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OPRW 2019: Outbreak Prevention: Current Challenges & Future Threats · The SHEA Podcast

• 0:07
  SPEAKER_00: The Society for Healthcare Epidemiology of America is proud to present this podcast, Outbreak Prevention, Current Challenges and Future Threats, as a part of SHA's Outbreak Prevention Response Week 2019.
• 0:20
  SPEAKER_00: This podcast has a slightly different audience than the normal SHA podcast because it's really meant to promote the field of healthcare epidemiology, infection prevention, and antibiotic stewardship beyond the SHA membership.
• 0:32
  SPEAKER_00: We hope that Shea members will help share this with their colleagues, friends, family members, and patients to really give a better idea of what it is that we do.
• 0:41
  SPEAKER_00: I'm Dr.
• 0:42
  SPEAKER_00: Mike Stevens, and I'm here with my friend and colleague, Dr.
• 0:44
  SPEAKER_00: Gonzalo Behrman.
• 0:46
  SPEAKER_00: I'll give a brief intro of myself and then I'll let Gonzalo do the same.
• 0:49
  SPEAKER_00: I'm an IDE physician here at Virginia Commonwealth University, an associate hospital epidemiologist, and the director of our antibiotic stewardship program.
• 0:58
  SPEAKER_00: In terms of what I do with SHA, I'm a longstanding member and currently the chair of the publications committee and also sit on the guidelines committee.
• 1:05
  SPEAKER_00: Thank you for that very nice introduction there.
• 1:08
  SPEAKER_00: I'm Gonzalo Beerman.
• 1:09
  SPEAKER_00: I'm an infectious disease specialist and a hospital epidemiologist here at the Virginia Commonwealth University.
• 1:16
  SPEAKER_00: I also am a SHA member and I'm currently on the SHA executive board or the board of directors.
• 1:22
  SPEAKER_00: I previously I worked on various SHA committees, including the Guidelines Committee, which I was the chair of.
• 1:28
  SPEAKER_00: Fantastic.
• 1:29
  SPEAKER_00: So to start, significant progress has been made in preventing many health care associated infections, but hospitals must remain vigilant in identifying and maintaining infection control processes to reduce common infections and stay ahead of emerging pathogens.
• 1:44
  SPEAKER_00: Every year, 700,000 inpatients in the U.S.
• 1:47
  SPEAKER_00: or about 3% of all hospitalized people suffer a healthcare associated infection at significant cost.
• 1:54
  SPEAKER_00: So I'm going to ask you some questions.
• 1:56
  SPEAKER_00: That's all good.
• 1:57
  SPEAKER_00: All right, to begin with, healthcare epidemiologists and infection prevention experts are critical because they provide a specific skill set and expert guidance required in prevention.
• 2:08
  SPEAKER_00: But for much of the public and even some in healthcare, the field of healthcare epidemiology is a bit of an unknown.
• 2:14
  SPEAKER_00: Can you talk about the three main goals that you have as a hospital epidemiologist?
• 2:19
  SPEAKER_00: Yes, I think in the preamble to the question you were talking about, 700,000 patients in the United States are 3% of all hospitalized patients suffering from a healthcare associated infection.
• 2:28
  SPEAKER_00: But you pause to think about that.
• 2:31
  SPEAKER_00: Numbers are still really quite staggering.
• 2:33
  SPEAKER_00: 3% is really quite big.
• 2:35
  SPEAKER_00: Although we've made a lot of improvements over the over the years, we wish it would be lower than that.
• 2:40
  SPEAKER_00: So I guess the three main goals relevant to that is obviously to further reduce the risk of health care associated infections.
• 2:47
  SPEAKER_00: That's done through really three ways, in my opinion.
• 2:50
  SPEAKER_00: Number one is trying to maximally implement what we know should be done or what risk reduction interventions we know will work, implementing those in real-world scenarios across a diversity of hospital settings to scale.
• 3:06
  SPEAKER_00: So that's a real challenge, and that's really one of the major goals.
• 3:09
  SPEAKER_00: Our goal number two is to really advance the science of infection prevention so that we learn more about how to control and prevent infections so that we can later implement that to scale and further reduce the risk of infections.
• 3:24
  SPEAKER_00: And goal number three is to really raise awareness and train the next generation of hospital epidemiologists and people interested in infection control and fake infection preventionists to further that mission and to help us in that goal towards high reliability and risk reduction.
• 3:40
  SPEAKER_00: That's great.
• 3:40
  SPEAKER_00: That's a fantastic perspective.
• 3:42
  SPEAKER_00: We're lucky at VCU because we're well resourced and well supported by hospital administration.
• 3:48
  SPEAKER_00: But I know many of our colleagues struggle with this.
