NACCHO is pleased to recognize the Polk County Department of Health’s (DOH-Polk) Healthcare-Associated Infections (HAI) Team as our latest Infection Prevention and Control (IPC) Champion. NACCHO’s 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

Traditionally, the work done by HAI teams has been limited to case investigations performed by the core DOH-Polk Epidemiology Team on multidrug-resistant organisms (MDROs), including Legionnaires’ disease, as well as outbreak investigations involving pathogens like influenza and norovirus. Because these investigations tend to be labor-intensive and time-consuming, there has been a need for a separately established team that could be dedicated not only to the investigations themselves, but to educational outreaches on IPC principles, particularly for long-term care facilities (LTCFs). 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 LTCFs 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 LSIU to fill vacancies left by some of the original LSIU team members. Using principles of change management, including those referenced in 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 Florida 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 educational outreach in IPC to sharpen their skills in those areas. As LSIU gained more experience and training with other HAIs, they were renamed as the HAI Team, and their members are proud of the progress they’ve made to increase their IPC capacity with the support of FDOH and other partners.

The DOH-Polk HAI Team recommends that LHDs take advantage of change management resources when shifting new responsibilities among existing staff. They also recommend taking advantage of HAI/IPC training resources available through NACCHO’s 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 partnered with the largest hospital in their jurisdiction to facilitate additional IPC training to local long-term care facilities (LTCFs) and home health agencies. To continue fostering the relationship they established during the COVID-19 pandemic, the HAI Team also 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’ve 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’ve 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 their staff with education on IPC topics.

While there haven’t been many opportunities to cross-collaborate with other teams at their LHD, the DOH-Polk HAI Team 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 and proper disinfection practices for them, particularly those for C. auris, 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’ve 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 the needs of facility staff are met such that they understand not only the fundamental procedures of infection control, but how it interplays with overcoming cultural barriers. One example of this is 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

• Gregory Danyluk