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Role of Healthcare Epidemiology in Public Health · The SHEA Podcast

• 0:08
  SPEAKER_02: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the fields of healthcare epidemiology and antibiotic stewardship.
• 0:23
  SPEAKER_02: I am Dr.
• 0:23
  SPEAKER_02: David Bannock from the University of Connecticut, and I will serve as today's podcast moderator.
• 0:28
  SPEAKER_02: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:37
  SPEAKER_02: Shay is excited to launch this episode of the podcast, COVID-19 updates, what we know now.
• 0:42
  SPEAKER_02: Today's discussion will focus on the role of healthcare epidemiology in public health.
• 0:46
  SPEAKER_02: Our guest on the podcast today is Rosa Tammer, infection control epidemiologist at the Oregon Health Authority.
• 0:53
  SPEAKER_02: Thank you for joining us today.
• 0:54
  SPEAKER_02: Before we start our discussion, I would like to turn it over to Dr.
• 0:56
  SPEAKER_02: Jennifer Hanrahan to get us started with a brief news and guidance update for the week.
• 1:01
  SPEAKER_01: As of August 17, 2021, there have been 207,784,507 confirmed cases of COVID-19, including 4,370,424 deaths reported to the World Health Organization.
• 1:16
  SPEAKER_01: As of August 16th, almost 4.5 billion vaccine doses have been administered in the world.
• 1:22
  SPEAKER_01: About half of the U.S.
• 1:23
  SPEAKER_01: population is fully vaccinated.
• 1:25
  SPEAKER_01: The CDC has updated guidance for vaccines for moderately to severe immunocompromised people on August 16, 2021.
• 1:33
  SPEAKER_01: The CDC now recommends that people whose immune systems are compromised moderately to severely should receive an additional dose of messenger RNA COVID-19 vaccine after the initial two doses.
• 1:44
  SPEAKER_01: This includes people who have been receiving active cancer treatment for tumors or cancers of the blood, people who have received an organ transplant and are taking medicine to suppress the immune system, those who received a dental transplant within the last two years or taking medicine to suppress the immune system, those who have moderate or severe primary immunodeficiency, those with advanced or untreated HIV infection, and those with active treatment with high dose corticosteroids or other drugs that may suppress the immune system.
• 2:12
  SPEAKER_01: People should talk to their healthcare provider about their medical condition and whether getting an additional dose is appropriate for them.
• 2:18
  SPEAKER_01: This third dose should be administered at least four weeks after the second dose of a messenger RNA vaccine.
• 2:23
  SPEAKER_01: There's not enough data at this time to determine whether immunocompromised people who received Johnson Johnson's COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.
• 2:35
  SPEAKER_01: An article published in the New England Journal of Medicine describes the effectiveness of COVID-19 vaccines against the Delta variant.
• 2:42
  SPEAKER_01: This study from England found that effectiveness after one dose of vaccine, either Pfizer or AstraZeneca, was notably lower among persons with the delta variant than among those with the alpha variant.
• 2:54
  SPEAKER_01: It was 30.7% for the delta variant and 48.7% for the alpha variant.
• 3:00
  SPEAKER_01: The results were similar for both vaccines.
• 3:02
  SPEAKER_01: With the Pfizer vaccine, the effectiveness of two doses was 93.7% among those with the alpha variant and 88% among those with the delta variant.
• 3:11
  SPEAKER_01: With the AstraZeneca vaccine, the effectiveness of two doses was 74.5% among persons with the alpha variant and 67% among those with the delta variant.
• 3:22
  SPEAKER_01: The authors concluded that only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses.
• 3:32
  SPEAKER_01: Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose.
• 3:37
  SPEAKER_01: This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations.
• 3:44
  SPEAKER_01: An article published in the Journal of the American Medical Association described quantification of specific antibodies against RS-CoV-2 and breast milk of lactating women vaccinated with the messenger RNA vaccine.
