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The Flip Side: One Physician's Experience With HAIs

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Intro: Welcome to Stories of Care, a podcast from the American Medical Association and CDC's Project Firstline. No patient expects to get an infection in the hospital that they did not arrive with, yet over 500 000 patients do each year (about 1 in every 31 patients). Patients who suffer from health care associated infections, or HAIs, have higher morbidity and mortality than those who don't. These preventable infections impact patients and families alike. Dr Tuan Ta, an infectious diseases physician, shares how his family was impacted when his premature son developed an infection in the NICU. Focusing on improving infection prevention and control measures can ensure that other families don't have to suffer through this same experience.

Megan Srinivas, MD: Thank you so much Dr Ta for joining us.

Tuan Ta, MD: Thank you. Thank you for having me.

Megan Srinivas, MD: I would love to delve into this whole world of hospital acquired infections today. You're an infectious disease physician yourself, right?

Tuan Ta, MD: Correct.

Megan Srinivas, MD: And being on the physician side for so long, it's interesting when we think about hospital acquired infections, we always think about it from a very calculated standpoint of, okay, how do we prevent this?

But trying to put ourselves into the footprints of patients is a completely different issue. And it's something you've had frontline experience with, right?

Tuan Ta, MD: Yes, yes.

Tuan Ta, MD: So yeah, the story is that my son was born at 24 weeks. And so, when you're, and clearly I didn't know any of this prior to getting involved with this, was that being born at 24 weeks is fraught with so many issues.

Just because things are not developed yet, you're at risk for everything because essentially you don't really have a great immune system. You're in the hospital forever, it seems like. And so many complications can happen, and of course one of them being hospital acquired infections, just cause you're there for so long.

Megan Srinivas, MD: And for most patients, you don't think about the hospital as a place where you can get sick. You think of it as, I am sick, so I go there and this is a safe place. It's almost the concept of you're in this bubble. It's a magical bubble. You're only going to get better when you're here.

To think that you can get sick in a hospital and that can actually impact your health more is such a foreign concept to so many people.

Tuan Ta, MD: Yeah, exactly. And I knew that, that the hospital wasn't the, what people think of as, "oh, it's super clean, I'm going to get well here." It's fraught with things that can happen, and of course infections and things. It was like this struggle between, okay, we got to get out of here versus we got to stay to get better.

And, that was that was something that I learned obviously firsthand.

Megan Srinivas, MD: And being the father to somebody who was susceptible to being sick, to being in a very susceptible position that, what was your reaction? What were you thinking when you first thought, okay, my son is in the hospital, could potentially be exposed to this whole world of whatever's out there at 24 weeks.

Tuan Ta, MD: It's a whole different world because day one he needed a I think it was an intravenous line through the umbilical cord, and then eventually got a PICC line, I believe. So, it was right off the bat, has to have good access. And there's tubes and lines everywhere.

So, he was intubated, obviously initially from day one at 24 weeks all the way until I forget or try not to remember the full details of it, but it was, at least I think, up until month two and a half to three almost. Because I think the last month he or the last month and a half or so, he was finally extubated, kind of like on high flow.

He was intubated for a long time and had like a central line and PICC line, so there's only there's only so many things that you can do. And there's things that you can't avoid in terms of he needed a central line, he needed this and this and this.

Megan Srinivas, MD: It was the lines that led to his infection while he was in the hospital?

Tuan Ta, MD: I don't know. Because I think it was even after one week, even at 24 weeks they were recommending and obviously advising that we do kangaroo care. So, we had, we put him on us. And it was a very delicate experience because he was intubated and there was no cuff.

So, it was like, the tube was just precariously in there and it took, and none of this was known to me before. You see this hole and you're like, oh my God, I can't believe this is happening. They're carrying this tiny baby that's like a pound and some, and they're putting it on your chest, and it's, clearly that's going to be more beneficial than the risk of colonization with whatever you have on your body.

And then they tell us like, "Hey, you have to sleep." They give, my wife and I, they gave us these little I guess these little dolls, I think they called 'em stuffies or something. So, like basically that they would have the smell, because we can't be there 24-7 holding him. Right?

