Clinician-Educator Pathway

Infectious Diseases Fellowship Infection Prevention & Control/Hospital Epidemiology Rotation and Track Core
Competencies and Activities
CompetencyActivitiesRotationTrack
Surveillance and Reporting
Understand how healthcare associated infection (HAI) surveillance is conductedObserve Infection Preventionists (IP) reviewing microbiology results and applying NHSN definitions for:
  • Central line-associated bloodstream infections (CLABSI)
  • Catheter-associated urinary tract infections (CAUTI)
  • Surgical site infections (SSI)
  • Ventilator-associated events (VAE)
  • Clostridioides (Clostridium) difficile and multidrug-resistant organisms
Consider methods of validation and auditing of HAI dataDiscuss the internal validation of HAI data
Identify the opportunities for external validation of HAI data
Review the advantages and limitations of surveillance software in the process of HAI surveillanceReview with IP Data Analyst or Informatics team members the sources of surveillance data
Review the SHEA Research Methods white paper1 on administrative and surveillance data
Distinguish between HAI surveillance and clinical definitions for infectious syndromesParticipate in a multidisciplinary discussion, quality review, or teaching session that includes case-based review describing surveillance-identified HAI
Understand and effectively utilize various HAI measures including numerator and denominator, and counts, rates, and adjusted ratesAs part of routine IP work or project work, present HAI outcome data with appropriate case ascertainment, at-risk population, and consideration of risk adjustment.
Evaluate facility performance on HAI and HAI prevention process measures using internal and external benchmarksFor at least one HAI, consider and discuss internal and external benchmarking options
Consider the role of HAI in the context of other patient safety events, including falls, pressure ulcers, and other adverse outcomesAttend ≥1 patient safety or hospital quality meeting, and compare and contrast infection-related and non-infection-related outcomes including reporting, benchmarking, and improvement interventions
Review requirements for reporting community- and healthcare-associated infections to public healthReview state and local health Department reporting requirements
Observe IP processes for identifying reportable illnesses and performing reporting
Cluster Detection, Investigation, and Resolution
Describe what defines an epidemiologically significant cluster, including differences in cluster detection among pathogensParticipate in the investigation and response to a single case of an epidemiologically significant pathogen, such as vancomycin non-susceptible Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, Candida auris, Legionella, invasive mold, or SARS-CoV-2
(If no case is available, describe pathogens for which one or a few cases define an outbreak and those for whom clusters are differentiated from endemic rates)
For a multiple-case cluster, understand the application of multiple steps of an outbreak investigationParticipate in the investigation of a HAI cluster
(If no cluster is available, describe from the published literature at least one description of an outbreak investigation)
Understand the roles of case-control or cohort study in identifying potential transmission routes leading to a cluster of infectionsPerform a case-control or cohort study as part of a cluster investigation
Describe the findings of a cluster investigation to stakeholders and hospital leadership, including proposed or enacted changes to baseline prevention practices
Describe the role identification of genetic relatedness plays in cluster identification, and understand commonly used techniques from antimicrobial phenotype to molecular typing and whole genome sequencing (WGS)Participate in a meeting where the use of WGS is considered for a possible cluster and/or results are reviewed
Review ≥2 published articles2,3 of healthcare-associated outbreaks and be able to describe the methods used to establish genetic relatedness
Understand the key elements of an exposure investigation: identifying patients and providers potentially exposed; incubation period; post-exposure measures including prophylaxis, vaccination, monitoring, furloughAssist in an exposure investigation (e.g., tuberculosis, varicella zoster, SARS-CoV-2) in conjunction with Infection Preventionist
Consider the role of active surveillance testing in the prevention of multidrug-resistant organismsCompare published observational or clinical trial with institutional practice for ≥1 multidrug-resistant pathogen such as methicillin-resistant S. aureus, vancomycin-resistant enterococci, or carbapenem-resistant Enterobacteriaceae
Pathogen Transmission and Transmission Interruption
Understand modes of pathogen transmissionBe able to describe the common and potential modes of transmission of healthcare-associated pathogens
Describe the rationale for transmission-based precautions for pathogens commonly observed in the healthcare settingReview the CDC “Type and Duration of Precautions Recommended for Selected Infections and Conditions”4 and compare to institutional practices