• 3:56
  SPEAKER_01: This prospective cohort study included lactating women older than 18 years who were vaccinated against R-CoV-2 with the Pfizer BioNTech COVID-19 vaccine.
• 4:05
  SPEAKER_01: Serum and breast milk samples were simultaneously taken from each participant at three time points, two weeks after receiving the first dose of the vaccine, two weeks after receiving the second dose, and four weeks after the second dose.
• 4:16
  SPEAKER_01: The study included 33 participants.
• 4:19
  SPEAKER_01: No participants had confirmed SARS-CoV-2 infection prior to vaccination, nor during the study period.
• 4:24
  SPEAKER_01: Authors collected and analyzed 93 serum and milk samples from the 33 participants.
• 4:29
  SPEAKER_01: The Pearson correlation coefficient between breast milk and serum IgG levels was 0.7.
• 4:35
  SPEAKER_01: The authors concluded that breast milk from women vaccinated with the novel messenger RNA-based Pfizer BioNTech vaccine contained specific anti-SARS-CoV-2 IgG antibodies.
• 4:44
  SPEAKER_01: Furthermore, they found that after the second dose, breast milk IgG levels increased and were positively associated with corresponding serum levels.
• 4:52
  SPEAKER_02: Thank you, Dr.
• 4:53
  SPEAKER_02: Hanrahan.
• 4:53
  SPEAKER_02: I now want to move into our discussion with Rosa Tamer, our guest.
• 4:58
  SPEAKER_02: So Rosa, thank you for joining the COVID-19 update podcast.
• 5:02
  SPEAKER_02: Welcome back.
• 5:03
  SPEAKER_03: Thanks, David.
• 5:04
  SPEAKER_03: It's great to be back here with you again.
• 5:06
  SPEAKER_02: So today we wanted to engage in a discussion and evaluating what our respective roles have been, myself as a hospital-based healthcare epidemiologist, and your role in healthcare epidemiology from the state health department perspective.
• 5:22
  SPEAKER_02: I mean, I think COVID has really brought us together in a really important way.
• 5:25
  SPEAKER_02: And I'm hopeful that that will continue moving forward.
• 5:28
  SPEAKER_02: But I thought it would be helpful for the audience to get an understanding as to each of our different roles and perspectives, both pertaining to COVID, but also more broadly in regard to healthcare epidemiology.
• 5:39
  SPEAKER_02: So I thought we could maybe dive a little bit into some of the broader context, you know, our backgrounds, the type of work that we do.
• 5:46
  SPEAKER_02: So, you know, I'll start with some questions and then we can sort of exchange back and forth.
• 5:50
  SPEAKER_02: So tell me a little bit about your background and the background of others who you work with in your health department in the infectious disease epidemiology division.
• 5:59
  SPEAKER_03: Thanks, David.
• 6:00
  SPEAKER_03: Well, yeah, I mean, public health is so interdisciplinary, and public health professionals really come to the field with very diverse backgrounds.
• 6:08
  SPEAKER_03: I would say that healthcare associated infections or HAI work is what we refer to it in public health, is one of the more clinical disciplines within infectious disease epidemiology because the staff who work in HAIs are just more likely to have an interest or background in clinical care than the average epidemiologist at the state or local level.
• 6:30
  SPEAKER_03: And of course, they exist at all levels, but many have a background similar to my own.
• 6:35
  SPEAKER_03: So, for example, I have an MPH in epidemiology of microbial disease.
• 6:39
  SPEAKER_03: I did a Cal EIS fellowship, which is an applied epidemiology fellowship with the state of California, and I have a certification in infection control.
• 6:48
  SPEAKER_03: I've also worked for state healthcare associated infections programs in New Hampshire, Connecticut, and now Oregon.
• 6:54
  SPEAKER_03: I also think it's kind of important to point out that the concept of healthcare epidemiology or HAIs can seem sort of rarefied or complex, but you know, the local public health authority epidemiologists in Oregon investigate most of our outbreaks and cases.
