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Infection Control Starts HereAn AMA Medical Student Introduction to Project Firstline

Learning Objectives
1. Describe Project Firstline, an infection control collaborative between the CDC and AMA
2. Review how to navigate the resources Project Firstline has on infection control practices via events, informative videos and discussions
1 Credit

In the webinar, the Centers for Disease Control and Prevention experts Michael Bell, MD and Liz McClune discuss Project Firstline and how medical school students can access infection control resources that help HCPs protect themselves, their patients, and communities.

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Video Transcript

Reilly Bealer: [00:00:59] Hello, everyone, and thank you so much for joining us today. My name is Reilly Bealer and I am a fellow medical student and member of the American Medical Association's medical student section. Just so you know, this webinar will be recorded today and hopefully you will be able to view this later. In today's webinar, we will be introducing Project Firstline, the CDC's new comprehensive infection control training initiative for physicians and health care personnel in the United States. As we all know, COVID-19 has exposed gaps in infection control, knowledge and understanding among our health care workforce. Improved infection prevention and control strategies are among the most important tools that we have to prevent and contain the spread of diseases in health care settings. Project Firstline. As a result of a collaboration between the CDC, the AMA and other clinical public health and academic institutions, as well as dozens of state and local health departments to help ensure that frontline health care workers have the knowledge and confidence that they need to prevent the spread of infectious diseases and other health care settings, including hospitals, outpatient centers, nursing homes and other facilities. Health care professionals will learn effective infection control practices through a series of events, informative videos and discussions to empower students and physicians with the knowledge of how to apply these control practices, as well as the science and reasoning behind these practices. Today, we are joined by Dr Mike Bell, deputy director of the CDC's Division of Health Care Quality Promotion, and Liz McClune program lead of Project Firstline at the CDC. Dr Bell's career has focused on investigating and preventing transmission of health care associated illnesses for patients and staff. He is here to discuss the concept of infection control and why it's important. And then Liz will share information about the initiative. They will both be available to answer your questions and help you navigate the many resources the project first line has to offer. We are so appreciative of the pre-submitted questions, but you have shared in the registration process and ask you to please feel free to submit additional questions using the Q&A box down below, as well as the chat box and the presentation. We will do our best to get to as many of them as possible. Now, please join me in welcoming Dr Bell.

Dr Michael Bell: [00:03:37] Everybody, good afternoon, thank you for making time to join us today. My name is Mike Bell and I am happy to be talking to you about infection prevention and control. It's always kind of exciting to be asked the broad question, what is that? And I always flash back to one of my early days in med school when I was about to walk into a patient room in an ICU and a kindly but firm nurse grabbed me by the collar and pulled me back to the room because it was an isolation room. I had no idea there, was so much going on, so much stimuli. And I was trying to pay attention to everything, but I didn't see the sign in the door. It was very mysterious back then, but over time, it's become very clear that it's extremely basic and absolutely essential.

[00:04:25] So what is it? Infection control is what it used to be called and it became infection prevention. You might have seen people calling themselves infection prevention. It's just kind of odd English, but it gets at that. Prevention is better than trying to solve a problem right now, I think for the most part with the infection control. And just for context, I'll share that. You know, we can think about it as related with different things. Infection prevention tends to focus on what we do as a strategy to keep from creating an infection when we do something like a procedure. What I mean by that is if you think about putting in a central line, we know that we can create a bloodstream infection if we're not careful. So we have some rules sometimes in the form of checklists. That is infection prevention, implementation. Infection control is what we do when we know something is spreading and we want to stop it. Right? So something along the lines of COVID has led us to using masks for source control as well as a variety of other strategies. That's infection control.

[00:05:28] So it's a related pair of disciplines that are all packaged as one. And when you think about it, it really is at the heart of medicine with a big M. It's part of the Hippocratic Oath. It's part of the concept of primum non nocere. It's a moral imperative. Right? Like an ethical standard and therefore a standard of care. You would never want to be the person that accidentally gave a patient hepatitis because you contaminated a multi-dose vile. And so we applied good infection control practices to make sure that never happens. These are things that are at their heart systems of practice that are designed to protect patients, but also your colleagues, health care personnel. We all want to be able to go to work and come home without bringing bad stuff with us. And so infection control, when you think about the admonition to do hand hygiene before you put on gloves, some people might say that's silly, you're about to put on gloves. But if you've got stuff on your hands, schmutz from the hallway or maybe from a patient and you reach into a box of clean gloves, you've now contaminated those for everyone else who reaches that. We don't want to do that.

[00:06:41] So it's a system that protects both patients and health care personnel. And by extension, if you think about some of the terrible things that have happened to patients that have then led to a health system to become disadvantaged, almost having to shut down, that is a problem for the entire community. If you think about health care personnel bringing infections out into the community because we all live in the community, then infection control has a strong connection there as well. So it is a very, very holistic thing that even though we like to think about it as just gloves and respirators and some PPE is really a great deal more than that. I think it's worth thinking about how infection control crosses disciplines within health care, most of us train in big tertiary hospitals, places that have infection, infection control professionals, infection prevention, hospital epidemiologists, environmental services staff that are trained to do the disinfection cleaning for our environment. We have a robust central supply, reprocessing, sterile processing group, all of those things that we like to take for granted.