Identify clinical situations for which standard precautions (and specific elements of standard precautions) should be employedPerform with Infection Preventionists observations of personal protective equipment use
Hand hygiene: understand the evidence base for hand hygiene as an infection prevention tool to reduce transmission in the healthcare settingReview the World Health Organization guidelines5 on hand hygiene, and describe at least one high-quality study of the effectiveness of hand hygiene
Hand hygiene: observe the measurement and feedback of hand hygiene adherenceParticipate in hand hygiene observations with a member of the Infection Prevention team
Conduct independent observations of hand hygiene adherence and provide feedback to observed units
Hand hygiene: understand interventions that may be employed to improve hand hygiene adherence in the acute care settingPlan a unit-based intervention to improve hand hygiene adherence
Be able to describe interventions to prevent catheter-related bloodstream infectionsCompare and contrast institutional policies with evidence-based practices in SHEA Compendium of Strategies to prevent central line-associated bloodstream infections6
Be able to describe interventions to prevent catheter-related urinary tract infectionsCompare and contrast institutional policies with evidence-based practices in SHEA Compendium of Strategies to prevent catheter-associated urinary tract infections7
Be able to describe interventions to prevent ventilator-associated eventsCompare and contrast institutional policies with evidence-based practices in SHEA Compendium of Strategies to prevent ventilator-associated infections8
Be able to describe interventions to prevent surgical site infectionsCompare and contrast institutional policies with evidence-based practices in SHEA Compendium of Strategies to prevent surgical site infections9
Be able to describe interventions to prevent healthcare-associated infections due to C. difficileCompare and contrast institutional policies with evidence-based practices in SHEA Compendium of Strategies to prevent C. difficile10
Consider the risk of transmission from contaminated and incompletely reprocessed reusable medical equipmentPerform an observation of clinical care on ≥1 unit, and propose an intervention to reduce the risk of device contamination
Understand the steps for reprocessing, and quality assurance of reprocessing adequacy, of devices requiring high-level disinfection and sterilizationParticipate in observations of one or more reprocessing events:
  • Survey the reprocessing program in Sterile Processing Department
  • Observe the reprocessing of a duodenoscope and assist in performing duodenoscope cultures
  • Conduct high-level disinfection regulatory rounds with Infection Preventionist and Regulatory team
Environment of Care
Observe water safety measures including Legionella water monitoringConduct water quality surveillance with IP
Participate in a water quality/safety meeting
Environmental cleaning – understand the evidence to support the relationship between environmental contamination and pathogen transmissionReview at least one published article of transmission from prior room occupant and/or environmental cultures and pathogen acquisition
Environmental cleaning – observe the evaluation of quality of environmental cleaning, and understand potential methods to assess environmental cleaningParticipate in environmental cleaning observations with Environmental Services (post-discharge cleaning) or Infection Prevention (special case)
Review the literature for evidence to support the use of fluorescent marker, adenosine triphosphate, visual inspection, and microbiologic cultures
Environmental cleaning – understand the potential role for no-touch disinfection in reducing pathogen transmissionReview the BETR trial11,12 and current hospital practices for the use of no-touch disinfection13
Understand the methods by which Infection Prevention mitigates the risk of transmission (including pertinent pathogens involved) resulting from construction in acute care settingsParticipate in observation of construction risk assessment rounds with Infection Preventionist
Air management – be able to describe the role of airborne isolation for select pathogens including tuberculosis, and the difference in clinical- and infection prevention-related risk assessmentsParticipate in IP team discussions related to the removal of precautions for a potential case of tuberculosis
Advanced air management – understand advanced principles related to air management including monitoring negative pressure, airflow in surgical settings, UV disinfectionConsider in depth at least one advanced risk and related mitigation measures in use at the facility
Understand the role of Life Safety (Environmental Health and Safety) in preventing infection- and non-infection related adverse eventsIdentify at least one condition for which Life Safety standards may differ from standards recommended solely for Infection Prevention-related purposes
Quality Improvement: Principles and Practice
Understand the role of regulatory structure and oversightAttend ≥1 multidisciplinary meeting that includes a discussion of quality improvement and accountability related to ≥1 infection-related quality measure(s)