So, you'd have to have this thing where like you would put it on you. You sleep with it at night and it has your, I don't know, I'm sure it has your bacteria and all your organisms on it too, but it essentially has your smell and things, and you leave it there when you leave so that the baby can smell it, get acquainted to you and whatever.

So, thinking from one side of okay, as the parent okay, this is great. You're there when you're not there, but also you're introducing, and then the other side, you're thinking as an infectious disease physician, you're like introducing all this stuff from your own body to him, you're like putting 'em on you.

And it's, we would wash our hands. And they told us to put our phones and things like that in a bag. You take pictures, but obviously put it in a bag. Be very strict with kind of hand hygiene. But then again, you're not like washing your chest as you're putting 'em on you and sitting there for hours at a time.

So, there were things that we had to do that I knew were going to be, that I knew were going to be not great infection-wise. And so, it was one of those where, okay, the benefit outweighed the risk.

Megan Srinivas, MD: And it's such a different world.

What was, how did that feel being in this whole new world in this new situation? And feeling Hey, I'm a physician, but I really, I don't know what's going on here. What's the best thing to do?

Tuan Ta, MD: Yeah, I remember distinctly thinking that I did not want to sit there all day, because sometimes you see patients, families sit there all day and they're living and breathing, looking at the monitor. And for adult patients it's, if they're stable then okay, heart rate is 80, whatever everything's fine. With a NICU infant, I mean, their heart rate is always like 130, 150, right? So, it's and then, the main thing was his oxygenation because he was born so early.

So, it was one of those where, you sit, if you're sitting there, you're just going to be stressed the entire time. Monitors are going off all the time, oxygen sensors are dropping to the eighties. And it was one of those where okay, I could come for a small amount of time and then I would usually go after work, but I wouldn't, I didn't want to stay the entire time because I, I knew that it would be so anxiety provoking. And I, I was one of those where I was like, I'm just going to leave it up to the people who know what they're doing. Leave it up to the NICU team, the attending, the respiratory therapist, the nurse. So, I was like, I'll just, some of it is I'll just close my eyes to certain things and let things happen.

Megan Srinivas, MD: Just kind of let the world take care of you.

Tuan Ta, MD: Yep.

Megan Srinivas, MD: It's really hard for somebody in the world of medicine to do, so kudos to you for giving yourself that space.

And how about your wife? Is she in medicine as well?

Tuan Ta, MD: She's a social worker. So, she's kind of, but like on the side a little bit. But she, we got very well acquainted with NICU care.

Megan Srinivas, MD: And so, then when your son was first in that situation, you're seeing him with all of the tubes and the lines. And, and I'm sorry cause I know this has got to be hard to relive as we're talking about this, even though, spoiler alert, things did turn out well.

How was his course? What ended up happening as you were waiting?

Tuan Ta, MD: Yeah. It was a, it was, I guess a rocky course, but the course ended up okay despite being a rocky course. So, he ended up having, I think the initial thing was he ended up having some sort of discharge from his eye.

And they cultured it, and it turned out to be MRSA. So, we were wearing gowns, doing kind of the isolation thing, the contact isolation thing for fairly early in the beginning, from what I remember, even maybe like the first month. There were no other rooms where there was an isolation cart outside. We like, we were the only ones, which is good. I was like, okay, that's great. He'll be in isolation, everyone would be washing hands, be real careful.

Megan Srinivas, MD: How old was he at the time?

Tuan Ta, MD: He must have been, I think it was within the first month. So, he was born in April in 2018. So, this must have been like somewhere in probably like May, somewhere. So fairly early.

Megan Srinivas, MD: Week 27, 28, something like that.

Tuan Ta, MD: Oh yeah. Something very, very early. Okay. So, isolation. And I don't think that they treated it, just cleaned up the eye, but clearly had MRSA on him. And at that point, I was thinking okay, where did he get this, right? I'm sure no hand hygiene and whatever is a hundred percent. And I thought, okay, I'm sure he probably got it from me, or my wife. So, I was like, it's okay.

