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Infection Control and Multi-Drug Resistant Organisms (MDRO) Surveillance
with Medical Epidemiologist Dr. Kavita Trivedi |
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Interviewer:
Madeline Roberts, PhD, MSPH EpiMonitor: Your work centers on mitigating infection spread, often in healthcare contexts. Can you talk about Multi-Drug Resistant Organisms (MRDO) surveillance efforts in the Bay area—what systems are in place and how this is monitored at the population level?
KT:
Electronic laboratory reporting is required for specific diseases in
California
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/LabReportableDiseases.pdf EpiMonitor: Within the more specific context of health care settings, can you discuss some of the pitfalls you see and, conversely, best practices with respect to infection mitigation? KT: Acute care settings have staff that are dedicated to infection prevention and control. However, during the pandemic these professionals were extremely important to hospital operations and many of these professionals were overworked and overwhelmed creating a considerable turnover in this field. In long-term care facilities, nurses designated as infection preventionists but they often do many other things in the facility, preventing them from focusing on infection prevention. Best practices are the infection prevention team that thoroughly investigates an MDRO exposure in their facility ensuring all exposed patients are identified and offered testing for the MDRO. Another best practice is the infection preventionist from a nursing home who ensures that their residents are transferred to the acute care hospital with an interfacility transfer form notifying the accepting facility that the patient has an MDRO; the accepting facility then can ensure appropriate infection control precautions are implemented. EpiMonitor: PubMed search results show that articles mentioning "antibiotic stewardship" have exponentially increased over the past ten years. Can you talk about the importance of antibiotic stewardship in your work and for the health of future generations? KT: Modern medicine relies on antibiotics. Transplantation, chemotherapy and burn management would not exist without antibiotic treatment. It is our duty as stewards of antibiotics to only prescribe them when they are necessary. Many clinicians were trained when we prescribed antibiotics "just in case" there was a bacterial infection and we no longer endorse that rationale. In the past, when a resistance was encountered, the pharmaceutical industry would develop another antibiotic to combat the new infection. However, we now have fewer pharmaceutical companies that are engaged in antibiotic development and therefore have few if any new antibiotics (with novel mechanisms) that will be able to combat our most resistant infections. Therefore, it is imperative that we use antibiotic Therefore, it is imperative that we use antibiotic stewardship principles now so that we don't enter the post-antibiotic era. EpiMonitor: Your consulting work and your work at the Alameda County Health Department give you a unique vantage point in public health. What do you see as the biggest challenges currently facing public health in the Bay Area and the U.S.? KT: The biggest challenge to public health remains meeting the moment and communication. Throughout the pandemic it was difficult for public health leaders to address the need for infection control measures in a way that was acceptable to the public. It is important to continue engaging with the public to see where their understanding is on the public health issues of concern and meet the public where they are and not where public health thinks they should be. It is equally important for public health leaders to work with communications experts to get their message across in a way that is understandable to community members – taking into account timing, nuance, language and unintended consequences. ■ |
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