Celebrating the remarkable achievements of COPH distinguished alumni, this article highlights the notable contributions of MPH alumni Bernhard Kloppenburg, Joshua McDonald and Dr. Gregory Danyluk, as well as BSPH alumni Jennifer Balderas-Olalde, Uriel Ramirez and Edgar Trejo-Chavez. Their successes were featured in a recent story by www.naccho.org.
NACCHO is pleased to recognize the Polk County Department of Health鈥檚 (DOH-Polk) Healthcare-Associated Infections (HAI) Team as our latest Infection Prevention and Control (IPC) Champion. NACCHO鈥檚 IPC Champions are passionate leaders in IPC and exemplary models for best practices. These teams advance infection prevention and control capacity, activities, guidelines, and engagement in their work as local health departments.
In our interview with the DOH-Polk HAI Team, they share their experiences connecting with high-risk facilities throughout and beyond the COVID-19 pandemic, tips for shifting staff responsibilities and practices to address evolving HAI threats, and how they manage challenges to IPC efforts in their community. A full list of the DOH-Polk HAI Team members can be found at the bottom of this announcement.
Team Origins and Shifting Roles
The work done by HAI teams has traditionally been limited to case investigations performed
by the core DOH-Polk Epidemiology Team on pathogens such as multidrug resistant organisms
(MDROs), Legionnaire鈥檚 disease, and for outbreak investigations involving pathogens
such as influenza and norovirus. Because those investigations tend to be labor-intensive
and time-consuming, there has been a need that a separate team should be established
that could be dedicated not only to the investigations themselves, but to educational
outreaches on IPC principles, particularly for long-term care facilities. Several
members of the DOH-Polk HAI Team were originally hired as COVID case investigators
and contact tracers, and they were primarily responsible for providing guidance and
assistance to long-term care facilities and other types of congregate living facilities
that were experiencing outbreaks. The COVID contact tracers at that time were recognized
as the LTCF Surveillance and Investigation Unit (LSIU) and included an epidemiologist
funded by NACCHO through the BLOC COVID-19 project to conduct Infection Control Assessments
and Response (ICARs), as well as an epidemiologist assigned to the department by the
state HAI program.
Eventually, these case investigators and contact tracers were brought into the LSIU to fill vacancies left by some of the original LSIU team members. Using principles of change management, including change management resources from NACCHO, members of the LSIU team were trained to expand their focus beyond a single HAI to other threats faced in IPC work, such as influenza and respiratory syncytial virus (RSV). Experienced 51在线 Department of Health (FDOH)-Polk epidemiologists led this training with considerable support from the state HAI program, including multiple shadowing opportunities for conducting infection control assessment and response (ICAR) activities, and IPC educational outreaches to sharpen their skills in those areas. As they gained more experience and training in other HAIs, the 鈥淟SIU team鈥� was renamed as the 鈥淗AI Team鈥�, and its members have developed pride in how they have expanded their knowledge and capacity in IPC over the years with the support of FDOH and other partners.
The DOH-Polk HAI Team recommends that LHDs take advantage of change management resources when shifting existing staff to new responsibilities. They also recommend taking advantage of HAI/IPC training resources available through NACCHO鈥檚 IPC Living Learning Network, CORHA, APIC, and other public health organizations to bolster their capacity for IPC in their own operations.
Evolving Work and Relationships
The Polk HAI Team expanded their educational outreach to high-risk facilities (e.g., nursing homes and dialysis centers) to go beyond conducting ICARs and include demonstrated application of basic IPC principles to other HAI pathogens, such as MDROs. The HAI epidemiologist members of the team also address when and how to implement enhanced barrier protection for patients colonized with C. auris and explore other topics such as antibiotic stewardship. Together with their state HAI program, the DOH-Polk HAI Team has partnered with the largest hospital within their jurisdiction to facilitate additional IPC training to local long-term care facilities (LTCFs) and home health agencies. To continue fostering the relationship established during the COVID-19 pandemic, the HAI Team has worked on building coalitions with LTCFs by inviting them to participate in monthly video conference calls to discuss timely topics related to IPC.
The DOH-Polk HAI Team is proud of the relationships they鈥檝e built with their high-risk facility partners over the years, and the ways in which these strong connections have positively impacted community health. By continually working with them to increase their MDRO and antibiotic stewardship knowledge, facilities have expressed a growth in confidence in responding to MDROs and colonized patient care. They鈥檝e also grown more comfortable contacting specific HAI Team members to seek timely guidance and expertise on MDRO issues, such as C. auris, and actively invite the team to provide them with education on IPC for their staff.
While there haven鈥檛 been many opportunities to cross-collaborate with other teams at their LHD, they note that the state HAI Team has been an excellent resource whenever the Polk HAI Team has needed assistance with carrying out IPC operations.
Lessons Learned and Overcoming Challenges for the Future
One of the greatest challenges the Polk HAI Team faces is turnover among key staff,
including their main points of contact at high-risk facilities, which can disrupt
effective communications and operations. To address this, they maintain frequent contact
with facilities so that key facility staff members are aware of the HAI Team, what
they do, and what they can offer.
Another major challenge is ensuring facilities alert hospitals when they transfer
a patient on contact precautions for an MDRO. One responsive strategy has been to
educate emergency medical staff about MDROs, particularly C. auris, and proper disinfection
practices for it, to ensure streamlined efforts for patient care across facilities.
The HAI Team also facilitated a meeting between EMS and hospital infection preventionists
to discuss and identify strategies for challenges in transferring patients.
The Polk HAI Team shared that the greatest lesson they learned throughout their years of IPC work is the importance of a holistic approach towards their own training in IPC and passing along what they鈥檝e learned to healthcare facility staff. They also learned how crucial it is to create an inclusive space for IPC work that accommodates diversity in cultures, demographics, and language. This includes ensuring facility staff needs are met such that they understand not only the fundamental procedures of infection control, but how it interplays with overcoming cultural barriers, such as the importance of using appropriate language for non-English speakers. The DOH-Polk HAI Team looks forward to the continued evolution of their work with HAIs with confidence in their ability to adapt to and overcome new challenges moving forward.
DOH-Polk HAI Team Members and Roles:
HAI Team Supervisor
- Bernhard Kloppenburg
Team Lead
- Jennifer Balderas-Olalde
Team Members
- Uriel Ramirez
- Jessica Rangel
- Edgar Trejo-Chavez
HAI Epidemiologists
- Geraldine Hidalgo
- Joshua McDonald
HAI Team Support
- Amanda Webster
Epidemiology Program Manager
- Dr. Gregory Danyluk
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