state are super helpful to y'all?
• 16:15
  SPEAKER_02: And I will start this one off with Dr.
• 16:17
  SPEAKER_02: Shinoi.
• 16:18
  SPEAKER_01: Yeah, I think we've covered most of them.
• 16:20
  SPEAKER_01: I can't emphasize enough how important the documents like the compendia are, white papers.
• 16:26
  SPEAKER_01: I, if I ever, whenever I meet someone who's an author on one of the compendia that I'm using a lot, I try to thank them because the work that they've done really makes it a lot more straightforward for us to digest and implement locally.
• 16:39
  SPEAKER_01: So I would reference those.
• 16:40
  SPEAKER_01: We talked about the community of resources and just reaching out even to some person that you might not know.
• 16:45
  SPEAKER_01: But if you see that they've written a paper on something, most people, if you reach out to them, I think my experience has always been they'll they'll be glad to find time to talk something through with you.
• 16:54
  SPEAKER_01: So I would say don't be shy, read as much as you can, but reach out to individuals to get uh some additional guidance.
• 17:01
  SPEAKER_02: We're all a little bit nerdy and like to talk about all things infection prevention related.
• 17:06
  SPEAKER_02: So we'll just reiterate, you know, I I have become less hesitant about reaching out to people that I was like, oh, they're too smart for me or at a different level.
• 17:15
  SPEAKER_02: Um, you know, people love sharing their insight and prior experience within within our field.
• 17:19
  SPEAKER_02: Dr.
• 17:20
  SPEAKER_02: Bruno Murtha's uh same question for you.
• 17:22
  SPEAKER_02: Anything else you want to add on resources or your support system?
• 17:26
  SPEAKER_00: Yeah, I think Erica hit all the important uh points, but you know, I just want to say as well that the Shea Town Halls have been really fantastic over the course of the past five years now.
• 17:40
  SPEAKER_00: And you know, I've reached out to those presenters on multiple occasions to pick their brains some more.
• 17:46
  SPEAKER_00: And, you know, just to reiterate that the Shea community really is there to help each other.
• 17:52
  SPEAKER_00: And just I admire the organization for providing that network.
• 17:57
  SPEAKER_00: I think that everyone should feel welcome to reach out to a colleague in in the society for help.
• 18:03
  SPEAKER_00: And I've always felt that there's um great professional and personal responses anytime I've done that.
• 18:11
  SPEAKER_02: Very, very well said.
• 18:12
  SPEAKER_02: Thank you.
• 18:13
  SPEAKER_02: Um, we're getting to the end of our time.
• 18:15
  SPEAKER_02: So just kind of in the way of wrap-up, any final words of wisdom and or, you know, we've talked about some of the challenges, you know, weave in what you love about your job, why you do what you do.
• 18:25
  SPEAKER_02: There's other paths you could have taken.
• 18:27
  SPEAKER_02: You chose this one.
• 18:28
  SPEAKER_02: Um, what is it that keeps you coming back?
• 18:30
  SPEAKER_02: And I'm sorry, I will start with Dr.
• 18:32
  SPEAKER_02: Bruno Murtha.
• 18:34
  SPEAKER_00: Thanks, Katie.
• 18:35
  SPEAKER_00: Oh, I really enjoy what I do.
• 18:37
  SPEAKER_00: I think I like it because you really are a physician that covers the full gamut.
• 18:44
  SPEAKER_00: We're dealing with surgeons, we're dealing with primary care providers, we're dealing with ED providers, we're dealing with our nursing colleagues and you know, case managers.
• 18:54
  SPEAKER_00: We we really have conversations with everyone working in the healthcare system.
• 18:59
  SPEAKER_00: And I really do like that.
• 19:00
  SPEAKER_00: So that's one thing I like.
• 19:02
  SPEAKER_00: And, you know, I've had the good fortune, even though we're a small community-based healthcare system, I'm starting to list all the trainees that I've had.
• 19:11
  SPEAKER_00: And I think there's about a dozen who've actually pursued ID, even though our medical residency is really intended to attract people in primary care.
• 19:20
  SPEAKER_00: So I think uh, and my colleagues have been instrumental in getting people interested in ID.
• 19:25
  SPEAKER_00: And I do not fail to tell them all that they should seriously consider training in healthcare, Epi, and antimicrobial search, because it's a great balance as a career.
• 19:36
  SPEAKER_00: Doing all clinical is very, very hard work, and that's what's contributing to burnout.
• 19:42
  SPEAKER_00: You need something else to bring in a variety of uh different perspectives.
• 19:48
  SPEAKER_00: And so that's you know what I would and continue to encourage my former trainees who are pursuing uh a career in the field.
• 19:57
  SPEAKER_01: Thank you.
• 19:58
  SPEAKER_01: And Dr.
• 19:59
  SPEAKER_01: Shinoy, how about you?
• 20:01
  SPEAKER_01: I wouldn't never choose anything different than this field.
• 20:05
  SPEAKER_01: It's everything that Luann mentioned, it's it's never boring.
• 20:10
  SPEAKER_01: It requires a lot of thinking, it requires risk assessment, balancing different aspects, integrating literature, principles, and then that piece around what Luann described as a whole gamut, you really do get a chance to work with individuals and groups across the spectrum to try to solve problems.
• 20:33
  SPEAKER_01: You're practical, you can be very useful, and most importantly, at the end of the day, you're supporting the safety and the quality of care that we give to our patients and the environment that all of all of us, our colleagues, colleagues like across everywhere are working in.
• 20:49
  SPEAKER_01: And that's just a very, I think it brings a lot of joy, at least to me, to be able to be a part of that.
• 20:55
  SPEAKER_01: So if you're in this job because you got, I think, assigned it, which sometimes happens, or because you came to it, I would um really take the opportunity to take, take some of the resources that are available and become more and more into it and educate yourself more and contribute to Shay.
• 21:12
  SPEAKER_01: Because, well, I think we may be calling you at any point to ask you a question about something you've seen that we may not have seen.
• 21:19
  SPEAKER_01: And so uh it will be you will be a great resource to others and find a lot of joy in your work.
• 21:24
  SPEAKER_02: Great summary from both of you.
• 21:26
  SPEAKER_02: Uh I just want to thank Dr.
• 21:27
  SPEAKER_02: Chinoy and Dr.
• 21:28
  SPEAKER_02: Bruno Murtha for being, you know, given their words of wisdom and sharing their experiences.
• 21:33
  SPEAKER_02: We'll put one more shameless plug.
• 21:35
  SPEAKER_02: For people that do feel like they're not connected, if you're out in a community setting, feel like you're not connected to others, the community healthcare epidemiology and stewardship group is a great resource.
• 21:46
  SPEAKER_02: Consider joining um and you know, building that community to help support you.
• 21:51
  SPEAKER_02: And thank y'all for listening very much.
• 21:53
  SPEAKER_02: Thanks so much.