Recognizing Local Champions in Infection Prevention and Control.

Abstract

Infection Prevention and Control (IPC) describes a set of practices that aim to prevent the spread of infections, including health care–associated infections (HAIs) and emerging infectious diseases—like COVID-19—in health care facilities and other congregate settings. IPC includes hand hygiene, use of personal protective equipment (PPE), safe injection practices, and proper environmental cleaning. The National Association of County and City Health Officials' (NACCHO) IPC Champion recognition aims to highlight the IPC achievements of local health departments (LHDs) and honor the staff leading this work. NACCHO IPC Champions are passionate, well-versed, and respected individuals working in local public health who are advancing infection prevention and control capacity, activities, guidelines, and engagement. They are knowledgeable and enthusiastic about infection prevention and control. They promote and lead HAI prevention initiatives by educating colleagues and partners, preventing and responding to outbreaks, solving problems, and leveraging lessons learned to improve policies and practices. IPC champions: Build and strengthen partnerships between local public health and facilities (health care and other congregate settings) in their communities to build trust and to develop a reputation as a community IPC resource; Facilitate communication between and across facilities to identify and stop interfacility transmission; Identify and respond to outbreaks in facilities of HAIs, including COVID-19; Strategize to proactively prevent infections and improve IPC efforts; Engage and educate internal staff and external partners to increase their buy-in and awareness of IPC; Apply lessons learned to improve policies and practices in their community—and potentially, across the state/country; and Speak up to illustrate the needs of LHDs in this work and to share experiences and insights. To date, NACCHO has featured the IPC work of health departments in Mobile County, Alabama, Prince George's County, Maryland, Fairfax County, Virginia, and DuPage County, Illinois. Individual spotlights have also recognized Dr Stephanie R. Black, Medical Director of the Communicable Disease Program at the Chicago Department of Public Health; Dr Matt Zahn, Medical Director for the Epidemiology, Assessment, and Immunization Program at the Orange County Health Care Agency in California; and Dr Dawn Terashita, Associate Director for the Acute Communicable Disease Control Program at the Los Angeles County Department of Public Health, for their impact promoting IPC practices in their community and beyond. Mobile County Health Department During the height of the COVID-19 pandemic, the Mobile County Health Department's (MCHD) Infection Prevention Team (IPT) utilized a community-centered approach to combat the spread of the virus in Alabama. They partnered with community organizations, local health care providers, K-12 schools, and other high-risk congregate settings to better understand the needs of underserved communities and provide essential epidemiological resources (eg, case investigations, contact tracing, data entry and surveillance, outbreak testing, and infection prevention education resources). They also worked with county-employed dentists to provide IPC information to facility partners early in the pandemic to support nursing homes and other congregate care settings. The IPT conducted more than 30 community-wide outreach events, which included the provision of more than 2500 rapid COVID-19 tests, as well as lodging and food for 700 COVID-positive members of the homeless community when local shelters were unable to provide isolated facilities. When staffing shortages, testing, and personal protective equipment (PPE) resource scarcity impacted long-term care facilities (LTCFs), the Mobile County stepped in to provide PPE and utilized their partnership with an ambulance service to provide tests. In addition to responding once an outbreak occurred, Mobile County's IPT worked to help LTCFs prepare more proactively for outbreaks by keeping regular contact on guidance updates, supply needs, and reporting regulations. Their efforts to strengthen relationships in this way have allowed partner facilities to request and receive support more frequently from the MCHD. Prince George's County Health Department The Fostering Local Infection Prevention Control & Capacity (FLIP-CC) Project Team was established as a cross-collaborative effort across the Health and Wellness Division, the Communicable and Vector-borne Disease Control Program, and the Public Health Emergency Preparedness Team at Prince George's County Health Department in Maryland. They credit the resultant diversity in skills and experiences with IPC as a major factor in their success mitigating the impact of the COVID-19 pandemic within their community. Throughout the pandemic, the FLIP-CC Team provided high-risk facilities with ongoing assessments, facilitated frequent meetings and communications, reviewed data to inform outbreak status protocols, and provided customized technical assistance on IPC for frontline workers. FLIP-CC also worked with the LHD's strike team to improve vaccination rates for the most vulnerable populations in their community, resulting in remarkable