• 3:50
  SPEAKER_00: What are the benefits of being well resourced that you see as the compelling reason to fund this area?
• 3:56
  SPEAKER_00: Well, you're right that we're very lucky at VCU to have the kind of support and the trust and the being valued by the administration the way that we are.
• 4:05
  SPEAKER_00: And to give a little historical perspective, you know, BCU has a long history of infection prevention excellence, going back to Glenn Mayhall, the original author of infection control textbooks.
• 4:17
  SPEAKER_00: And of course, Richard Wenzel, Michael Edman were here, and then our group, we're kind of like a fourth generation, I think, as I've said before.
• 4:24
  SPEAKER_00: So we've kind of inherited all those programs over the years from people that were really high achieving infection prevention.
• 4:31
  SPEAKER_00: With that, it leads to an awareness of infection prevention at VCU, a also national awareness of the program and what we try to do here.
• 4:40
  SPEAKER_00: And last but not least, it's maybe the most important for us locally, is that it leads to a kind of respect from hospital administration leaders of the mission and of our accomplishments, and with that comes additional resources.
• 4:52
  SPEAKER_00: The benefits of having additional resources is the more resources you have and the more successes you have, it's kind of that success begets more success.
• 5:02
  SPEAKER_00: It's a process that continues to grow.
• 5:04
  SPEAKER_00: That's great.
• 5:05
  SPEAKER_00: When most people think about outbreaks, they immediately think of the movies and people in Tyvek suits investigating mysterious illnesses in often remote parts of the world.
• 5:14
  SPEAKER_00: But outbreaks come in many different ways.
• 5:16
  SPEAKER_00: Can you talk about an outbreak or a potential outbreak you've had to investigate or monitor and your role along with the team in making sure patients were safe?
• 5:25
  SPEAKER_00: You're absolutely correct that outbreaks come in many different ways.
• 5:28
  SPEAKER_00: And I would say the majority of outbreaks with healthcare settings are not that glamorous, made-for-television sexy thing that's going to get a lot of attention.
• 5:37
  SPEAKER_00: It's actually something that's much more mundane.
• 5:39
  SPEAKER_00: That you have an increase in either staphylococcal infections or certain kinds of gram-negative rod infections or bacterial infections in the unit.
• 5:46
  SPEAKER_00: And it's not going to be something that's going to resonate with the majority of the public.
• 5:50
  SPEAKER_00: But what's important is that we apply the appropriate epidemiology assessment principles, outbreak investigation tools to correct that, and also to implement the safety strategies that are going to prevent that for either either happening again or propagating any further.
• 6:08
  SPEAKER_00: In terms of recent outbreaks, and I've been here since 2003, we're very fortunate we've not had a significant outbreak of VCU health since then.
• 6:16
  SPEAKER_00: We're very proud of that.
• 6:17
  SPEAKER_00: We've investigated some things that we thought may have been an outbreak, but it didn't turn out to be that way.
• 6:23
  SPEAKER_00: So there's some discussion about the end of healthcare associated infections, i.e.
• 6:27
  SPEAKER_00: a getting to zero program.
• 6:29
  SPEAKER_00: What are your thoughts on this?
• 6:30
  SPEAKER_00: Oh, yeah, so we have a lot of opinions about the getting to zero program.
• 6:34
  SPEAKER_00: I think it's an aspiration goal to eliminate health care associated infections, but I like to put that in some sort of perspective.
• 6:41
  SPEAKER_00: So Mike has heard this many times, and so have those that are around me, so kind of like a broken record.
• 6:46
  SPEAKER_00: But to my knowledge, in the history of medicine, the only infectious disease that we have eradicated is smallpox.
• 6:52
  SPEAKER_00: So to say that we're eradicating health care associated infections, you know, that's a bit of a tall order.
• 6:57
  SPEAKER_00: So what we're looking for is really trying to maximally focus on the reduction of potentially preventable health care associated infections.
• 7:05
  SPEAKER_00: Not all healthcare associated infections are preventable in 2019.
• 7:10
  SPEAKER_00: The science isn't quite that robust at this time.
• 7:13
  SPEAKER_00: It may be in 100 years from now, 50 years, who knows?
• 7:16
  SPEAKER_00: But it currently isn't.
• 7:17
  SPEAKER_00: So our goal is really to be clear on what we can expect.
• 7:21
  SPEAKER_00: You know, perhaps 35, 50, 70% of healthcare associated infections are preventable.
• 7:28
  SPEAKER_00: Our focus is on the maximal reduction of risk for those potentially preventable infections by maximally implementing what we know is supposed to work reliably to scale.
• 7:39
  SPEAKER_00: And that's really should be the focus.
