Hospital Epidemiology and Antimicrobial Stewardship

Introduction

In collaboration with the Boston VA health care system, BMC has implemented a new training track in hospital epidemiology for BMC ID fellows.  The goal of the Healthcare Epidemiology and Antibiotic Stewardship (HE-AS) Track within the Boston Medical Center (BMC) Infectious Disease Fellowship Program is to prepare trainees for a career in academic hospital epidemiology, incorporating practical hands-on skills while providing mentorship and resources towards focused academic research. In the absence of a formal ACGME-approved training program in healthcare epidemiology and antimicrobial stewardship, this dedicated advanced training program will position our trainees as competitive candidates for academic hospital epidemiology positions and, for some, form the foundation for a successful research career. It also leverages and augments existing strengths of the BUSM ID Fellowship Program, including faculty with nationally recognized expertise in those areas and the availability of diverse facilities such as the VA and the Massachusetts Department of Public Health.   The advanced track involves a third year of training, based at the Boston VA health care system.  We have been successful obtaining funding for this third year through VA training resources.

Objectives:

  • Provide practical training in healthcare epidemiology/antibiotic stewardship
  • Provide didactic instruction in disciplines of epidemiology and biostatistics  
  • Provide research mentorship

 

Overview

A. Core experience: Practical training in antibiotic stewardship /healthcare epidemiology (ASHE):

The trainee will learn how to perform the core activities of the hospital epidemiologist or antimicrobial steward through active participation as a member of both the infection control and antimicrobial stewardship teams.  Those activities will begin in the second year of fellowship training (first year of the HE-AS track) and, for trainees in the advanced track, will continue throughout the two-year training period with progressive responsibility and independence.

Components of the training:

1. Hands-on participation in HE-AS activities at the VA and BMC

    • Activities will include disease surveillance, outbreak investigation, federal and state reporting, implementation and practice of an antimicrobial stewardship program

2. Active participation in HE-AS committees and Quality Improvement

3. Didactic training in HE-AS and biostatistics online with an opportunity to attend an in-person training conference

4. Participation in a scholarly project relevant to HE-AS (this can be an academic extension of the quality improvement project or a separate endeavor) with the goal of preparing an abstract for presentation at a national meeting, and submission of a manuscript to a peer-reviewed journal.

B. Advanced Training Experience:

In addition to the components that are contained within the core experience, fellows opting for advanced training will have a program individualized to his/her career goals.

Fellows may choose to focus on one of two tracks: Clinical Practitioner Track or Mentored Research track.  The Clinical Practitioner Track will focus on practical training in HE-AS to prepare the trainee for a position as a hospital epidemiologist or antimicrobial steward upon graduation.  The trainee in the Mentored Research Track will also receive practical training in HE-AS but the major focus will be creation and completion of a scholarly project that can serve as the basis for a career-development grant proposal.  The trainee will designate a primary mentor (either clinical or research- focused depending on the track), with secondary mentor(s) as needed.

  • There are four core faculty who will serve as mentors:
    • Kalpana Gupta, MD – Professor of Medicine, Boston University School of Medicine; Chief, Infectious Diseases VA and Director of the HE-AS Track
    • Tamar Barlam, MD – Associate Professor of Medicine, Boston University School of Medicine; ID Program Director; Director, Antimicrobial Stewardship Program BM
    • Nahid Bhadelia, MD – Assistant Professor of Medicine, Boston University School of Medicine; Associate Hospital Epidemiologist BMC; ID liaison National Emerging Infectious Diseases Laboratory (NEIDL)
    • Mari-Lynn Drainoni, PhD – Associate Professor of Health Policy and Management, Boston University School of Public Health; Associate Professor of Medicine, Boston University School of Medicine; Research Health Scientist, Center for Health Quality, Outcomes, and Economic Research at the Edith Norse Rogers Memorial Veterans Hospital.
    • The hospital epidemiologists at the VA (Judith Strymish, MD) and BMC (Carol Sulis, MD) will be actively involved in infection control and hospital epidemiology hands-on training

 

Publications with fellows (fellows names are underlined)

1. Baker S, Brecher S, Robillard E, Strymish J, Lawler E, Gupta K. Extra-nasal MRSA colonization on admission to an acute care VA hospital. Infect Control Hosp Epidemiol, 2010;31(1):42-7

2. Linares LA, Thornton DJ, Strymish JM, Baker E, Gupta K. Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria. Infect Control Hosp Epidemiol. 2011;32:644-8.

3. Strymish J, Branch-Elliman W, Itani K, Williams S, Gupta K. A clinical history of MRSA is a poor predictor of pre-operative colonization status and post-operative infections. Infect Control Hosp Epidemiol 2012;33(11):1113-7.

4. Kabbani D, Weir S, Berg G, Chien G, Strymish J, Gupta K. Cohorting based on nasal MRSA status: An opportunity to share more than a room. Am J Infect Control 2013;41(5):401-4.

5. Weir S, Fram J, Berg G, Kabbani D, Strymish J, Tang M, Fitzsimmons D, Brecher S, Gupta K. Molecular epidemiology of newly identified MRSA carriage. J Clin Micro. 2012;50(10):3283-6.

6. Strymish J, Branch-Elliman W, Itani K, Williams S, Gupta K. A clinical history of MRSA is a poor predictor of pre-operative colonization status and post-operative infections. Infect Control Hosp Epidemiol 2012;33(11):1113-7

7. Branch-Elliman W, Strymish J, Gupta K. Development and validation of a simple and easy-to-employ electronic algorithm for identifying clinical MRSA infection. Infect Control Hosp Epidemiol 2014; in press

8. Valencia-Rey P, Strymish J, Robillard E, Evans M, Weinberg J, Gupta K. Survival time of methicillin resistant Staphylococcus aureus-free status after institutional clearance. Infect Control Hosp Epidemiol 2014; in press

Primary teaching affiliate
of BU School of Medicine