So, then I think at one point, maybe a handful of weeks later, I remember that we were there and he was more tachycardic than what I thought, supposedly was his normal. He was, they're always tachycardic, but he was more tachycardic and the attending who saw him that night, I think she was like, "Let's just get some blood cultures." So, I was like, okay. I knew, I was like, God, blood cultures. It's, anytime they have to draw blood, it's just harrowing, right? Because these veins are so tiny and you're drawing these pediatric bottles. I'm like, oh my God.

Okay, so then they drew the blood cultures. I sure there's going to probably be nothing. You always going to assume oh, probably nothing. And of course, the next day, I think it came back preliminarily with gram positive cocci in clusters. And we were gonna, I was like maybe it's coag negative Staph.

Maybe it's a whole bunch of nothing too. And I believe she started antibiotics, as the blood cultures were done. He was on vancomycin, I think he was on ceftazidime and blood cultures came back and I was like okay, maybe it's nothing. Of course, they then came back as MRSA. And then kind of everything just runs wild.

I was like, oh my God, I can't believe it's MRSA. He was actually doing fine. I think they drew blood work, his white count was barely above normal. Not hypotensive, not febrile. And so ultimately, I was like, okay, fine. Let's go through the course of treatment. And there were things that they did in the pediatric world, in the NICU world, that we don't normally do.

So, then they said, suggested that we get a lumbar puncture. And I was like, oh my God. Okay. So, a lumbar puncture

Megan Srinivas, MD: Is it, in that world, that they just assume everything goes everywhere because they're so young and so immunocompromised?

Tuan Ta, MD: Probably, yeah, probably. And again, it was one of these where I was like, I didn't wanna question it too much because I'm like, I'm sure the NICU attending knows what they're doing.

I'm not going to be like, why are you getting a lumbar puncture? Cause we don't normally get a lumbar puncture in adult infectious disease. I was like, "okay, you do you, get the lumbar puncture." And I remember I was at, I was driving to the clinic, and I knew that they were going to do it that morning.

They did the whole consent thing and everything. And I know that, and then I remember the NICU attending called me and was like, "it was a pristine tap, zero white cells."

Megan Srinivas, MD: Wow.

Tuan Ta, MD: Looks fine. We don't have to extend the course of vanco[mycin]. And then at that point they also called a pediatric infectious disease.

Doing the vancomycin, everything like that. And obviously we see infectious, we see MRSA a lot, or Staph aureus bacteremia a lot in the adult world. And all these things that you have to do. All the things that could go wrong, right? So, I was just like, okay, let's take it day by day.

It's one of those, day-by-day things just. Treat the antibiotics and whatnot. And he did fine. He got, I think, he got like a 10-day course, which I was a little, I was like, oh, 10 days. That's it. And not 14 days, like adults. And I remember talking to the infectious disease the pediatric infectious disease doctor, and she was like, "Yeah, 10 days."

Megan Srinivas, MD: Did they have to change out the lines? I know it's so hard in NICU patients.

Tuan Ta, MD: Yeah. I think that they did. I don't remember exactly okay, take out lines because there were so many issues with his respiratory issues. It was almost as if the bacteremia, even though the, as severe as that was, is, was a step back from, not the main issue with his respiratory, because his respiratory was always the main issue.

Megan Srinivas, MD: This infection that was relatively small in the overall course of things happened so early on. Did it, how did it affect you and your wife after that, for the several months that he still remained in the NICU?

Were you worried about more exposures? Was this kind of a scare that heightened your sense of anxiety?

Tuan Ta, MD: Yeah, I mean everything was scary just because you know of what potentially can go wrong. Like the feeding, the intubation. But I think once we got outside that, I guess I would say first two-month window, so like basically by end of June, I think he was then doing a lot better.

Like he was gaining weight a lot better, feeding a lot better. Closer to the end, and so this is probably August or so, he had a peripheral IV. And they're now doing peripheral, so no more PICC lines and stuff. He had a peripheral IV that got, I don't know if it was infiltrated, but there was like a little, like, pustule, a little pustule on his hand. I was telling the nurse we had to take this out.