[00:07:53] We also have adult patients that are able to adhere to many of the things that we asked them to do. And that's all well and good until you move from that tertiary hospital to something like an ambulatory care setting. I'll never forget getting a call from a friend of mine. She's a head and neck surgeon in San Francisco. And she asked me about an infection control problem, I said well ask the infection control professional that's there. And she's like, I'm here alone, except for a receptionist and my patients. And I said, good gracious, where are you? And she's like, I'm in this ambulatory surgical center. Like, why on earth would you use a place like that? She's like, Oh, the parking is awesome. So we make these decisions for very valid reasons, but we sometimes move our care to places that don't have the same infrastructure that we train with that we take for granted. And so it's important to think about that transposition of what we do and how we need to tailor our approach, whether it's ambulatory care, rehab medicine or if you think about more challenging places. Think about nursing homes and long-term care. These are places that are also supposed to be a home for your residents. And we can't necessarily isolate people the same way we may have people with memory, difficulty or behavioral problems. Think about psychiatric care. There are some major challenges there when it comes to implementing what we take for granted as infection control.

[00:09:18] So all of these things lead to a need to be able to think about it critically. A couple more examples. Pediatrics, right? I'm an adult medicine doctor. My patients tend not to crawl on the floor and lick things. But that's not true of your pediatrician. And when you need to apply infection control to that setting in a way that is both effective but also supportive of our patients, then you really need to understand what's going on. That is one of the reasons why I'm incredibly excited about Project Firstline. Here's the pitch. [00:09:54]The issue here is that it can't be just you and me being specially trained in infection control. Think about the number of people taking care of patients in a hospital every single day. Think about the number of times we each touch or interact with a patient. Multiply that across thousands of patients and then over hundreds of days and you can see the intensity with which transmission risk is present all the time. We need everyone to understand what we want them to do. We need everyone to help us because it's not just us, the doctors that are at the bedside twenty-four, seven. Our nurses are there a lot more than we are. Our environmental services staff are there day in and day out doing critical work. Everyone needs to get it, right? And that's good enough as a logo. But when you think about what that means, we need to bring the information to everyone and in ways that make sense to them. And that's what this is going to describe. I think at the end of the day when we deal with a subject like this where we have to pick it up and retailor it, when we move from one location to another, or makes some hard decisions. If you think about resource-limited locations internationally or recently when we were short of supplies during COVID, you have to make some hard choices. And if you don't understand why you're doing something or why you're wearing a piece of PPE, then it all seems kind of magical. If it's just a list of rules on the wall, that's not good enough. We all need to understand why we're doing things so then we can explain it to other people, but also make those decisions if we need to make an adjustment. [98.8s] So with that, that is my very quick, high-level overview of infection prevention and control. Happy to talk more about it any time you want to. But for now, let me hand back and give the baton to Liz.

Liz McClune: [00:11:57] Thanks, Mike and Reilley, thank you as well. I want to go ahead and get started. I know time is tight and I think there are some slides as well, but I can also chat with the best of them. So welcome, everyone, to kind of a quick overview of Project Firstline, head to the next slide, You might go, "what exactly is Project Firstline?" And Reilly did a fantastic job of introducing us. And it really does reflect the fact that infection control is a collaborative effort. I can do everything right. I can know exactly what I'm doing every single time with every patient. But if my colleagues don't, my patient's still at risk. And so in that same way, we as a program are collaborative. And we also know that you all are experts in medicine. You are experts in the fields of medicine that you're training and now and that you'll go into and be leaders of. And we're here to partner with you as infection control leaders throughout the health care community. So Project Firstline is, at its heart, a collaboration of over 74 organizations. If we had one of those like McDonald's ticker tapes, it feels like every few weeks we get to add one more. And the whole point is to reflect as much of the health care community and public health community as we possibly can, which is why we're always adding to that McDonald's ticker tape. And the idea is that if we can work together, we can build infection control, education that's relevant and directly to the people who need it most. So folks like you. And then it should be transparent. It should be responsive. If there are new questions that come up, we should be there to help answer questions and help people feel through the why. And the whole big goal is to create this culture of expertise on the front lines. It's great to have infection prevention tests. But as Mike mentioned, there are times when you don't have one and there's no way that we figure it out yet to clone enough of them, that they could be a one-to-one ratio with everyone in the health care system. And so what that means is we want people to feel empowered, to think for themselves and to understand the why behind these recommendations. Next slide, please. So. As Riley mentioned, COVID-19, well, it revealed a lot of things, but one of the things that revealed was these long-standing gaps in infection control, knowledge and practice in health care settings. And it certainly isn't an indictment of health care workers and their commitment to their patients, but more of these long-rooted disparities in the current health care workforce, where there had been this approach of let's train infection preventionists, and that knowledge might trickle down and then, kind of to reflect that, most people during their formal training, whether it was their medical school training or their nursing education, didn't receive a lot of information about infection control training and the why behind it. So they were learning on the job. And when you learn on the job, it tends to be this just do it approach. Here's the checklist. Don't ask any questions. Make sure you do it right every time. And it really wasn't rooted in educational approaches. If you think about how you're learning on the job now, where you're learning the why behind it, then you get to practice it. Then you get to ask questions. When it comes to infection control, it usually is just a checklist on the wall and it's not good enough. It's important to note that these gaps predate the pandemic. And we recognize that unless we all work together, they'll continue as well.