decreases in COVID-19 case rates and hospitalizations. Another significant accomplishment was the low to zero bloodstream infection rates reported from local dialysis facilities during this time, indicating that IPC practices communicated by FLIP-CC were in place and being followed properly. In utilizing direct feedback from local health care teams in dialysis, nursing homes, and assisted living facilities, the FLIP-CC Team was able to design specialized technical assistance and capacity-building activities. Facility directors also became more aware of the services provided by the LHD and viewed them as a reliable and trusted source of information that they could request resources from. Fairfax County Health Department In collaboration with state and national partners, the Fairfax County Health Department's Acute Communicable and Emerging Diseases (ACED) Program strategically built and maintained partnerships with local care facilities to disseminate IPC resources and guidance in Virginia. These partnerships fostered peer-to-peer sharing of best practices and lessons learned in Fairfax County such that they could inform and advise state-level stakeholders on measures to optimize IPC measures within their health care facilities. During the COVID-19 pandemic response, ACED's interactions with facilities expanded to include surveillance and reporting, more frequent site visits with an emphasis on ensuring compliance with mitigation measures, assessment of PPE use and other infection prevention measures, outbreak investigations, and support for tests and vaccinations. In addition to on-site communication, they expanded outreach to include monthly webinar meetings with LTCF partners to provide COVID-19, HAI, and antimicrobial resistance updates. The team's IPC work has also expanded to include collaborations and consultations with the County's correctional facility, homeless services programs, and shelters. The results of their efforts include improved disease reporting from LTCFs, resulting in the investigation of cases and prevention of further infection. The ACED Program's investment in building partnerships has also led to greater success in collecting data from local facilities. These partnerships have resulted in improved collaboration and involvement with activities such as Infection Control Assessment and Response visits, PPE training, and respiratory fit testing. LTCF staff and residents in Fairfax County also exceeded the national rates for early COVID-19 first-dose vaccination coverage as reported by the Centers for Disease Control and Prevention (CDC) in a Morbidity and Mortality Weekly Report released on February 5, 2021. DuPage County Health Department The DuPage County Health Department's HAI team was established in 2012 with support from NACCHO and the CDC to better identify and understand the impact of HAIs, multidrug-resistant organisms, and extensively drug-resistant organisms within their jurisdiction. Since then, they have had extensive on-site and remote engagement with local LTCFs to conduct point-prevalence surveys, infection control audits, and follow-up visits and provide educational support and infection prevention guidance resources in conjunction with the Illinois Department of Public Health staff. When the COVID-19 pandemic arose, the HAI team quickly shifted and expanded their focus to COVID-19 surveillance, investigation, and prevention and control activities in congregate health care facilities, educational settings, and business/workplaces in DuPage County, Illinois. They have improved relationships and responsiveness through regular outreach efforts and by continuing to identify partners and their team roles (eg, medical director, infection prevention designee, director of nursing, environmental services) in their consultation and outreach efforts toward multidisciplinary engagement. Internally, DuPage County Health Department functioned as a hub to receive and provide PPE to facilities in their jurisdiction, particularly LTCFs that experienced extreme PPE shortages for several months. Beyond infection prevention and control challenges, the DuPage County Health Department is also committed to addressing health inequities. The DuPage County COVID-19 Health Equity and Access Response Team (HEART) was established through a partnership between the DuPage Health Coalition, DuPage Federation for Human Services Reform, Impact DuPage, and the DuPage County Health Department. HEART provides a countywide voice for health equity and access, ensuring that all residents of DuPage County reach the highest level of health possible. Their most recent priorities include supporting and coordinating vaccination clinics through community outreach, multilingual COVID-19 vaccine surveys to assess COVID-19 vaccine hesitancy and build confidence, and the recruitment of Health Ambassadors for public service announcements, interviews, and town hall meetings. These LHDs serve as role models for their innovative approaches to reduce the burden of infectious disease in their communities. For more information on characteristics of NACCHO's IPC Champions, or to nominate yourself or a colleague for consideration, visit https://www.naccho.org/programs/community-health/infectious-disease/infectious-disease-prevention-and-control/infection-prevention-and-control-champions.