• 7:11
  SPEAKER_03: They work in healthcare settings all the time, right?
• 7:13
  SPEAKER_03: So during outbreaks of neurovirus or influenza like illness and long-term care settings, those are also HAIs.
• 7:21
  SPEAKER_03: Our program and our HAI epics handle the more complex investigations, the more worrisome organisms and situations like infection control breaches that we believe may have a major impact on the health of the larger community.
• 7:35
  SPEAKER_03: Can you tell me a little bit about your background?
• 7:38
  SPEAKER_02: Sure.
• 7:39
  SPEAKER_02: My background, and I think that to some degree reflects the backgrounds of many individuals who work in hospital-based healthcare epidemiology roles.
• 7:47
  SPEAKER_02: So I'm a physician by training.
• 7:49
  SPEAKER_02: I completed medical school and then my residency training in internal medicine and a fellowship in infectious disease.
• 7:55
  SPEAKER_02: My epidemiology training was sort of scattered throughout each of those different portions.
• 7:59
  SPEAKER_02: So for instance, I did an MPH concurrently with medical school.
• 8:03
  SPEAKER_02: And additionally, during my infectious disease training, I did some additional work in focus in healthcare epidemiology and infection prevention.
• 8:12
  SPEAKER_02: I was very fortunate I had the mentors both during my residency and fellowship and also after finishing my fellowship who really helped me get some hands-on training and learning kind of the day-to-day activities of healthcare epidemiologists working based out of a healthcare facility.
• 8:26
  SPEAKER_02: And I'll sort of reflect a little bit on some of the scope of what we do, which you kind of alluded to in your work.
• 8:31
  SPEAKER_02: So our work is primarily hospital-based, you know, and that can look very different from setting to setting.
• 8:37
  SPEAKER_02: So for instance, I work in an academic health center.
• 8:40
  SPEAKER_02: So you know, we take care of patients, we have all of our staff.
• 8:43
  SPEAKER_02: We also have learners, so that includes medical dental students, we have residents and trainees at different levels.
• 8:50
  SPEAKER_02: So our community consists of our learners as well as our patients and employees.
• 8:55
  SPEAKER_02: And our role in healthcare epidemiology, based out of an academic health center, really kind of straddles all of those.
• 9:00
  SPEAKER_02: We know other colleagues I have that work at community hospitals, their situation is a little bit different.
• 9:05
  SPEAKER_02: And then I have colleagues that work based out of other types of facilities, like long-term care facilities, where they focus on their specific patient population and staff.
• 9:14
  SPEAKER_02: So, you know, I think our communities may be different, but certainly a lot of overlap.
• 9:18
  SPEAKER_02: And I think that COVID's really brought that to the forefront.
• 9:20
  SPEAKER_02: So you alluded to some of the activities that you engage in in terms of you know outbreak investigation in facilities, but can you give kind of a broader scope in terms of the type of work that you do based out of a state HAI program?
• 9:33
  SPEAKER_03: Yeah, so you know, we have a really broad spectrum of interventions that are available to us in public health.
• 9:42
  SPEAKER_03: So we will certainly do things to support our clinician partners in terms of, you know, wanting to kind of work towards preventing HAIs for all Oregonians or anyone, you know, getting care here or delivering care here.
• 9:58
  SPEAKER_03: And we, you know, help clinicians identify good practices, like helping them to interpret diagnostic tests or understand recommendations at a public health level, but we don't provide clinical advice.
• 10:10
  SPEAKER_03: So what we do are things like set guidance or create recommendations for healthcare settings in Oregon.
• 10:17
  SPEAKER_03: We work on legislative policy, implement reporting requirements and publish reports of surveillance data.
• 10:24
  SPEAKER_03: We do outbreak investigations as well as investigations of things like infection control breaches or drug diversion events.
• 10:31
  SPEAKER_03: We survey, we create educational materials, we put on training, we do special studies, facilitate testing and sampling, we do committee work and work with other public health agencies and related agencies at all levels.
