West Virginia internist Michael Stevens, MD, knows firsthand of the challenges rural health systems face in fighting infectious diseases. There are staff shortages and geographic isolation to contend with, as well as challenges in accessing mentoring in infection prevention and control.
Infection prevention and control is a continuous journey, said Dr. Stevens, a professor of internal medicine in the Division of Infectious Diseases and system health care epidemiologist at West Virginia University Health System.
“You're always learning some new thing you could be doing, or you're refining what you're looking at and how you feed it back. And I think we're on that journey, as everybody is,” Dr. Stevens said during an episode of the “Stories of Care” podcast in which he discussed what rural facilities can do to train and empower staff.
The “Stories of Care” podcast is sponsored by AMA and the Centers for Disease Control and Prevention’s (CDC) Project Firstline, a national training collaborative for infection prevention and control.
75% of rural hospitals qualify as “critical access”
Rural hospitals may have a smaller footprint than larger health systems, but they can turn around new protocols quickly.
“One thing I will point out that I have been struck by—and I'm always inspired by—is the commitment of people working at smaller facilities, particularly in rural areas,” said Dr. Stevens.
A 25-bed rural critical access hospital that provided almost as many monoclonal antibodies as a 900-bed academic facility during the COVID pandemic, exemplifies this commitment, he added.
Their disadvantage is their infrastructures may not be as robust.
The Centers for Medicare & Medicaid Services has assigned a “critical access designation” to about 75% of the 1,800 rural hospitals in the United States. The designation allows these institutions to stay financially viable, said Dr. Stevens, who sees a lot of poverty and poor health access in his own state. West Virginians disproportionately suffer from negative health outcomes.
“We perform in the lower quartile across a lot of important metrics. And so, there's a lot of need here, for sure,” he said.
Shortage of training programs, experts
Rural hospitals face several challenges with infection prevention and control. Generally, they don't have the equipment or staff to dedicate to infection control.
Compounding this problem is the ongoing shortage of infectious diseases physicians. For example, Dr. Stevens noted, when a hospital appoints someone as their infection preventionist, what steps can it take to fully equip that person to be the best infection preventionist possible?
“That's such a challenge, especially when we look at some of these smaller hospitals who don't have a health affiliation with the larger hospital that has the resources” to have an infection prevention and control team, noted Dr. Srinivas.
Investing in society resources
A health professional appointed as the infection preventionist at their facility often lacks formal education in this field. They need community support to learn this role.
“It’s really important for that person, if they're isolated, to join some sort of group,” advised Dr. Stevens, who recommended the Association for Professionals in Infection Control and Epidemiology (APIC). “Oftentimes they'll have a state branch, and so you'll get a network of contacts,” he said.
This type of network can lend support and advice during those times when a tuberculosis or varicella outbreak occurs at a clinic, or the infection expert is trying to figure out a bloodstream infection is due to a central line. APIC offers a toolkit to support infection preventionists working in isolated areas.
The Society for Healthcare Epidemiology of America also provides good resources for infection prevention, including training courses. “It's a wonderful community, particularly for physician champions of health care epidemiology,” said Dr. Stevens.
Facilities and their leadership should be investing in these dedicated professionals. “You’ve got to get them to a place where they're going to be doing the work as best as they can. They're going to feel supported in that, but then also feel like they're doing the work the right way,” said Dr. Stevens.
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