Improvement tools: learn how root cause analysis and the steps of Plan-Do-Study-Act (PDSA)14 cycles are used to reduce risk of HAIsConsider the application of PDSA cycles for at least one HAI type
Observe a discussion of an HAI root cause analysis conducted by infection preventionists or quality team
Improvement tools: learn how advanced techniques are applied to reduce HAI15-19
  • PDSA, Lean, Six Sigma
  • Implementation science
  • Human factor design
  • Organizational change
  • Failure modes and effect analysis
  • Root cause analysis
Review educational material related to advanced techniques in quality improvement
Participate in an ongoing or new quality improvement project in which one or more quality improvement techniques are applied
Statistical methods in IP: understand the analytic methods used for quasi-experimental and observational studiesReview the SHEA Research Methods white papers on quasi-experimental studies20 and observational studies21
Statistical methods in IP: understand the analytic methods used for randomized controlled trials, mixed methods studies, mathematical modelingReview the SHEA Research Methods white papers on randomized controlled trials,22 mixed methods studies, and mathematical modeling23
Apply principles described in any of the SHEA Research Methods white papers24 to a research project
Practice effective methods of education for healthcare workers and patientsDevelop and administer at least one educational intervention in support of either a quality improvement project or HAI reduction initiative
Microbiology Laboratory Partnership
Appreciate the role the Microbiology Laboratory plays in identification of clinical or environmental surveillanceParticipate in at least one multidisciplinary meeting in which cultures obtained for Infection Prevention purposes are discussed
Understand the concept of diagnostic stewardship25Review ways providers’ testing choices are influenced to improve patient care related to urine cultures and C. difficile testing, and other diagnostic tests
Understand how test selection and test characteristics may impact HAI surveillanceConsider for at least one test the sensitivity, specificity, positive predictive value, and negative predictive value, and be able to describe the effect of these test characteristics on HAI surveillance and reporting
Antibiotic Stewardship Partnership
Appreciate the resistance profile of bacterial and fungal pathogens at the institutionReview and interpret the organizational antibiogram, and compare with rates of multidrug-resistance among common HAI pathogens
Understand the relatedness between antibiotic use and multidrug-resistant organismsFor at least one common multidrug-resistant pathogen, compare HAI rates and antibiotic usage rates for pertinent antimicrobials.
Occupational Health and Infection Prevention
Describe the impact of a healthcare worker vaccination policy on the risk of transmission of pathogens in the workplaceFor at least one of the following pathogens, review the healthcare worker vaccination policy and consider published evidence of patient-to-healthcare worker transmission in developed settings: influenza, hepatitis B, measles, mumps, rubella, hepatitis
Understand the role of presenteeism in healthcare-to-patient transmission of respiratory and gastrointestinal infections26Perform observations of healthcare worker behaviors (if rotation during respiratory virus season)
(See also “Assist in an exposure investigation...” in section “Cluster Detection, Investigation, and Resolution”)
Emergency Preparedness
Consider the role of Infection Prevention in prompt identification and mitigating the transmission risk of emerging pathogensReview organizational Ebola preparedness plans
Review the role of Emergency Management and other stakeholders in preparing for seasonal epidemicsReview the organizational plans for seasonal and pandemic influenza
Leadership and Program Implementation
Understand hospital administrative structure, and the internal reporting structure for Infection PreventionReview the organization leadership and quality charts
Attend at least one leadership-level meeting
Project management: understand the role for a project planDevelop a project plan for the quality improvement or research project of the rotation
Meeting management: understand and practice principles of successful meeting managementReview with preceptor successful strategies and barriers to efficient meetings, conduct at least one meeting, and debrief following the meeting observations of strategies employed and areas for improvement in meeting management
Understand the role of a project/team charterReview an existing Infection Prevention-related project/team charter, or create a new one for a fellow or team project
Supplemental and Advanced Topics
Infection Prevention in non-acute care settings
Strategic planning
Negotiation strategy and tactics
Return on investment analyses
Data visualization techniques
Media training: print, radio, television, and web-based reporting
Social media and non-conventional methods of professional communication
Conference presentations (oral and poster) and manuscript writing
Grant writing/application
Education and mentorship of trainees
REFERENCES

 

  1. Drees M, Gerber JS, Morgan DJ, Lee GM. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases. Infect Control Hosp Epidemiol 2016;37:1278-1287.