• 10:45
  SPEAKER_03: So our interventions are largely non-medical in nature.
• 10:48
  SPEAKER_02: So I'll contrast that with some of the interventions that we engage in here.
• 10:52
  SPEAKER_02: So our work, you know, is very directly clinical.
• 10:54
  SPEAKER_02: So for instance, you know, we'll be working closely with our providers dealing with patient-specific situations.
• 11:01
  SPEAKER_02: So for instance, patient who is infected or colonized with a multidrug resistant organism, what are the best transmission-based precautions needed to provide care to that patient?
• 11:10
  SPEAKER_02: We'll deal with situations like employee exposures to infectious diseases.
• 11:15
  SPEAKER_02: You know, certainly during the COVID pandemic, that's been a big focus and trying to prevent unprotected exposures and how to respond to exposures when they do occur.
• 11:23
  SPEAKER_02: But that occurred, you know, even before COVID.
• 11:25
  SPEAKER_02: So we would be responding to situations where a patient or another staff member presented with an infection.
• 11:31
  SPEAKER_02: And you know, we have to look at protecting our employees and how to respond to employees who may have been exposed to a patient or staff member with an active infection.
• 11:40
  SPEAKER_02: So a lot of that is going to be sort of hands-on guidance.
• 11:43
  SPEAKER_02: And a lot of what we do in our interventions is really focused on education.
• 11:47
  SPEAKER_02: So providing the staff education on prevention of healthcare associated infections.
• 11:52
  SPEAKER_02: You know, there's a big focus on device-associated infections, central line associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and all the prevention strategies.
• 12:03
  SPEAKER_02: So a lot of what we do is education of our staff.
• 12:06
  SPEAKER_02: We do routine grand rounds with all of our different groups to ensure that they're implementing evidence-based practices in their work.
• 12:14
  SPEAKER_02: And then we also have a role in educating our learners who are at various phases in terms of infection prevention-based practices.
• 12:22
  SPEAKER_02: And we work very closely also with our occupational and employee health programs in responding to events like blood-borne pathogen exposures, as well as developing prevention activities focusing and on preventing workplace exposures.
• 12:36
  SPEAKER_03: Yeah, I always think of like healthcare epidemiology, infection control, and employee health as being sort of the big three of people that we're often talking to.
• 12:46
  SPEAKER_02: You know, we work very closely together.
• 12:48
  SPEAKER_02: And one other group that has really become a big part of infection prevention is our antimicrobial stewardship programs.
• 12:54
  SPEAKER_02: We uh now have very close relationships with that program.
• 12:58
  SPEAKER_02: You know, I have a direct role in ours, but in other facilities, maybe uh more leadership of each program working together.
• 13:04
  SPEAKER_02: You know, antimicrobial stewardship now is up is at the forefront of patient safety and quality of care.
• 13:10
  SPEAKER_02: So I think there's really a lot of overlap there.
• 13:12
  SPEAKER_02: Can you give our listeners some insight into kind of more granular detail on your day-to-day activities?
• 13:18
  SPEAKER_02: So, you know, I think you know, some of us have different visions of how our partners in public health spend their time, but maybe you could kind of give a little bit more detail in terms of some of the activities that you do on a routine basis for our listeners to learn about.
• 13:31
  SPEAKER_03: I'd love to.
• 13:32
  SPEAKER_03: And I think I'll start talking with the kinds of investigations that we do.
• 13:35
  SPEAKER_03: Since you already mentioned a little bit of that work on your end, and I think there's a lot of parallel between the work that we do on these various kinds of things like investigations or policy work.
• 13:48
  SPEAKER_03: So in Oregon, we have an Oregon administrative rule that requires reporting of any known or suspected disease outbreak, including any outbreak associated with health care, regardless of the pathogen.
• 13:59
  SPEAKER_03: So we do ask that all outbreaks and clusters be reported directly to the state.