[00:15:34] Next slide. So I'm not going to… I assume you made in medical school, you can read a slide, our fantastic partners I want to highlight, of course, first our American Medical Association, who's really. This vanguard of innovation towards disseminating this information directly to physicians and to medical students, but as you can see, even on the clinical health side, it's robust, it reflects different professions, to be sure, but different ethnicities and cultures. And that certainly interplays with where and how health care is delivered. So are our tribal health care partners are really important of translating the information we have to the settings that it's being practiced in some locations, for example. Next slide, please. And then on the public health side, we believe very strongly at Project Firstline that public health and clinical health are really two sides of the same coin. And so we've brought in our health departments in your state are local health departments in your jurisdiction, in some national public health as well, to make sure that we're connecting the clinical and the public health. And the next slide, please. And then we know that there's a lot that we don't know about how best to educate about infection control, about the best technologies to leverage about transmission. And it comes with being in the education space. This need to always improve and always push to do better. And so we have a wonderful array of academic partners that are helping us understand how health care workers perceive infection control, knowledge, for example, different approaches to using augmented reality for training and all different ways of supporting health care workers to make these really sometimes challenging decisions. That takes a lot of critical thinking. Next one. So you might say, what does that look like? And for us, it looks like a lot of things because, in order to reach 23 million people, which is the health care sector in ways that are relevant to them, you're really not going to be able to make one slide deck and call it a day. We tried the first week. It didn't work. And so there are a lot of different approaches that we use and we collaborate with our partners to use. So we have our Inside Infection Control series really highly recommend you if you want a quick five to seven minutes of the different ways that COVID spreads and how you can stop that spread and the different tools that you used to do that inside. Infection control is a great place to start. We have a facilitator's tool kit so that if people want to be a leader and they do their outpatient staff or on the ward, that they can actually do trainings in as little as five to seven minutes. Then we walk people through that. We certainly have infographics, but we always include the why and so really making sure that we're providing that information. So we're not going to deny it, but we're not doing that. Just do it approach. And then we're using events like this with AMA, but also with some of our partners to leverage important health equity goals. Our Asian Pacific Islander American Health Forum, for example, most trainings with us, and they do live interpretation into five common Asian languages so people can get the information that they need in the language that they learn. Even if you can speak English, you may prefer to learn in a different language. Next slide, please. But not all events are the same, so certainly the health forum is fantastic at leveraging things like Facebook, but using different platforms that people are already engaged in. Project Firstline is for you and meant to be designed for you, which means where you guys are already congregating, either whether it's in the virtual world or hopefully one day in the physical world. We'll meet you where you're at. And we're trying to use different tools to get at you, even if it takes a T-rex, wash your hands, humor bit. We will use whatever we can to kind of bring infection control to you and show how it's relevant.

[00:19:50] Next slide. So really want to highlight that fantastic just first year of work with AMA that we've already succeeded together and putting an important spotlight and relevance to infection control. So one you'll see, of course, Firstline on the AMA Ed Hub. Again, we want to go to where you are. We know that sometimes surfing the CDC website is not anyone's go-to. And so if you're on the Ed Hub, we'll be on the Ed Hub and really excited in the coming weeks to launch a new podcast in collaboration with them of stories of care, which is focusing on the intersection of health care, equity and infection control, and then working with different parts of CDC as well about how to spot a counterfeit N95 and with the American Society of Nephrology on infection control specific to dialysis settings.

[00:20:44] Next slide, please. So I want to stop here and really focus on the different ways you can reach us. I will say if you shout at us, we'll check back. So we really it, we're, of course, on the web. We're on Facebook, on Twitter and YouTube. If email is helpful to you, you can sign up for a listserv. And when there's new things that come out, we let everyone know. And we'll also let you know when there are events. So shameless plug and for an event will be hosting next week. We've received a lot of questions of late about infection control during this current experience with the Delta variant. Are things the same? What does it mean that Delta is more transmissible and what does it mean for infection control? How do I keep it from spreading to me and how do I keep it from spreading to my patients? So we'll be covering that and actually be doing a large Q&A session where we'll be taking questions that as we get them for 30 minutes. And so if you have a question about infection control during COVID infection control more broadly, please keep keep us up to date with us and with AMA for use your information about that next week. And of course, we'll report it and send it out as well. So with that, I will close. I want to make sure, as always, we have as much time for question and answer. And thanks for having me.

Bealer: [00:22:12] Thank you, Dr Bell and Liz, for being here today. It was very informative and I'm hoping that maybe we can get some more information on how to find that webinar next week on combating the Delta virus and infection prevention.

