NACCHO recognizes Prince George’s County Health Department, Fostering Local Infection Prevention Control & Capacity (FLIP-CC) Project Team as its latest Infection Prevention and Control (IPC) Champion. Team members include:

• Myra Ball, MSN: Infection Preventionist Nurse Manager in the Communicable and Vector-Borne Disease Program
• Kim Stinchcomb, MPH, CPH: Training and Exercise Coordinator for Public Health Emergency Preparedness
• Augustine Amuta, MD, MSHA: Health Information Technology Analyst in the Health & Wellness Division
• Renee Adams: Administrative Assistant in the Health & Wellness Division
• Deborah McGruder, MPH: Associate Director of the Health & Wellness Division
• Michael Jenifer, MSN, RN: Community Nurse in The Adult Evaluation and Review Services/Nursing Monitoring Program in the Health & Wellness Division
• Katie Richards, MPH, CPHQ: External Infection Prevention Control Consultant, Health Quality Innovators (HQI)
• Darlene Saunders, PhD, MPH, MCHES: Special Projects Manager within the Health & Wellness Division and serves as project lead for the FLIP-CC

**Individual details on the team members’ position and roles are listed at the bottom of the page.

FLIP-CC is a diverse team created based on their background and experience working in infection prevention and control (IPC) and their role in the County’s COVID-19 response. The FLIP-CC Team focused efforts within high-risk facilities by having ongoing assessments, frequent meetings, and communications, reviewing data to inform outbreak status protocols, and providing customized technical assistance on infection prevention control to front-line workers to assist with the County’s COVID-19 response. FLIP-CC was a part of the LHD strike team mobilization contributing to decreasing COVID cases and hospitalizations and increasing vaccine uptake within populations most impacted. Health care professionals in Dialysis facilities reported low to zero bloodstream infection rates (an indicator of IPC practices being in place and followed); another significant feat.

The FLIP-CC Team is a leader in listening and designing technical assistance and capacity-building activities based on direct feedback from the health care teams working in dialysis, nursing homes, and assisted living facilities. These collaborative efforts strengthened partnerships with both nursing homes and dialysis facilities. Facility directors became more aware of the services the LHD provides and viewed the Health Department as a reliable and trusted source of information. Overall, the FLIP-CC Team complements these health facilities IPC programs and provides resources for other requested services.

NACCHO’s IPC Champions are passionate, well-versed, and respected leaders in infection prevention and control. These individuals work at local health departments and advance infection prevention and control capacity, activities, guidelines, and engagement. Another quality not often highlighted is the power of adaptability which the FLIP-CC team embodied. Throughout the pandemic, the FLIP-CC Team was able to take on each hiccup in stride and learned the importance of being proactive rather than reactive.

“COVID-19 has made it abundantly clear that we need to anticipate having infectious disease outbreaks. Reviewing and revising our policies and procedures consistently ensures that we will be better prepared to handle emerging disease outbreaks in high-risk facilities.”

The FLIP-CC Team’s mission is not over, and they plan to continue supporting nursing homes, assisted living facilities, and dialysis facilities to bolster their IPC protocols. Because of the Team’s determination and impact, NACCHO is thrilled to announce Prince George’s County Health Department, FLIP-CC Project Team as NACCHO’s newest Infection Prevention and Control Champion.

Overcoming the Challenges in High-Risk Facilities

The COVID-19 pandemic has especially impacted high-risk facilities negatively. These high-risk facilities had competing demands in terms of individuals wanting to conduct assessments and provide support. The FLIP-CC team had to be strategic and knowledgeable of these entities to best coordinate technical assistance services without duplicating efforts on what had already been provided. For dialysis facilities, the Team observed coordinating with regional directors, who in turn, contacted facility directors to minimize multiple contacts for IPC audits and/or data requests. This worked best for scheduling and supporting health care workers in this setting. For nursing homes, the Team coordinated with the Health Department’s IPC nurse liaison who had existing relationships with health care workers in this setting. Building on this trusted partnership helped to expedite information exchange and enhanced receptivity of the Team for conducting ICARs in nursing homes.

The FLIP-CC Team also gained a deeper appreciation of the limitations and challenges experienced per facility type. For dialysis centers, they learned the importance of working through their corporate offices and for nursing homes they learned how staffing shortages and burn out affected care. Therefore, streamlining training activities to the most essential elements given limited staff-time for participation was necessary.

Another challenge the FLIP-CC Team encountered was identifying an available representative due to staff schedules and high turnover during the pandemic. These staffing patterns impacted attendance at technical assistance webinars. One way the FLIP-CC Team navigated through these obstacles was to ensure that staff had access to resources by recording and distributing technical assistance webinars so they could be viewed and referenced at their discretion.