• 14:04
  SPEAKER_03: Outbreak investigations routinely are led by our local public health authorities, but we sometimes provide significant assistance or take the lead on these investigations, especially if they're multi-jurisdictional or they require specific HAI experience.
• 14:21
  SPEAKER_03: You know, maybe there's a tricky bug.
• 14:24
  SPEAKER_03: Additionally, we can really offer some infection control expertise.
• 14:28
  SPEAKER_03: I think investigations and education go so hand in hand because when we do these investigations, we kind of get to bring, you know, the facility and the local health department along with us, kind of working to identify gaps in practices that might be contributing transmission and helping to mitigate those issues so that additional cases are prevented.
• 14:49
  SPEAKER_03: So this could include remote observation, in-person visits and assessments, always providing the facility and local health, you know, our assessment of what gaps in practice need to be addressed.
• 15:03
  SPEAKER_03: How can they address those gaps?
• 15:05
  SPEAKER_03: I mean, during COVID, that hasn't been straightforward either.
• 15:08
  SPEAKER_03: And then we also liaise with other state public health jurisdictions and federal agencies if needed.
• 15:14
  SPEAKER_03: So, for example, if a contaminated medical product was implicated, we would be working with FDA, CDC, for example, if testing is needed that we don't have capacity for in our state public health lab, or if we need some more organism-specific expertise.
• 15:29
  SPEAKER_03: And if something is bleeding out of our state boundaries.
• 15:33
  SPEAKER_03: Do you want to talk a little bit about the investigations that you do within your facility?
• 15:38
  SPEAKER_02: Sure.
• 15:38
  SPEAKER_02: So our investigations sort of run the gamut.
• 15:41
  SPEAKER_02: So we do investigations of patient safety events.
• 15:44
  SPEAKER_02: So for instance, we do sort of a mini root cause analysis for all of our CLABS and our CODI events, where we work closely with our frontline staff to evaluate patient-specific situations where one of those device-associated infections develops, evaluate whether we're implementing best practices, try to learn from each of those different events.
• 16:02
  SPEAKER_02: Same thing with some of our surgical site infections as well as our hospital onset C diff cases.
• 16:07
  SPEAKER_02: So we do investigations at sort of individual patient levels.
• 16:10
  SPEAKER_02: And then more broadly, if we do see a cluster of infections and you know, any other unusual kinds of situation, we would embark on doing a sort of facility level investigation.
• 16:20
  SPEAKER_02: And in a lot of those situations, we engage with our state health department and they provide a great resource to work with, both with our individual facility investigation, but also can help identify whether or not there's some commonality or we may see whether similar events are occurring at other facilities in our state.
• 16:35
  SPEAKER_02: So, you know, I think the types of investigations that we do vary quite a bit.
• 16:39
  SPEAKER_02: And, you know, I think, you know, our role is to provide the expertise and sort of the guidance in infectious disease-specific areas and working closely with all the other team members that are involved.
• 16:50
  SPEAKER_03: I think this is one of the places where we really get to work together closely, you know, at facilities and in the HAI programs is on these investigations.
• 17:00
  SPEAKER_03: We love for facilities to involve us early because we feel that we have a lot of resources to offer.
• 17:05
  SPEAKER_03: So some of the things that we can offer facilities in these investigations are kind of looking beyond their catchment of their patients and saying, hey, is this something that is happening on a community level at other facilities in our jurisdiction?
• 17:19
  SPEAKER_03: And the other thing we get to do is be a pair of fresh eyes.
• 17:22
  SPEAKER_03: So, you know, where there may be people who have been kind of working the same process, maybe they're reprocessing an instrument or doing the same surgical procedure, we get to step in and say, you know, this isn't something that we're heaped in on a daily basis.
• 17:38
  SPEAKER_03: So how can we bring that new perspective in comparing, you know, internal policies to CDC recommendations, to manufacturers' guidance, and bringing that whole picture together as something that we can really offer healthcare facilities in these investigations?
• 17:53
  SPEAKER_02: Thanks.