McClune: [00:22:28] Sure. So if you follow us on Facebook or on Twitter, all of that promotion will come directly to you. And then and usually we email something out or AMA will as well. And you can register right there. Or if you're busy and you don't feel like registering, we'll be live streaming to Facebook. So if you will send you a kind of a save the date and if you can next Wednesday at 3:15, I'm just gonna ahead and plug it. If you want to hop on our Facebook page, you'll see us livestream there. You can comment in any of your questions. And then again, if you can't make it, we know people's time is pretty busy. We'll record it and send it back out.

Bealer: [00:23:06] Perfect. Thank you so much for sharing and we have tons of medical student questions for you today, so we're really grateful that we can keep you on here to answer those. As you know, medical students are kind of the new kids on the block or just entering what it's like to be in the medical center, outpatient hospital, all the different types of medical environments. And so one of our medical students asked a fantastic question. His name is Anand Singh. What is the medical students' role in the prevention of transmission of disease? And how can we partner with our physicians and administrators to meet this goal, that project first line and the CDC has set out?

Bell: [00:23:51] So I think personally, there's a wonderful moment when as a trainee, you have more freedom to ask questions than anyone else. You're there to ask questions. You're there to figure stuff out. And I think that can actually help more than just you. So when you are asking questions about what's the rationale for this, not in a mean way. Don't be rude. But when you ask questions because you clearly want to know, the people around you learn as well. Ideally, we all work in a place where people are open to questions. If you run into a situation where people are guarded and unhappy with questions, then there may be other people you can ask. But I think at the end of the day, being inquisitive about this and striving to really understand what's going on is one thing. Equally important is that we are all patient advocates. We have a deep obligation to protect our patients no matter what. And that includes from infections. And so each of us, whether we're just learning to put in IVs or learning to draw blood. We have an opportunity to prevent harm from happening to our patients. And so that's important. The other stuff that I mentioned applies to all of us. Right? It doesn't really matter where you are in training. That's one of the notable things about infection control. It's not a hierarchical thing. And when it is, that's a problem. It needs to be as horizontal as possible. So recognizing that it exists. Striving to learn about it and then applying it diligently to protect your patients, and those are the things that we all should.

Bealer: [00:25:44] Absolutely. Thank you so much for that, Dr Bell. Liz, did you have anything you wanted to add to that as well?

McClune: [00:25:49] Yeah, I just I wanted to thank for that question and to say that it's never too late to ask why. So even if you're a few months in and you've always wondered why a practice is the way that it is, it's never too late for us at Project Firstline. We've been at this for a year and I don't think we received a dumb question yet. So if you ever are curious as to why or just feel like maybe everyone was there that day in school and I didn't get it. One is we're developing materials to help to answer those questions. But if you're still not finding what you're looking for, shout at us, email us. We will respond. And our goal is that you then take that knowledge and share it with others, because if you're wondering, it's a pretty good idea that other people are wondering, too, and it allows you to be a leader in the space.

Bealer: [00:26:35] Absolutely, along those lines, medical students are also in a very unique and potentially vulnerable position being trainees, as you know, we can learn some amazing techniques and good habits from our attendings and from those that we witness. But sometimes we can also witness some, maybe not so favorable habits and practices. How can we be a patient and self advocate in a situation where maybe leadership isn't following prevention and control guidelines?

Bell: [00:27:08] I'll start and then I'll hand it to Liz, who's an expert in this area. I think there's an entire series of talks we can give on how to intervene across those sort of hierarchical boundaries, across social challenges. And I won't belabor that point here. I think you need to use sort of your common sense about how and whether to challenge people. But when you do or whether you do or not, actually the key here is that you're recognizing a problem. The danger that I see is if you assume that just because somebody is at a certain level, what they're demonstrating is correct, even though you think it might be wrong. It's good to investigate and settle for yourself if that was, in fact, the right thing to do. If you have questions, it's also OK to ask. It's not easy to ask, but it's OK to ask. I remember early in my career seeing a surgical attending drag her white coat sleeve through a wound, exudate and then move on to another patient. And it took some gumption, but I tugged on her sleeve and I said, Can I talk to you over here for just a sec? You didn't notice it, but I saw the sleeve go through and you can see a little bit of exudate right there, and I know you wouldn't want to drag that to the next station, heaven forbid. And she was very gracious, but it was scary until I empathize completely, it's not an easy thing to do, but it is possible. Liz, do you want to chime in?