Throughout the pandemic, there were several opportunities for the state and local health departments to coordinate to ensure staff and patients/residents at high-risk facilities had life-saving protective equipment, testing materials, and access to vaccinations. This collaboration helped to build a valuable public-private rapport to decrease the spread of COVID in these facilities and community. Throughout the project, the FLIP-CC team was able to build upon those relationships even more by evaluating and listening to the needs and concerns of the staff. The FLIP-CC was able to empower facility staff to act as patient advocates and share their needs, ultimately encouraging a collaborative rather than an enforcement-based relationship.

Building a Diverse Team through Internal Cross-Collaboration

The Internal Local Health Department (LHD) cross-collaborations within the Health and Wellness Division, the Communicable and Vector-borne Disease Control (CVDC) Program, and the Public Health Emergency Preparedness (PHEP) team was critical to the success of this project and the establishment of the FLIP-CC Team. The CVDC team served as subject matter experts and led coordination with the skilled nursing and assisted living facilities. Most of the CVDC program staff were detailed full time to COVID outbreak response, contact tracing and surveillance. Since these IPC activities were managed, the primary tasks of the FLIP-CC team consisted of completing a 3-part infectious prevention control training that included COVID specific content to be able to conduct ICAR assessments and to provide customized capacity building and technical assistance based on the findings of the needs assessment conducted with dialysis, nursing homes, and assisted living facilities and synthesis of information obtained through ICAR site visits. The PHEP team took the lead in coordinating tabletop exercises with the Maryland Emergency Response System (MDERS). These exercises consisted of realistic scenarios and expected responses from the expertise of the CVDC, Health and Wellness teams, and external partners – Network 5 and HQI. The PHEP team will also rely on support from the Health and Wellness and CVDC teams to control and evaluate exercises for partner facilities in the future.

The internal LHD team collaborations also facilitated the FLIP-CC Team’s success due to greater coordination and connections between services, like transportation and vaccinations. The strengths of team members were assessed, and tasks were assigned accordingly. This awareness assisted the team in achieving its goals and proactively addressing implementation challenges.

FLIP-CC Team’s advice to other LHDs for coordinating team efforts:

• Develop a crosscutting team that has established relationships in the core components of your project’s implementation plan.
• Establish a set meeting schedule and coordinate between meetings, as necessary.
• Ensure you have support from administrators from other departments within the LHD for staff availability to participate in meetings and contribute throughout the project duration.
• Encourage open feedback and clear communications to promote transparency throughout the process/project.
• Provide margin in your project design for delays in the contracting process, and for coordination with partners and team members.
• Communicate any concerns, challenges and/or new insights with the project officer, team members, and partners to make any necessary changes to enhance project deliverables and outcomes.

Developing External Partnerships

The FLIP-CC Team’s collaboration and coordination efforts went beyond the LHD to other agencies and technical assistance providers that helped enhance and extend program resources and services. A lesson learned was to be aware of other IPC activities for coordination (e.g., QIN-QIO, ESRD Network, State Health Department, Governor’s Initiatives, Regulator Agency Requirements), to maximize resources, complement existing outreach and technical assistance efforts, and to avoid duplication of services. One mission of the FLIP-CC team was dedicated to communicating the benefits to facilities for partnering with their Local Health Department for IPC, such as providing needed resources to front line workers in high-risk facilities.

FLIP-CC Team’s External Partnerships:

• Health Quality Innovators (HQI) – Provided IPC training and support to the FLIP-CC Team. A train-the-trainer model was used to build the capacity of the FLIP-CC Team to conduct ICAR assessments. HQI was an integral part of the Team and worked on each phase of the project from planning, implementation, to mitigation activities.
• Maryland Department of Health – Coordination with the Maryland Department of Health (MDH) involved prioritizing facilities for conducting ICARs. This was essential since at the peak of the COVID-19 pandemic MDH strike team were conducting outbreak investigations daily. The FLIP-CC Team’s external IPC consultant worked with the MDH team prior to working at HQI and our internal infection preventionist nurse had a collaborative relationship with the MDH team prior to the FLIP-CC Project. MDH provided a list of nursing homes they visited and shared ICAR reports with recommendations that helped the Team to prioritize nursing homes to conduct IPC and capacity site visits. Overall, it was important to convey a unified approach, and to not unnecessarily burden facilities that have received a recent ICAR, and to share perspectives and updates from both the state and county level on what the Team was observing at the facility level. Discussions with MDH also helped shape the Team’s implementation plan by choosing to focus more on conducting ICAR Assessments with Dialysis Facilities, since Nursing Homes/Long-Term Care Facilities were being visited on a frequent basis due to their outbreak statuses. The FLIP-CC Team selected 10 Nursing Homes/Long-Term Care facilities to visit and 26 Dialysis facilities.
• End Stage Renal Disease Network - Network 5 – Through the FLIP-CC Team’s IPC external consultant they were able to connect early on with the Executive Director and IPC content staff at Quality Insights, the End Stage Renal Disease Network for their region. The Executive Director was enthusiastic and supportive of their training plan and helped by supplying Blood Stream Infection rate data for facilities to help prioritize facilities who may need additional support. Quality Insights also made recommendations of facilities to visit, helped with introductions to dialysis facilities, and responses from needs assessments to learn of facilities IPC infrastructure, training needs, and capacity.
• Maryland National Capital Region (NCR) Emergency Response System – This partnership provided subject matter experts to assist the FLIP-CC Team in developing tabletop exercises for emergency preparedness on IPC in dialysis facilities and nursing homes. NCR Emergency Response System also worked with the Team’s subject matter experts (team members who conducted ICAR assessments, IPC consultant and other external subject matter experts) to develop scenarios for prevention, response, and recovery. A train-the-trainer modality was used for this scenario activity that included modelling implementation, observing staff dry-run implementation of exercises per facility type, and providing feedback to modify and strengthen exercise delivery.