• 17:53
  SPEAKER_02: I think that's really important to emphasize how important the collaborations are between health departments and individual facilities.
• 17:59
  SPEAKER_02: You know, one question that I had been wondering about is what's kind of the on-call responsibilities at the health department?
• 18:06
  SPEAKER_02: So, you know, we in health facilities are used to clinical calls.
• 18:10
  SPEAKER_02: So, you know, we have a rotating group that shares calls pertaining directly to clinical care patients, particularly within our infectious disease clinical division.
• 18:18
  SPEAKER_02: And we also have our infection preventionists that are on call 24-7 for emergencies, and we're sort of de facto backup to support them when they're on call for specific issues pertaining to our department and our hospital.
• 18:30
  SPEAKER_02: But you know, I think you know, when it comes to sort of public health emergencies and sort of off-hours events like unusual pathogen, and someone from the facility calls into the health department.
• 18:39
  SPEAKER_02: Can you talk about what that looks like in a health department?
• 18:42
  SPEAKER_02: You've worked in a few different health departments, and I'd imagine you've taken call in all of them.
• 18:46
  SPEAKER_02: But can you give us a sense as to what that looks like, both in terms of the frequency and who's taking calls off hours, and then maybe even some of the types of calls that typically occur off hours?
• 18:56
  SPEAKER_03: Yeah, absolutely.
• 18:58
  SPEAKER_03: There's typically a few people on call at a state health department.
• 19:02
  SPEAKER_03: For example, we have an epidemiologist from our section, which is acute and communicable disease prevention, 24 hours a day, seven days a week.
• 19:11
  SPEAKER_03: But there are also folks who are on call from other programs like environmental health, for example.
• 19:18
  SPEAKER_03: So there are sort of different resources that are available 24-7, including us.
• 19:24
  SPEAKER_03: We take calls from all over the state and beyond.
• 19:27
  SPEAKER_03: Being on call in communicable disease, no matter where you are, is always guaranteed to be a mixed bag.
• 19:33
  SPEAKER_03: Clinicians call with questions about our recommendations and how to implement them.
• 19:38
  SPEAKER_03: So, for example, during COVID, you know, lots and lots of questions about infection control recommendations, TPE optimization, disinfection, and then just how to manage ill patients or patients with symptoms, you know, not to mention requests for assistance with things like testing supplies or requests for consultation from our group for facilities that want that extra assistance with their infection control practices to get assessed.
• 20:07
  SPEAKER_03: Local public health authorities in Oregon, we're a home rule state, so our county-level health departments really bridge the gaps between community members and ourselves often.
• 20:17
  SPEAKER_03: So local public health authorities may call us to do things like report cases of diseases or outbreaks, request assistance with investigations, and to understand our guidance.
• 20:28
  SPEAKER_03: So for most of our reportable illnesses here in Oregon, we have documents called investigative guidelines, and they will kind of go through, you know, the basic information about the organism and then what follow-up steps need to happen, case classifications, et cetera.
• 20:43
  SPEAKER_03: So they will often call needing assistance, applying those investigative guidelines, or working at the case, or doing an outbreak investigation as well.
• 20:52
  SPEAKER_03: We also get calls from other state agencies, we get federal agency calls, and then of course the general public.
• 20:59
  SPEAKER_03: Maybe they're encountering a medical issue, seeking services or looking for data.
• 21:03
  SPEAKER_03: Some of them have complaints and questions about some of our processes.
• 21:07
  SPEAKER_03: Certainly that's not unusual, especially during the last year and a half since public health and infectious disease is really in the eye of the public in a way that it isn't often.
• 21:17
  SPEAKER_03: But yeah, so our calls can really run the gamut from everything from you know an animal bite to someone stepping on a syringe to complex questions about, you know, how to clinically sort of manage infection control practices for a particular organism, or more specific questions about our data.
• 21:35
  SPEAKER_03: So, how does this report get, you know, published?
• 21:38
  SPEAKER_03: How are these numbers calculated?