McClune: [00:28:41] Yeah, I actually think in your example, you kind of nailed the heart of it, which is if you come at people with, I know that you don't want to hurt patients. Right. And it's not a gotcha. It's not a, you know, I know I'm questioning authority. It's 'hey I noticed this.' And I know you don't want to spread anything to our patients. And so can you help me understand why you're doing what you're doing? It's possible that they've never even thought about why they're doing what they're doing. Right. Some of our behaviors and infection control is kind of at its base, their actions, their behaviors, and sometimes they become these thoughtless behaviors and you don't know the why. And so sometimes creating that dissonance of why did you do it that way? My understanding is that, you know, that there's risk there. So part of it is kind of chasing down that dissonance, you know, what is the right thing and then feeling comfortable of connecting it to something that is a shared goal. I know we care about each other. I know we care about our patients. I'll even say no. We have had people bring scenarios where it's it's an exhausting time right now. And some people are not wearing their antibiotics correctly. And people have been afraid to point it out. And when they do, it's just the people are tired. And so coming up at someone and saying, I know you're exhausted, I but I care about you and I want to let you know that you're not wearing it properly and bringing it back to that. Why and that hearing, I think, can help to alleviate some of that tension. And the last thing I'll say is if the person that you're if you're being respectful, if you're connecting it to a shared goal and they're still going to be angry at you, I think it's says a lot more about them than it does about you. So don't let that stop you, although it does take courage for sure.

Bealer: [00:30:28] Absolutely. And that brings me to a topic that's really become prominent in medicine for physicians and medical students, the topic of misinformation, this has been even more evident with COVID-19, as we're seeing, you know, sharing on Facebook different data that may not be evidence-based. And we as medical students, health care professionals, our colleagues in nursing, pharmacy, all have to combat misinformation. So how do we fight misinformation regarding infection control?

Bell: [00:31:05] So I think the hardest thing to do is to combat misinformation, if you're not sure yourself. We always sort of pause if we're thinking 'maybe I'm wrong.' And that's a healthy thing in many situations. But for some things, it's good to be certain. Right. And so take syringe reuse or needle reuse. It's never OK, full stop. And you can be confident about that. There's never a good excuse to be reusing injection equipment in this country. We have disposables that need to be used once and only once for each of our patients. The risk of doing something otherwise is completely unacceptable, and so there are things like that that you don't need to be uncertain about. There can be some things that you might not be certain about, and maybe it's because there's not an easy answer. Here's a good one. Flu season is coming. We're using respirators, N95s, fit tested and all, for COVID, but we don't traditionally do that for flu. Should we?

[00:32:10] And the answer is, maybe we do recommend it when it's a bad strain of new flu, like a pandemic strain, and the rationale there is that we know if you got sick, a lot of other people could also get sick. So we can have a huge wave of disease and we've just seen what that does to our hospital system. It can be horrifying. We also don't necessarily have a vaccine for a new strain of flu, just like we did in procedures at the beginning of causes. We didn't have it either. And likely there isn't a specific treatment and certainly maybe not enough of it for everybody. So then in those situations, we really rely on something like a respirator to prevent exposure. That line of thinking, though, isn't necessarily clear to everybody, and it's OK for it not to be clear, because we're all thinking about many things, but there is a rationale and finding that rationale, becoming comfortable with it and then being able to share it is sort of the next wave effect. And that's what we want. That's why Project First Line is delivering this information to such a wide range of people. We in medicine have the luxury of grand rounds. We have the luxury of going to professional conferences. Right? Sitting in hour-long lectures. You don't have that necessarily. If you're a nursing assistant working in a nursing home, for example, you're lucky if you get a decent lunch break. And so figuring out, well, how do you deliver information? It's not a one-hour lecture on a PowerPoint is part of the work the project first line and group are doing, and it's pushing us to separate. What does someone really need to know in just 90 seconds? What's the meat of the matter? And that requires a lot of sifting and a lot of combing, but it's a really great exercise.

McClune: [00:34:02] It's a great point and I will caution people in this day and age of information really quick that you can Google anything and someone will tell you anything. And so we know the allure of something like, oh, there was a really good YouTube video on this. My sisters are nurses. They you know, people access YouTube all the time and it's quick and easy, but that doesn't necessarily mean it's accurate. And so making sure you're checking your sources, making sure that, you know, the AMA is a trusted source. CDC is a trusted source. So even just looking down and saying, who's telling me this can be a good way of stopping yourself from getting two minutes into a video that doesn't make a lot of sense or that makes almost too perfect sense. Right? Like they had it all figured out. And then I'll just reflect something that a colleague of mine gave advice to me last week is you shouldn't trust someone who says they know everything. So someone who comes across as I figured it all out and there's absolutely no way you should question me, should be a reason why you should doubt them in the first place. So I think it says a lot about a group of people, what we're trying to do here at Project Firstline to tell people what we know, but also what we don't know yet and what we're trying to find out more. And I hope people have a good, healthy dose of skepticism for someone who's figured it all out.

Bealer: [00:35:24] Absolutely. Thank you, Liz. I think, you know, the glorious part of being in medicine is that we are always learning, we're always learning things new every day, every minute, every hour. Actually, when Dr Bell is talking about washing your hands before putting gloves on, that caught me off guard because I don't always do that. So, you know, we can always, always learn more. Something that a student asks. I think it's incredibly relevant, especially in this day, giving COVID-19 we as medical students train in different clinical environments. For example, I have friends in larger metropolitan areas such as L.A., Chicago, New York City, who may have big hospitals with a plethora of resources. Personally, I live and work in rural eastern Washington where our hospitals and clinical centers are smaller and may not have access to as many resources. It really struck me, Dr Bell, your conversation with your friend who lives in San Francisco, I believe, who didn't have access to an infection control and prevention specialist, regardless of where we are at, in what situation we are in, how can we be the best infection prevention and control advocate for our patients and for our health care workers?