  2. Sundermann AJ, Babiker A, Marsh JW, et al. Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional Radiology: Detection Through Whole-genome Sequencing-based Surveillance. Clin Infect Dis 2020;70:2336-2343.
  3. Sundermann AJ, Chen J, Miller JK, et al. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis 2020.
  4. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory C. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007;35:S65-164.
  5. Sax H, Allegranzi B, Chraiti MN, Boyce J, Larson E, Pittet D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827-834.
  6. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S89-107.
  7. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S32-47.
  8. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S133-154.
  9. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S66-88.
  10. Dubberke ER, Carling P, Carrico R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S48-65.
  11. Anderson DJ, Chen LF, Weber DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805-814.
  12. Anderson DJ, Moehring RW, Weber DJ, et al. Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection). Lancet Infect Dis 2018;18:845-853.
  13. Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning Hospital Room Surfaces to Prevent Health Care-Associated Infections: A Technical Brief. Ann Intern Med 2015;163:598-607.
  14. Langley GJ. The improvement guide : a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.
  15. Sreeramoju PV, Palmore TN, Lee GM, et al. Institutional quality and patient safety programs: An overview for the healthcare epidemiologist. Infect Control Hosp Epidemiol 2021;42:6-17.
  16. Liker JK, Meier D. The Toyota way fieldbook : a practical guide for implementing Toyota’s 4Ps. New York: McGraw-Hill; 2006.
  17. DelliFraine JL, Langabeer JR, 2nd, Nembhard IM. Assessing the evidence of Six Sigma and Lean in the health care industry. Qual Manag Health Care 2010;19:211-225.
  18. Harry MJ, Schroeder R. Six sigma : the breakthrough management strategy revolutionizing the world’s top corporations. 1st ed. New York: Currency; 2000.
  19. Saint S, Howell JD, Krein SL. Implementation science: how to jump-start infection prevention. Infect Control Hosp Epidemiol 2010;31 Suppl 1:S14-17.
  20. Schweizer ML, Braun BI, Milstone AM. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Quasi-Experimental Designs. Infect Control Hosp Epidemiol 2016;37:1135-1140.
  21. Snyder GM, Young H, Varman M, Milstone AM, Harris AD, Munoz-Price S. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Observational Studies. Infect Control Hosp Epidemiol 2016;37:1141-1146.
  22. Anderson DJ, Juthani-Mehta M, Morgan DJ. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Randomized Controlled Trials. Infect Control Hosp Epidemiol 2016;37:629-634.
  23. Barnes SL, Kasaie P, Anderson DJ, Rubin M. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Mathematical Modeling. Infect Control Hosp Epidemiol 2016;37:1265-1271.
  24. Morgan DJ, Safdar N, Milstone AM, Anderson DJ. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship. Infect Control Hosp Epidemiol 2016;37:627-628.
  25. Madden GR, Weinstein RA, Sifri CD. Diagnostic Stewardship for Healthcare-Associated Infections: Opportunities and Challenges to Safely Reduce Test Use. Infect Control Hosp Epidemiol 2018;39:214-218.
  26. Szymczak JE, Smathers S, Hoegg C, Klieger S, Coffin SE, Sammons JS. Reasons Why Physicians and Advanced Practice Clinicians Work While Sick: A Mixed-Methods Analysis. JAMA Pediatr 2015;169:815-821.
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