• 21:40
  SPEAKER_03: Or why is this group being prioritized for this intervention and not this other group?
• 21:44
  SPEAKER_03: So it's pretty broad.
• 21:46
  SPEAKER_02: It sounds like all kinds of interesting questions arise at any hour of the day for our health department.
• 21:52
  SPEAKER_02: COVID has certainly brought that to the forefront, like you mentioned.
• 21:55
  SPEAKER_03: Yeah.
• 21:55
  SPEAKER_03: And although we do not do clinical consultations for patient care.
• 22:00
  SPEAKER_03: We typically do, I just wanted to address part of your question.
• 22:03
  SPEAKER_03: During our off hours, we typically do have someone who is a clinician on call.
• 22:08
  SPEAKER_03: Just so, you know, in case something extra complex arises, there is that extra level of education and expertise there.
• 22:16
  SPEAKER_02: Interesting.
• 22:17
  SPEAKER_02: So, you know, I think sort of the last few minutes, I do want to talk a little bit more specifically about COVID and how it has impacted activities both at hospital-based healthcare epidemiology and infection prevention programs, as well as your perspective from the state health department.
• 22:32
  SPEAKER_02: So, I mean, I know from our angle, you know, there's so many new challenges that have come with COVID.
• 22:37
  SPEAKER_02: But I think one of the real silver linings here is that it's really strengthened our relationship with our state health department and our colleagues across the state.
• 22:45
  SPEAKER_02: So here in Connecticut, you know, we're a relatively small state, and our state healthcare associated infections program has really brought infection prevention leaders from all of our different facilities together.
• 22:55
  SPEAKER_02: We have routine calls and we've had very active discussions on practices across the state.
• 23:01
  SPEAKER_02: I think that's been a huge resource.
• 23:03
  SPEAKER_02: And, you know, I really kudos to our in public health here in Connecticut for taking a leadership role in that.
• 23:07
  SPEAKER_02: So can you sort of reflect a little bit on your experience working through COVID over the last couple of years and how that's impacted your relationship with healthcare facilities and your interactions with facility-based healthcare epidemiologists, infection preventionists, infectious disease physicians over the last couple of years?
• 23:25
  SPEAKER_03: Well, I think it's brought us together, just like you're saying, in a way that we were not as cohesive before.
• 23:32
  SPEAKER_03: And that's to some degree true for our relationship with ourselves in public health and our sort of sister agency regulatory bodies.
• 23:41
  SPEAKER_03: So I think, you know, COVID does have some silver linings to it in terms of kind of coalescing the community together in some ways.
• 23:51
  SPEAKER_03: COVID also really highlighted the importance of public health, I think, to the general public.
• 23:57
  SPEAKER_03: So public health and particularly healthcare-associated HAI program staff were critical to the pandemic response at every level.
• 24:05
  SPEAKER_03: I don't want to speak about it in the past tense, so I should say are critical to the pandemic response.
• 24:11
  SPEAKER_03: And it also highlighted some of the ways that we can bolster, you know, our own institutions and our infrastructure and our resources and our connections with our clinical partners to address the challenges that arose over the past year and a half.
• 24:24
  SPEAKER_02: So I think, you know, what we've seen with COVID is, you know, there's it's really been a public health tragedy, but it does identify how important our public health leadership and our state public health departments are in responding to these types of emergencies.
• 24:38
  SPEAKER_02: So can you share your thoughts as far as what you see both now and in the future with regard to the role of the State Health Department and infectious disease programs and HII programs in responding to COVID?
• 24:50
  SPEAKER_03: Yeah, well, we've seen our program, for example, grow tremendously with an influx of funding.
• 24:57
  SPEAKER_03: One of the challenges of public health, when it functions well, we are invisible because our focus is really on prevention.
• 25:04
  SPEAKER_03: When cases of infectious disease rise in the community, including a pandemic, that's a dramatic example, there's a gap.
• 25:11
  SPEAKER_03: Funding for public health often addresses special priorities.