Full Team Members Position & Roles Description

• Myra Ball, MSN is the Infection Preventionist Nurse Manager in the Communicable and Vector-Borne Disease Program. Ms. Ball tracked COVID-19 in nursing homes, provided weekly updates to nursing homes and assisted living facility directors, nurses and administrative staff. During the peak of the pandemic, she was on call 24 hours, 7 days a week to provide guidance to nursing homes and assisted living facility staff who needed further answers to questions regarding quarantine and PPE. Ms. Ball collected and reviewed line-lists from each facility that reported an outbreak. She explained all guidance coming from the Maryland Department of Health and CDC regarding nursing home matters. Another responsibility included providing a list of facilities with outbreaks as well as specific situations, such as deaths. Additional duties included providing education, recommendations, and assessments to assist facilities with managing outbreaks, conducting ICAR assessments in nursing homes and assisted living facilities, keeping health officer and command teams abreast of nursing home and assisted living outbreak status and recommendations, and provided updates to FLIP-CC Team for development of capacity building and outreach strategy.
• Kim Stinchcomb, MPH, CPH is the Training and Exercise Coordinator for Public Health Emergency Preparedness. Ms. Stinchcomb served as the liaison to Public Health Emergency Preparedness Division, provided data updates to the Team on vaccine uptake, County COVID-19 cases, provided PPE to high-risk facilities, served as team lead in coordinating with the National Capital Region Emergency Response System in developing table-top emergency preparedness exercises, and conducted ICARs in dialysis facilities.
• Augustine Amuta, MD, MSHA is the health information technology analyst in the Health & Wellness Division. Dr. Amuta conducted ICAR assessments with nursing homes, and dialysis facilities, and provided subject matter expertise as a prior coordinator for dialysis transport services at the health department and in previous work positions as an IPC trainer and administrator contributing to the program’s outreach and capacity building activities.
• Michael Jenifer, MSN, RN is a community nurse in the Adult Evaluation and Review Services/Nursing Monitoring Program in the Health & Wellness Division. Mr. Jenifer provided subject matter expertise from his experiences as a nurse manager in acute, ambulatory, and community health settings, conducted ICAR assessments in dialysis facilities, and reviewed and provided input for FLIP-CC communications and outreach strategies.
• Renee Adams is the Administrative Assistant in the Health & Wellness Division. Ms. Adams facilitated the scheduling of ICARs in dialysis facilities, conducted ICARs in dialysis facilities, updated tracking systems for ICAR assessments completed, and assisted in reviewing capacity building and outreach materials to high-risk facilities.
• Deborah McGruder, MPH is the Associate Director of Health & Wellness Division and served on the County’s executive leadership COVID-19 Response Team. Ms. McGruder reviewed the FLIP-CC training plan and its alignment with the County’s COVID-19 priorities. She also provided periodic updates to the Health Officer and executive leadership regarding program progress.
• Katie Richards, MPH, CPHQ served as the Team’s external Infection Prevention Control Consultant. Ms. Richards provided training to all team members on conducting Infection Control Assessment and Response (ICAR) assessments, reviewed all IPC content for educational materials and resources provided, shadowed team members in initial assessments, and facilitated initial partnership meetings with the MDH, Quality Insights, and QIN-QIO networks.
• Darlene Saunders, PhD, MPH, MCHES is the Special Projects Manager within the Health & Wellness Division and serves as project lead for the FLIP-CC Project Team. She assembled the cross-cutting COVID-19 capacity building and technical assistance training team, evaluated program progress and refined implementation strategies with team input to meet program deliverables, coordinated outreach to dialysis facilities, developed site visit protocols and SOPs for team ICARs, conducted ICARs in nursing homes and dialysis facilities, organized the webinar series, and facilitated collaborative partnerships with technical assistance providers and partners.

Submit a Nomination Today

If any of these qualities seem familiar to you, please take a moment to fill out a nomination form for this recognition. The nominations can be for a team, or an individual. A member of our team will reach out to you to get any other information we might need. If you would like to submit a nomination for recognition as a NACCHO Infection Prevention and Control (IPC) Champion, please use this form.