We have to make sure that this little thing doesn't get bacteremia again. But other than that, not many infections after the initial kind of rocky course.

Megan Srinivas, MD: That's good. And when you were talking about it initially, I picked up this sense of wanting, because with hospital acquired infections, we often don't know exactly what the etiology is. Right?

I could sense that you still replacing a little bit of blame on yourself as a potential cause, even though it likely wasn't you or your wife. It likely was just life and environmental causes, but you still seem to have a bit of blame on yourself?

Tuan Ta, MD: It's, I don't know if it's blame as much as trying to figure out where did this come from. Because you know, in infectious disease, you're always trying to see, okay, where did this come from? How can I prevent it from coming back?

Is there some sort of intervention that you can take to decrease the risk the next time? And hopefully there is not a next time, but that's the whole point. And so, I think with that I was like we're not going to clearly stop doing the kangaroo care that, I think, was very helpful. So that, we were like, okay, we'll just wash our hands a little longer. Make sure that we're really good with keeping our phones and, we kept washing our hands, hand gel, all of those things.

Megan Srinivas, MD: And in your case, thank goodness everything worked out really well. There was no harm from it. But then thinking about it from the parent standpoint, maybe the parent who doesn't even have any medical background, who also might not have as good of a course or as good of an outcome.

How can we help in that situation?

Tuan Ta, MD: I guess the only advice would be to trust the process. Because that is a process. That's a long road. And I think we were very lucky, after, despite all of that stuff, that nothing else happened. It's always one of those where it could always be worse. And you always hear these stories of infants who you know, either don't get out of the ICU, they don't make it out of the ICU, they have all these issues, meaning tracheostomy and feeding tubes and all these other things that I think we were very lucky. But I think some of it is you just have to trust the process.

Trust the team that's taking care of take, taking care of your loved one. Because ultimately, they always have your loved one's best interest at heart, right?

Because I think a lot of times, things happen in the hospital and you just, you just can't help it. Adults are not going to be doing kangaroo care, obviously, but it's one of those things where okay, family members are going to come in. Family members may be ill, they may give the patient something.

But again, is it more beneficial for the family to be there and provide support for the loved one? I'm sure that is. Right? If the person is able to be awake and alert and have a family member there, then that's going to be more helpful than, isolating them. So, I think my, my, I think advice would be to trust the process.

Megan Srinivas, MD: Honestly, your story, and thank you so much for sharing that of you, your family, your son, your wife. It is a very, it's a very emotional story that you had to go through. And for so many people who have children born at 24 weeks, I imagine that they have a story very similar to yours, just because an infection seems inevitable during such a long course, right?

And have a lot of the same struggles that you do. So, thank you for sharing all of that today.

Tuan Ta, MD: Oh, no problem. It's, we sometimes look back at the pictures of 2018 and again, it's like this whole era, because then COVID happened. It was like a whole nother time.

And it wasn't that long ago. It was like five years ago. So, we were like, God, we didn't wear any masks. We were just there.

And it's just, yeah, certain families, sometimes other families are not as fortunate despite all the stuff that happened with my son and, we're just lucky, I guess.

Megan Srinivas, MD: And how is he doing now? He's what, he's five years old.

Tuan Ta, MD: He turned five in April. He's great. After he came home in September, he was on oxygen, on oxygen 24-7 for the first year or so.

And then, he was only on oxygen at night. The first year was oxygen-related issues as well as GI-related issues. Feeding and he would have vomiting issues. He had multiple endoscopies, because initially he had what they thought was eosinophilic esophagitis, and he ended up just not needing it anymore.

Because basically we were like the GI later on who saw him was like, "I think it's just all anxiety." He didn't have anything on a biopsy later on, everything was clear. And these issues obviously I think pale in comparison to some of these other issues that other families have to deal with, like a trach and feeding tubes and heart surgeries and things like that.

Megan Srinivas, MD: That's, that's so interesting to think about, because I have to be honest, as we're talking about your story, I'm thinking about the anxiety that you and your wife must have faced through all of this.