• 25:15
  SPEAKER_03: For example, for public health emergencies.
• 25:17
  SPEAKER_03: That funding isn't always sustained to allow sufficiently large and well-trained public health workforce that can address the next emergency that comes along.
• 25:26
  SPEAKER_03: So we need to have stable funding even when nothing is in the news drawing attention.
• 25:31
  SPEAKER_03: You know, there was an interesting discussion paper in the National Academy of Medicines.
• 25:36
  SPEAKER_03: This is a De Salvo paper calling for closing the funding gaps for foundational capabilities, promoting structural alignment, investing in workforce development, modernizing data capabilities, and supporting cross-sector partnerships.
• 25:49
  SPEAKER_03: And I don't think I could have said it better myself.
• 25:52
  SPEAKER_03: And that kind of also, David, I think talks about partnerships, right?
• 25:56
  SPEAKER_03: And bringing us closer together in the clinical setting and in public health.
• 26:01
  SPEAKER_03: So there's that aspect to it, but also really needing funding that can support overall capacity that allows us the flexibility to kind of nimbly respond to all kinds of issues and to keep our connections with each other strong, even when there isn't kind of an overarching galvanizing force pushing us all forward.
• 26:21
  SPEAKER_02: Thanks.
• 26:21
  SPEAKER_02: I think you know it's important that we think to the future and what this means for the relationships between healthcare epidemiologists, both at the public health department as well as at individual facilities.
• 26:33
  SPEAKER_02: And I think that there's an opportunity to strengthen that and also leverage that to support programs and engage with funding resources moving forward to really protect the public and protect our patients.
• 26:45
  SPEAKER_02: So, Rosa, as we conclude, you know, I'm thinking about all of our listeners for these K podcasts.
• 26:50
  SPEAKER_02: They include infectious disease physicians, they include healthcare epidemiologists, infection prevention specialists, maybe even microbiologists, pharmacists.
• 27:00
  SPEAKER_02: We've got a great diverse listening audience.
• 27:02
  SPEAKER_02: So what advice would you give our broad audience regarding how to think about their state HAI programs and how to develop those relationships?
• 27:11
  SPEAKER_03: Well, we were just talking about, you know, the ways that public health and healthcare kind of come together.
• 27:16
  SPEAKER_03: And I just want to encourage everyone to take advantage of their state healthcare associated infections program.
• 27:24
  SPEAKER_03: Everyone will have one in their state, and we really want to be working with our clinical partners.
• 27:30
  SPEAKER_03: You know, the primary goal of these programs is to provide technical assistance and support.
• 27:35
  SPEAKER_03: We want to be engaged early in investigation so we can help.
• 27:38
  SPEAKER_03: We can assist with all kinds of things.
• 27:41
  SPEAKER_03: I believe that partnership is so important and it really bubbles up from personal connections as well.
• 27:47
  SPEAKER_03: So just don't hesitate to reach out and get involved.
• 27:51
  SPEAKER_03: Each state will also have healthcare associated and infections advisory committee or something along those lines.
• 27:56
  SPEAKER_03: So there are avenues for you to make your voice heard and to be in touch with your kind of counterparts at the public health department.
• 28:03
  SPEAKER_02: Thank you so much for joining our podcast.
• 28:06
  SPEAKER_02: I think our listeners are really going to appreciate your perspective.
• 28:09
  SPEAKER_02: Thanks again.
• 28:10
  SPEAKER_02: Thank you so much, David.
• 28:11
  SPEAKER_02: Thank you very much to our speaker for sharing her perspective and experiences.
• 28:15
  SPEAKER_02: This podcast can be accessed on Shea's online education center, learning CE, under the Rapid Response Program.
• 28:21
  SPEAKER_02: You'll also find resources such as the SHA COVID-19 town halls.
• 28:25
  SPEAKER_02: And this concludes today's episode of the Rapid Response Podcast.
• 28:29
  SPEAKER_02: Thank you for tuning in.