• 7:40
  SPEAKER_00: Otherwise, I think we're misleading the public, misleading ourselves on what we can do.
• 7:45
  SPEAKER_00: Another thing I like to mention is, and this is important from a kind of a paradigm perspective, is that historically hospital infection prevention has been focused on preventing infections from exogenous or external sources, you know, the dirty hands of the healthcare worker, the invasive device, the things that haven't been properly sanitized or cleaned, like rooms or equipment, et cetera, et cetera, leading to an infection.
• 8:08
  SPEAKER_00: That's absolutely true, and that's where most of our focus has been maximal disinfection, hygiene, checklists, et cetera, et cetera.
• 8:16
  SPEAKER_00: But there's a new threat on the horizon that's going to become more and more relevant is basically the internal threat of our own bacteria, such as you see with clustered imdificile, our own microbiome being adjusted or altered by the way we use immune modifying medications and antibiotics, et cetera, et cetera.
• 8:33
  SPEAKER_00: And that's the new frontier.
• 8:34
  SPEAKER_00: We in our science is much, much less robust in understanding and controlling our own microbiome as a cause of infections.
• 8:42
  SPEAKER_00: Great response.
• 8:43
  SPEAKER_00: The irreducible minimum.
• 8:44
  SPEAKER_00: The irreducible minimum is absolutely right.
• 8:46
  SPEAKER_00: I think if we if we oversell, we're really betraying the public's trust because we're not being clear and honest about what we can prevent.
• 8:53
  SPEAKER_00: All right.
• 8:53
  SPEAKER_00: Well, great.
• 8:54
  SPEAKER_00: For patients and caregivers, what do you see as the best thing they can do to protect themselves before or during a hospital stay?
• 9:02
  SPEAKER_00: The best thing you can do to protect yourself from a hospital car infection is not get hospitalized.
• 9:06
  SPEAKER_00: That's the absolute best thing.
• 9:08
  SPEAKER_00: But if you must be hospitalized, I would say you try to get out of there as soon as feasible.
• 9:13
  SPEAKER_00: Certainly have as few devices as necessary.
• 9:17
  SPEAKER_00: Encourage healthcare workers to wash their hands.
• 9:20
  SPEAKER_00: Encourage your family if they're going to come in and spend time with you to wash their hands and before they touch any devices or hug you, et cetera, et cetera.
• 9:27
  SPEAKER_00: But I think that the role that the patient can play is probably not as much as we wish it could be.
• 9:34
  SPEAKER_00: Patients can be vocal, but I've seen that patients also are less likely to be vocal because they feel uncomfortable about saying something to your providers, which is too bad.
• 9:43
  SPEAKER_00: Great advice for sure.
• 9:44
  SPEAKER_00: So how can Shea support healthcare members, infection preventionists, hospital epidemiologists with outbreak preparedness?
• 9:53
  SPEAKER_00: So there are multiple ways.
• 9:54
  SPEAKER_00: First of all, Shea continues to raise awareness about the importance of preventing hospital cord infections, the burden and the impact of it.
• 10:01
  SPEAKER_00: But Shea also has an educational role.
• 10:04
  SPEAKER_00: And for healthcare workers who actually have an interest in this particular area or this area of medical practice, if you will, Shay has an education and training courses for those that are interested in this, but that are intense courses.
• 10:20
  SPEAKER_00: But the way you learn the principles of epidemiology, outbreak control, understanding outbreaks, outbreak interventions, in addition to that, communicating outbreak, communicating risk, communicating with your colleagues, communicating with the public.
• 10:33
  SPEAKER_00: Really important.
• 10:34
  SPEAKER_00: There is a the SHA outbreak response training program.
• 10:38
  SPEAKER_00: I think we call the ORTP.
• 10:39
  SPEAKER_00: That's the one really that's available.
• 10:41
  SPEAKER_00: You can uh register online, and I would certainly encourage it.
• 10:45
  SPEAKER_00: Fantastic.
• 10:46
  SPEAKER_00: Yeah, that's a terrific resource that was created in collaboration with the CDC, and as you find out more on the SHA website.
• 10:52
  SPEAKER_00: So it's a terrific resource for folks.
• 10:55
  SPEAKER_00: All right, and finally, what's the best part about being involved in healthcare epidemiology?
• 11:00
  SPEAKER_00: What's the best part?
• 11:02
  SPEAKER_00: You know, I would say what I like the most about being involved in healthcare epidemiology is that it allows me to look at practice of medicine or practice medicine, I should say, in a different perspective.
• 11:12
  SPEAKER_00: For example, you and I, Mike, we were both trained in medical school and we're infectious disease consultants, and we see a lot of patients in the hospital and the clinics.
• 11:19
  SPEAKER_00: But that's seeing patients on a one-to-one level, right?