Bell: [00:36:47] So, you know, a lot of times I think we feel that we need to know everything, that we need to have the answer as individuals. And if there's misinformation that we need to be the one challenging and I don't think that's necessarily true, frankly, I don't think it's necessarily fair. It's much easier to do if we're doing it as a group, as a community. And if there's one thing we've learned thanks to COVID, it's that our community can be very widespread indeed. To all of you on a call like today's, you are working together. You are thinking together. And if you communicate together, you can also share information and support one. I think that with that in mind, whatever level of training you're at, if you know where to find information, if you have a smart way of accessing the best information, then you're going to be a resource. We all know people who have had some magical technique to get their fingers on the best, most pertinent publication. And that person is extremely useful. I think that we can all be that in our own ways, knowing what's the best YouTube clip is, knowing what's the best quick link to evidence bases might be or even having I keep on my phone a bunch of online posting material from Project Firstline because it's so handy. And being able to share a badge electronically is a nice thing. So we can all keep our stockpile of good information at hand, shared widely and keep it up to date. Always be looking for great resources because we always need them.

McClune: [00:38:42] Yeah, and I can't question I can't emphasize that enough, in fact, that wherever you're practicing, it's not enough just for you to know. So really, to the best thing sometimes that you can do is to be a leader and to let other people know. That doesn't mean you have to be the teacher all the time. But to recognize that, you know, you have gone through a medical school experience where you're used to accessing information, where you might have heard of opportunities like this, but it's possible that the EVS worker that you've worked with doesn't know about it. And so sometimes just sharing that, hey, there's a place you can go and I know that you're an expert in and also respecting the different expertise that's going to come with you in whatever facility you work. And your coworkers, for example, are experts. And so you'll often find access to knowledge and places maybe you didn't think to look. It's not all online. And so sometimes even asking folks that you work with every day of, hey, why don't you do it that way might help for you to realize that they're a resource to you that you didn't even know that you had at your disposal. So always be open-minded to that broad contribution that the entire health care team can play.

Bell: [00:39:52] One other thing that I'll add, I've been noticing this in today's conversation. Consider avoiding the word you when you're talking about infection control and when you're asking questions. I noticed that you did this or why do you do it that way? I find that in this field where it's all about avoiding mistakes, it's generally better to use me. Why do we do it that way? What is our rationale comes across much less confrontational. Rather than say I noticed you're not wearing your respirator correctly, it's probably better to say I noticed there's a gap between your nose and the edge of the respirator you're probably breathing in. Did you do a self fit check? But thinking about how you deliver this information is a core component of infection control. You're not going to get very much traction if you come across as criticizing or questioning. And I don't mean in that asking questions. That's what I mean in the challenging somebody's activities sense. That doesn't mean we don't need to do that. But think carefully about phrases and approaches that allow people to be open to what you're saying. And I think that the 'you' word tends to shut people down pretty quickly. They go on defense and start to sort of circle the wagons. But if you do the 'we' or identify the thing, whatever the practice is. That glove did this. Then I think you can go to.

Bealer: [00:41:27] Absolutely, being a medical student and working in the surgical center, I have to say I'm really grateful for the whole medical team, especially our scrub tech, that I've been yelled out more than once or twice for breaking sterility. And I know that they're doing their absolute best to protect the patients as well as protect us. So we are truly all in this together. One question that a student had as well was how has COVID-19 really shaped changed or maybe just emphasized the importance of infection prevention and control as well as the modality or the purpose of Project Firstline? You can talk about that.

Bell: [00:42:14] I'll defer the Project Firstline thing to Liz. What I will say is that it has become impossible not to notice infection control. It's everywhere, it's on TV, it's on the news, it's on the street corner, because a lot of what we do in health care has now become standard community practice in many places. I think that the level of comfort that our society has now is probably going to pay off down the road with things like that, flu seasons and RSV and things of that. We're approaching our second respiratory infection season now. During the first one was definitely notable for an almost complete absence of influenza. You may not think about it very often because it's just the flu, but influenza kills about thirty-five thousand Americans every year. It's not a negligible disease, and yet we treat it as though it's not a big deal. We do have a flu shot and it's good that we all use that. We have some tools to push against flu, but we really don't think about the infection control side of it very much. I'm sure also that there are documented instances where newborns that were otherwise healthy have died of what turns out to be rhinovirus that causes a common cold. How many of us have shown up at work with a little bit of a sniffle? Right. A little bit of a cough, but we're not that sick. And it would really be bad if we took the day off. So we show up and we work. That's our current culture. But I think we're going to be moving into a phase where we need to start rethinking some of that. Back in the day, there was no way to diagnose every last viral infection. But now with metagenomics and rapid sequencing techniques, we will be getting to a point where we'll have diagnoses. And so I look ahead at my work and think about the challenges, about what do we do with this information? How do we make it possible to keep doing good work and keep showing up without accidentally hurting somebody that was supposed to be taking care of? I think that is something that is a challenge in the future. But for now, we are benefiting as a field from greater appreciation, greater awareness, and a greater desire to learn about infection control from groups that never used to think about it. On the Project Firstline, I'll hand it to Liz.

