Acting largely unseen, like the microscopic organisms they track, public health professionals called Infection Preventionists (IPs) are working hard to protect people from pathogens like fungi, viruses and bacteria. As recent recalls on produce have shown, germs like listeria and E. coli can endanger people’s health, causing anything from minor stomach upset to organ failure and even death.
Part of a program that helps staff health departments around the country, the CDC Foundation’s Lorene Fong, Verlene Olson and Emily Lucrezia are members of the IP team in metropolitan New York City. When dangerous pathogens are reported in healthcare settings, nursing homes or other facilities, these highly trained specialists are called on to track the source of the infections, reduce the spread of related illnesses and educate and update healthcare workers on the latest hygiene techniques.
Investigating Infections
Drawn to public health for the opportunity to make a broader impact, all three nurses have played key roles in critical investigations since joining the IP team. When the New York State Department of Health received an alert recently from a hospital neo-natal intensive care unit, Emily was called in to investigate. Two babies had tested positive for a bacteria known as carbapenem-resistant enterobacterales (CRE), which can cause bloodstream, urinary tract and other infections, as well as pneumonia. Emily arranged for the infants’ blood samples to be sent to the state lab for testing. “We found out the strains were related, which meant that transmission was happening in the facility.”
Emily then toured the unit, assessing the availability of hand sanitizer, environmental cleansers and disinfectants, how the staff performed hand hygiene and how they used personal protective equipment. She then shared her findings with leadership. “It was very rewarding to identify the problem and then educate them. They were very receptive to that.” The spread of bacteria was stopped, and both babies recovered and were discharged. “So it was a good outcome,” she said.
Lorene Fong, RN, MSN, MPH, CIC – Healthcare-Associated Infections
Emily Lucrezia, BSN, RN, CIC – Healthcare-Associated Infections
Verlene Olson, MPH, BSN, RN – Healthcare-Associated Infections
In another investigation, several nursing home residents were admitted to a hospital with sepsis–a serious immune system reaction. When blood cultures revealed invasive group A beta-hemolytic streptococcal infection, Lorene, a former clinical care nurse, became involved in the case. “Group A strep is known for causing pharyngitis or strep throat, especially in school-aged children. In severe cases, it can cause sepsis, leading to organ failure and death, so it can get pretty scary.”
Tracing the Outbreak Origin
The first clue to the outbreak’s origin came with the discovery that all the admitted patients had bed sores, otherwise known as pressure ulcers, and had their wounds cleaned and bandaged at the nursing home.
“Once the skin barrier is broken, there’s a portal for the organism to enter your body,” Lorene explained. “Transmission can occur from contamination during poor wound care practices or it can happen when staff are unable to perform hand hygiene before and after providing care. Lapses in hand hygiene can transmit pathogens, especially when health care workers jump from one patient to the next.”
Like Emily, Lorene traveled to the site to observe the wound care team as they made rounds and asked the facility to test other patients and staff for the Group A Strep bacteria. Results identified several people who were positive, but asymptomatic. Even though these people showed no visible signs of illness, they could still transmit the infection to others, which could have continued the spread. But once everyone who tested positive for the bacteria was treated with antibiotics, there were no more reported infections. Another good outcome.
A different long-term care facility was faced with an outbreak of scabies. Eleven patients came down with this itchy skin disease caused by microscopic mites that spread via close contact. As the lead epidemiologist, Verlene Olson provided infection control guidance including treatment and isolation precautions, various hygiene reminders and even recommended the best way to launder personal items that could have been involved in the spread.
Emphasizing Hand Hygiene
In other cases, though, there are organisms resistant to the antibiotics that’ve been used to treat them in the past. “Their survival mechanism is pretty strong,” said Lorene.
That’s one of the reasons the team focuses heavily on hand hygiene. Reminding people that it’s acceptable to use hand sanitizer rather than soap and water if your hands aren’t visibly soiled can have an impact. “It's so simple and so basic. But at the same time it's so meaningful and significant,” Lorene offered. “When I see that they’re understanding the concept, that's rewarding for me.”
Verlene agrees, saying “My favorite aspect of the job is teamwork and forming partnerships with the people we serve in the community.”
Emily considers her role equally satisfying. “Having worked with the Foundation for a few years now, we've been able to develop a rapport and relationships with different healthcare facilities. It's been such a privilege to work with them, to strengthen their knowledge and practices, see that impact on patient care and hear their positive feedback on the education we provide.”