• 11:22
  SPEAKER_00: That's the classic doctor-patient relationship.
• 11:24
  SPEAKER_00: With healthcare epidemiology, you can still have a huge impact on patients, but not at the doctor-patient relationship on one-on-one.
• 11:32
  SPEAKER_00: You're actually doing it under the lens and the perspective of public health, which I think is really important because now we look at problems and issues and challenges from a public health perspective, saying what can we do that would be best for a population?
• 11:48
  SPEAKER_00: And with the resources we have, what can we best institute, implement, adjust, modify such that that population is safer and gets higher quality care in the hospital, and we avert bad things, consequences such as hospital card infections.
• 12:04
  SPEAKER_00: So it really allows epidemiologists who have been time both as clinicians and also as public health personnel dealing with uh medical conditions or medical issues on the one-on-one level and also on the population level.
• 12:17
  SPEAKER_00: And that's really exciting.
• 12:18
  SPEAKER_00: That's really exciting.
• 12:20
  SPEAKER_00: It's broad and exciting.
• 12:22
  SPEAKER_00: Gonzalez, thanks for joining me today and sharing your perspectives and experiences.
• 12:27
  SPEAKER_00: You really went through a lot of great information.
• 12:30
  SPEAKER_00: In the show notes, there's a link to an editorial you wrote with Dr.
• 12:33
  SPEAKER_00: Richard Wenzel, another giant in the field of hospital epidemiology.
• 12:37
  SPEAKER_00: There's a lot of great information there, so hopefully, people can take a look at that.
• 12:41
  SPEAKER_00: You really brought up a lot of key things, but it sounds like most of what we do, the best thing is to prevent infections.
• 12:48
  SPEAKER_00: And so hopefully the majority of our time is spent doing that as opposed to investigating outbreaks.
• 12:54
  SPEAKER_00: But if we focus on what we know works and implement these risk reduction interventions to scale reliably, we can essentially avert most, if not all, of the outbreaks, and that's the goal.
• 13:05
  SPEAKER_00: Making the outbreaks fewer and fewer in frequency.
• 13:09
  SPEAKER_00: Terrific.
• 13:09
  SPEAKER_00: Uh, and another key theme that was brought up is training the next generation, but then also resources for education.
• 13:16
  SPEAKER_00: Uh, and you brought up the ORTP VSHA, which I think is also you know a great resource.
• 13:22
  SPEAKER_00: Absolutely.
• 13:22
  SPEAKER_00: Now more than ever, these resources are available essentially.
• 13:25
  SPEAKER_00: You can sit at your at your computer on your couch at home and really access this high-quality material.
• 13:31
  SPEAKER_00: Oh, great, terrific.
• 13:32
  SPEAKER_00: One of the things you talk about in your editorial is some of the challenges in recruiting new infectious disease physicians.
• 13:38
  SPEAKER_00: Yeah.
• 13:38
  SPEAKER_00: Uh, you know, a subset of those physicians practice hospital epidemiology, having a community that can support you when you're doing frontline epidemiology, I think, is a wonderful thing.
• 13:47
  SPEAKER_00: So yeah, absolutely.
• 13:48
  SPEAKER_00: So a community that supports the frontline epidemiologists, and you said, Mike, they're becoming fewer and fewer in number because of the scarcity or looming shortage of infectious disease specialists, but also that generates ongoing enthusiasm about what we do.
• 14:03
  SPEAKER_00: So we continue to get those handfuls of high-quality graduates who want to pursue not only infectious disease, but the subspecially of possible infection prevention within infectious disease.
• 14:13
  SPEAKER_00: Well, fantastic.
• 14:14
  SPEAKER_00: So if you want to learn more, go check out the editorial and we'll close this podcast.
• 14:19
  SPEAKER_00: We hope you'll join us at the sixth International Conference on Healthcare Associated Infections, the Decennial 2020.
• 14:25
  SPEAKER_00: This conference will be held in Atlanta, Georgia from March 26th to the 30th, and it's co-hosted by Shea and the CDC.
• 14:32
  SPEAKER_00: And registration open this week.
• 14:34
  SPEAKER_00: So log in and sign up.
• 14:36
  SPEAKER_00: All right, all right.
• 14:37
  SPEAKER_00: Join Shea, everyone's doing it, right?
• 14:39
  SPEAKER_00: There you go.
• 14:39
  SPEAKER_00: Everyone's doing it.
• 14:40
  SPEAKER_00: You can find out more at www.decennial2020.org.
• 14:45
  SPEAKER_00: And this concludes this podcast on outbreak prevention, current challenges, and future threats.
• 14:50
  SPEAKER_00: Enjoy it.
• 14:51
  SPEAKER_00: Thank you very much.