McClune: [00:44:36] Yeah, I think, you know, it's hard to find a lot of silver linings with the pandemic, but I do think if you if you had to search that, the fact that we've realized we are our brothers and sisters keeper is something that I think people didn't think about a lot in health care. But the degree to which the entire population in a health care community, from the receptionist to the ABS workers to the clinician, to the nurses, that we're all interdependent upon each other. And so the, you know, the person who says, I don't think I need to wear that mask, it's not for me, has an impact on others. And the degree to which we're all, including our patients are part of this effort, I think is important. I think the other piece, and it's a big part of Project Firstline as well, is that when things are changing, when things are evolving, when you're learning new things every day, but you never knew the why to begin with. And when things change, it can seem like it's random or that it's not science-based as opposed to the data is improving. And so we're improving. And so I think it showed the really huge importance of understanding the why the rationale so that when things change, you can say, so this changed. And so now we're doing this differently. So it doesn't feel as if the sands are shifting all the time. And then last, I think it showed how important it is, how we communicate with each other. I mean, I think you saw Mike there point out to me, which is a good point. I'm using the word you a lot, that somehow language that you talk through every day that you think is obvious that we need to check and make sure that we're being understood when it when you're in positions of being a teacher, that it's not just enough to kind of yell into the void, that we have a real responsibility to make sure that what we're saying is being understood and that we need to adapt. We come here at CDC from a place of privilege, to be quite honest and foremost, to work on a project. First is from a place of privilege. So it is our moral responsibility to make sure that this information gets to the people who need it. And we should be adapting to make sure that happens. We shouldn't be asking of people to adapt to us. And so I think those big spotlight on health care equity has been important for the pandemic and certainly as the foundations for Project Firstline moving forward.

Bealer: [00:47:06] Thank you for addressing the concept of equity, I think is necessary with every single thing that we do is evaluate how this can be equitably put into place, as well as how it impacts populations who may have been marginalized or minoritized in the past. And currently, one area that you all talked about is really working as a team, working together to make infection prevention and control a priority. And for a lot of us and for a lot of health care workers outside of just physicians and med students, it can seem like a chore. Like you said, it seems like a list on a wall. OK, you have this responsibility for this day. She has this responsibility for this day, et cetera. How can we get our fellow medical students, our fellow colleagues, health care workers really excited and impassioned about health care, infection prevention and control methodology?

Bell: [00:48:07] This is a very, very difficult moment in history to get people excited about much of anything. I will say that I have colleagues who have lost partners and loved ones in health care to COVID. I've watched people burn out badly and we have a wave ongoing now that is once again taxing many of our health care systems. So it's not an easy answer. And I think acknowledging that is is important. Being empathetic about how we try to generate enthusiasm is a challenging balancing act. But I do think it's important that said. I will say that part of what we can do is lay down a metaphorical gantlet. I want all care to be perfect. Every last action that we do as health care professionals, I want it to be perfect and I'll be honest with you, I want it to be perfect, because when I have to be in the hospital, I would really want everything to be perfect. Everything. I think that's a reasonable thing. This is not a haircut where if someone does a somewhat crappy job, it'll grow out and I'll get another haircut. No harm done. Health care is asking more of us. Yes, it's asking us to do our very best. And that very best really needs to be aimed towards perfection. Is it a chore? Yeah, everything's a chore, right? If you're making pasta, you can do a crappy job of over boiling your noodles and it'll be yucky. Not a huge loss. You could make fresh pasta or you could just eat it and not care. But health care doesn't give us that freedom. We actually do need to do things perfectly every time. That's one of the reasons why, you know, the time that we spend a week is an important thing to consider. Our own mental health and resilience is so important because we can't afford to miss the thing that needs to get done correctly. I think all of us in health care, in one way or another, lose sleep over what did I miss? What could I have missed? What should I have done better? It's part of being human. But the drive to aim towards perfect is something we all have to maintain that that is in part what keeps you going on those really long. What keeps you going when it's been an endless pandemic and you're going for more? It's that desire to really do the very best for your patients. It's a heck of a cool profession for those reasons. But that doesn't make it easy.

