This week, October 16-22, marks both International Infection Prevention Week and Healthcare Quality Week. Infection prevention is both a means and an end to the work healthcare quality professionals do to manage risks, reduce mortality and incident rates, and, most importantly, protect patient safety. To explore local public health efforts to “Break the Chain of Infection,” NACCHO took a moment to speak with Robyn Weber, Communicable Disease Epidemiologist at El Paso County Public Health (EPCPH), Colorado, about infection prevention trainings and a tabletop exercise conducted with a unique healthcare partner as part of the LINC Initiative.

Who was your partner in this project and how did you decide to work with them?
We partnered with the Criminal Justice Center, which is our county jail. While the jail is run by the Sheriff’s office, the medical functions are contracted out to a third party provider. Last year, a suspect tuberculosis (TB) case attracted media coverage, and as a result we learned that inaccurate information was shared with the media that we attempted to correct. This case really opened our eyes to the need to strengthen our relationship with the medical unit at the jail, and to help improve overall communication.

Tell us about the trainings you did with them.
We had three goals for the training. First, we wanted to educate them about what we do at EPCPH with regard to infection control and prevention. The second goal was to provide training about best practices for infection control, particularly in healthcare settings. The third goal was to go over specific diseases that can spread easily, especially in the jail healthcare setting as patients seen at a jail medical unit have a higher incidence of certain community-acquired infections like C. difficile or MRSA than the general public. Every time they are seeking care at the medical unit, there is a possibility that their infection can become a healthcare-associated infection if the medical staff are not using proper precautions.

With those three goals in mind, we offered two 2-hour interactive trainings at different times of day to accommodate as many staff as possible. We started with a pre-test to get a baseline measurement of their knowledge about infection control practices, infectious diseases in general and in the jail setting, and what we do in the EPCPH communicable disease program. We followed up with a post-test in order to assess what they learned and if there were certain things that we needed to address with additional training or a tabletop exercise.

What was the response to you coming in to provide these trainings? What were the gaps that you identified?
The other gaps that we found were related to certain infectious diseases including what precautions to use when dealing with influenza patients or when patients need to be in airborne isolation.

You mentioned that some diseases may be spread more easily, but in what other ways did you find this setting different from outreach you have done before?
One big difference is the limitations with what they can do around infection control. For instance, they are not allowed to use bleach because it could be used as a weapon. We had to brainstorm what to do if you have a norovirus outbreak, for example, and cannot use bleach, which is the best practice for inactivating the virus and preventing the spread to other people. That was a very unique challenge because they are trying to do the best they can, but do not have the tools other healthcare providers might have to prevent the spread of infectious diseases. Another difficulty they face is very limited space, and they cannot always send patients to another facility if there is something going on at the jail.

The training led up to a tabletop exercise—what did that exercise address and how did you develop it? Because we identified gaps related to influenza, I developed a tabletop exercise that involved a mock outbreak of a suspected novel strain of influenza. I teamed up with our emergency preparedness program to adapt an existing tabletop exercise they used previously. Influenza also fit for this population because we have an Immigration and Customs Enforcement (ICE) unit at our county jail, so there is potential for people to be in our jail from anywhere in the world.

How did the exercise go?
It went well. We kept it to a smaller group of leaders within the medical unit, so we only had about five folks from the jail who attended. It allowed us to have an open discussion about their communications challenges, knowledge gaps, and how we could go forward in addressing those. Funny enough, while we were working through this mock influenza outbreak, we got a real call about a suspect TB case that was being discharged from the hospital and sent to the medical staff at the jail. As a result, we tabled the influenza scenario for a bit and switched our focus to the actual TB case and some of the communication and infection prevention issues related to it.

That is real life applicability right there! What do you feel like the tabletop exercise achieved? Do you have any lessons learned or major takeaways that you can share with other local health departments?
It definitely helped us to establish a good working relationship with their administrators. In fact, about three weeks after the tabletop exercise, they called us to report an outbreak in the jail and that was progress. We need to consider routine trainings for their staff and maintaining that relationship. It is also important to make sure to communicate the role of the health department so partners know we can help prevent healthcare-associated infections at the local level and that we are available for support.

We learned that in this setting, there is a lot of staff turnover and a possibility the medical unit could be contracted out, emphasizing the importance of having agreed-upon protocols and a communications plan with whoever is running the medical unit so they know to engage the local health department when there are issues with healthcare-associated or other emerging infections. I think that is applicable whether you are in a jail setting or working with a hospital or set of providers in your community.

Promoting Infection Prevention and Healthcare Quality at the Local Level
As antimicrobial resistance becomes an increasing concern in the U.S. and globally, infection prevention is more important than ever. If your local health department has an innovative infection prevention initiative or best practice to share, submit a Story from the Field to be featured in NACCHO’s story bank.

Check out some of these tools and resources from NACCHO and our partners to help strengthen your local health departments’ capacity to advance healthcare quality through infection prevention:

• Roundtable Report: Local Health Department Roles and Activities to Improve Infection Control, Preparedness and Response to Infectious Disease Threats
• Resources from the One and Only Campaign
• NACCHO’s Antimicrobial Resistance Fact Sheet
• Policy Statements on Antimicrobial Resistance and Healthcare Associated Infections
• The American Journal of Health-System Pharmacy supplement on Insulin Pen Safety
• Materials available through the Association for Professionals in Infection Control and Epidemiology