Catherine Kroll, MPH, CIC
BMGC Guest Author
If you told me 15 years ago that I would be the Director of Infection Prevention for an acute care hospital system spanning three states, I would have laughed. Acute care didn’t really interest me, I am an MPH epidemiologist devoted to population health. I dreamed of leading communicable disease control programs in the public sector. The thing is that I achieved those dreams relatively early on in my career and found myself still wanting. I wanted to not just solve the puzzle of the outbreak, I wanted to keep it from ever happening again. And that is why I ended up in the acute care setting.
My early career was devoted to public health communicable disease control. After the H1N1 pandemic, my local health department was awarded some funds to work on vaccination in populations where outbreaks were detected. These settings included daycares and post-acute care facilities. We surveyed the workers in these facilities about vaccination and found that, by and large, they understood the need to get vaccinated and were willing to do so. They didn’t need an education campaign, they needed access to vaccination. As minimum wage workers without health care plans, the workers had no access. I went to my boss with this information along with ideas for how we could partner with local healthcare to provide these frontline workers with vaccinations. My boss at the time didn’t even let me finish - interrupting me to inform me it wasn’t funded. We were funded to do education and it was their responsibility or the responsibility of their employer to make vaccines accessible. And that is when my rose-colored lenses cracked.
Why was local public health not being funded to do prevention work for communicable disease control? Part of epidemiology is about finding the pattern in the data and solving the mystery of what caused the outbreak. So many times, an outbreak is caused by people doing foolish things… a Salmonella outbreak linked to cock fighting comes to mind. In my very limited world, I hadn’t realized that communicable disease control in public health was funded to pull the babies out of the river. But why were the babies in the river in the first place? So much of the work in public health is about upstream interventions - why was the work for communicable disease control so downstream? The people were already sick by the time I was getting involved.
In the past, public health provided services for the low income. Some public health departments would run federally qualified health centers, while others were limited to providing services like vaccination, contraception, and testing/treatment for sexually transmitted infections. Over the past 20 years, many public health departments have altered that model. Rather than provide direct care services, the mantra in public health has been to move people to a medical home where all their healthcare needs can be addressed. This model works well when people know how to access it and can afford to do so. The challenge is, despite the affordable care act, many Americans still can’t afford or won’t choose services like a $15 flu vaccine. Unlike the public health setting, hospitals are financially incentivized to work in prevention and communicable disease control. The cost and impact of healthcare acquired infections is incredible. Infection Preventionists split their time between preventing infections and doing surveillance to identify outbreaks/infections.
This intersection of personal healthcare and public health is a haven for preventable harm. Over the last 8 years, public health has taken a much more active role in healthcare-acquired infections. If we want to move from a response communicable disease public health model to a prevention model, public health and acute care services must partner more effectively. The community benefit model of not-for-profit healthcare is no longer just about purchasing tables at a fundraising luncheon. It is about making measurable change in community health. The social determinants of health are a major focus, but there is room at the table for communicable disease prevention, too! Those of us straddling the acute care & public health border have a responsibility to look for and champion these opportunities. As state and local health departments dive into supporting healthcare acquired infection work, we must pave the way with understanding of the roles and responsibilities. Professionals trained in public health can take their population lens and push acute care to be better.