McClune: [00:50:59] Yeah, I will say I've spent, oh, 10 hours a day for the past almost two years thinking nothing, infection control, and I didn't come for control of a medical social worker. So and when you think of just rules for rules sake, it was the sign on the door. I just do the things. And I had a lot of patients to see. And I didn't think I had time for any of these things and I didn't see the consequences to not doing them. So one is, I think, how do you make it not feel like a chore or not feel like a list of rules is realized that there there's it's action, it's behavior, it's how you care. It's a show of caring. I think I had a mentor of mine where, you know, there's hand sanitizer outside the door. Now that I think about this, I can't imagine what a young 20 something whippersnapper I obviously was. But I said I didn't have time to, you know, use hand sanitizer in my hands. And my mentor pointed out the door and says it's right there. And do you not have time for your patient? And it was connected to that fear of you. Do you think your patient isn't worth making sure that you don't spread something? And it shocked me because I really didn't connect it to this act of caring. And when you start to break down, I have 30 seconds to use hand sanitizer. So that I can make sure that I keep people safe. It seems like such a small thing to ask. I think some of that how do you make it not feel like a chore? Sometimes we're all exhausted and we're all being asked so much. And so I think let's be honest with each other. It is and we are a bunch of nerds that try to make jokes, a project first line, but we haven't found one that's really gone viral yet. So I'm not going to lie and say that suddenly it's going to be, you know, cooler than Bridgton. But at the same point, I think connecting it to something that you all think about every day, which is healing and helping your patients get better and walk out that door. And I think if you can connect, these are the ways that we do that. I think it can go a long way and sometimes it can get you over that hump of I just don't want to do this today.

Bell: [00:53:13] And you on the point of connecting infection control the outcomes, I think that's a really important point that was mentioned. And I'll underscore it. It's easy to miss the connection. A lot of times the infection that we caused doesn't show up for several days or maybe the next hospitalization. And yet the horror of being the person that gave somebody a surgical site infection after they had a successful bypass. Right. Who wants to be that guy? No one. And so thinking about that invisible dotted line to the outcome, I think is an important exercise. It's not intuitive. I think we live in a sanitized society here. We go to the grocery store and the chicken looks pristine. It's in beautiful, clear wrap and a nice, clean white little tray. Of course, it's sanitary, but we know it's not right. We don't rub that chicken on a cutting board before we make a salad because we don't want to give our whole family campylobacter or salmonella. We do go that extra mile, even though it is a chore. But that's because we're very aware of the outcome that that dotted line is very clear to us that we will end up being ill in a very unpleasant way if we don't manage our chicken correctly. And so it's really about that connection, internalizing the fact that, well, you know, what Liz did by cleaning her hands before going in was a way not to be the importer of whatever was on the nurse's station countertop. So that could have been a multidrug-resistant Acinetobacter. And that's not what your patient needs, it really isn't. So think about the dotted line, even though the outcome doesn't show up right away.

Bealer: [00:54:57] I just want to thank you both for, you know, not only your expertise, but your vulnerability and personal experiences in this discussion, I think sometimes as medical students, you know, having leaders in the CDC and in infection prevention, it can be a little intimidating and knowing that we can all still learn all make mistakes and all do better is really critical for us as we finish this presentation. I always look like to look into the future. Look at what's next. Briefly, can we talk about a question from Angel Chavez Rivera and Tiffany Sanchez, which I think is incredible to finish off this presentation. What is on the horizon for Project Firstline over the next year? And how can medical students get involved and really pilot this effort?

McClune: [00:55:46] Yeah, I love where actually where we're headed, I think, you know, I wish we could say that it is in our rearview mirror. We know that it's not. But we also know that COVID isn't the only thing that's spreading, particularly in health settings. And so one is really taking what we learned during the pandemic and applying it in new and innovative ways to being able to recognize risk with the things that are spreading in health care every day. It doesn't take a pandemic to have something spread in health care, but also using kind of pulling back that veil of ignorance you get to have when you look at your hand. You know, you can talk about the chicken cutlet, Mike, but my hand also has millions of microbes on it right now. And I have a toddler, so probably millions more than you all have. And to really help people to see this invisible world of microbes that are spreading in health care and that you're a part of. And so starting in the new year, really beginning to talk about that. New topics, how you can get involved. One is please stay involved with your Aimé, stay involved with us. We as we put out more materials, we get feedback all the time. I know it seems really tried to say we listen to it. We do. There are times we have done things totally different the next time because we got feedback from the field up. Nope, it's not that I need that or I need things shorter. We started a year ago with things at ten minutes and got feedback of 'I've got five minutes' and we said, OK, challenge accepted. So we participate with us, ask us demand of us and, and feel free to, to share and bring people in. And I think together we can we really do have the power to stop infections. I know what's healthy, but it's something I believed before.

Bealer: [00:57:35] All right, thank you so much for attending the AMA and CDC is Project Firstline Introduction webinar. Don't forget to check out the links in the chat there from the presentation and a way for you to get involved as a medical student and bring product first line to your own communities. Your participation and feedback truly inform how we shape this infection control training initiative. So we need you. We strongly encourage you to complete the evaluation survey so that we can continue to bring quality programming that is catered to medical students' needs. Please look out also for our survey link that will be placed in the chat as well as an email tomorrow in case you missed it. And thank you, Liz and Dr Bell, for once again lending us your expertise for this critical discussion. I know I learned so much. We plan to have additional webinars more. So look out for those and we will, of course, keep you updated for future date topics and events. Until then, we thank you so much. Thank you all for your wonderful questions and wish you good health. Thank you.

Bell: [00:58:35] Thanks, everyone. Take care.

McClune: [00:58:36] Thank you so much.

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