I didn't even think about your son. He was so young. That the doctors are taking care of him. He's going to be fine. But it's true, think about the anxiety he must have faced.

Tuan Ta, MD: My wife was talking to me about this maybe like last year or so. We were like, when he's, as he got older and was able to communicate and he was, we did a little bit of the sign language teaching and stuff like that, and it ended up being just a lot of anxiety. Like he just had a lot of anxiety in terms of feeding, the meeting of people, because he was in isolation for essentially two years and then COVID happened, so that was another year and a half. It was just like there was a lot of anxiety and that was manifested in terms of vomiting.

Megan Srinivas, MD: And I have to ask actually, you, because you were probably on the front line during COVID, I imagine treating patients.

Tuan Ta, MD: Yeah.

Megan Srinivas, MD: And then you have your child at home who you know has had this long history of needing oxygen, certain vulnerabilities that even though he was probably fine by the time COVID hit, but you still didn't have those exposures yet. Did that impact, how were you approaching this thinking, okay, I have these risks at work. I can't bring them home. We all were thinking that. But you had this heightened,

Tuan Ta, MD: Yeah. Yeah. And I'm sure it's the same for a lot of physicians who, let's say, live with older family members or have an immunocompromised family member at home.

But it was, in the beginning it was very, just obviously a lot more anxiety. You're doing everything. You're washing your hands. You don't know how things are transmitted. Was it airborne? Was it droplet? Wiping things down. And at that point, I think in, in, it was at early 2020, he was still on oxygen at night.

And because I remember that we were doing sleep studies to see if he was hypoxic, when he would sleep. So, we delayed one of his sleep studies until later. Because we're like, "we're not going to go sleep in this random room, in this random sleep center place." What's, there was no, no benefit in that.

So, it was a lot of anxiety at the beginning just being as sterile, I guess, as possible. Preventing transmission of things. But it was, it was I wasn't as vigilant obviously prior to COVID, still washing hands and doing all that type of stuff. But it was more so during COVID.

Megan Srinivas, MD: Definitely. That makes a lot of sense. Now that you're on the other side, people are doing well, people are back, your son is back to the real world. What is, if we were to tell our listeners one thing, what is the one takeaway that you want people to get from your story and your journey?

Tuan Ta, MD: I think infections are preventable to a certain extent. You do all you can, but there's sometimes things that you can't prevent. You're not going to be in a bubble, right? You can't sterilize your skin to the point where you have no bacteria whatsoever. You're not going to not touch anything, right?

And I think that's why I love infectious disease, and to the extent that you can treat things you can make things better, relatively small intervention, a set defined duration of antibiotic or whatever thing that you can intervene upon and then, eventually get back to living life.

Megan Srinivas, MD: I love it. It's your same mantra that you started out with telling us, Trust the process. I like it. I like it. We'll make that a slogan bumper sticker for you.

Tuan Ta, MD: Yes.

Megan Srinivas, MD: Thank you so much for joining us today for sharing your story and sharing. Sharing your journey. It's been really wonderful to listen to and wonderful to get to know you and your family a little bit more.

Tuan Ta, MD: Thanks, Megan. It was, it was good talking to you.

Outro: As Dr Ta's story shows, health care-associated infections are preventable and can impact patients and their families for years. Living life – going to lunch with a friend, vacationing with family or volunteering at an animal shelter – all of these can expose us to an infectious disease. But we accept that risk as a part of living within, and connecting to, our communities. However, when patients seek medical care at a hospital or other health care facility, they trust that we, as health care professionals, are doing everything we can to keep them safe and free from infection. By focusing on proper infection control practices, we can give them the peace of mind, that they can, indeed, trust the process.

Stories of Care is a publication of the AMA and CDC's Project Firstline. Project Firstline is a national infection control training collaborative, working to provide all health care professionals with the foundational infection control knowledge they need and deserve to protect themselves, their patients, their coworkers, and their communities. For more information, trainings and other infection control resources, visit CDC.gov/projectfirstline and AMAfirstline.org.

Audio Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.


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