Faculty in Infectious Diseases Division

Sharon B. Wright, MD, MPH, Director, Infection Control/Hospital Epidemiology Division; Director, Infection Control Research

Howard S. Gold, MD, Medical Director, Antimicrobial Stewardship

Preeti Mehrotra, MD, MPH, Associate Hospital Epidemiologist

David S. Yassa, MD, MPH, ID QI Committee Co-Chair

Westyn Branch-Elliman, MD, MMSc, Healthcare Epidemiology research

Faculty in Department of Pharmacy

Monica Golik Mahoney, PharmD, BCPS, Clinical Pharmacy Coordinator, Infectious Diseases

Christopher McCoy, PharmD, BCPS
, Associate Director, Antimicrobial Stewardship

Description

All ID fellows will receive basic training in healthcare epidemiology, infection control and prevention. The fellow will become familiar with concepts relating to identification of and surveillance for healthcare-associated infections (HAIs), including antimicrobial-resistant and other epidemiologically important organisms; infection prevention strategies; outbreak investigation and control measures; and impact of HAIs on patient safety.

Additionally, all fellows will receive instruction and hands-on practice in antimicrobial management strategies as a means of infection prevention, including antimicrobial stewardship activities.

Didactic training

  1. Formal coursework in infection prevention: Each fellow is required to complete standardized training in infection control and prevention. All fellows are enrolled in the Society for Healthcare Epidemiology of America (SHEA) online self-study infection control course for fellows.

    Fellows with a specific interest in healthcare epidemiology and infection prevention may fulfill this requirement instead by participating in either the SHEA Annual Fellows’ course in Hospital Epidemiology & Infection Control (3 day course held in rotating US locations each July) or the SHEA/Centers for Disease Control and Prevention (CDC) Training Course in Healthcare Epidemiology Course (3 day course offered each spring as part of the annual SHEA Spring meeting).

  2. Infection Control seminar series: All fellows attend the infection control seminar series, held in 5-6 sessions over a two-year cycle. This course is designed to provide the opportunity to work through real-life examples of issues and controversies in infection control and prevention and in antimicrobial stewardship. Course format is case-based instruction with small group work, including developing case definitions for infection, outbreak investigation and designing bundled interventions for HAI prevention. These sessions go “beyond the basics” of formal coursework and discuss the application of quality improvement and public health in broader infectious diseases-related fields.
  3. Antimicrobial Stewardship Friday morning lectures: All fellows attend approximately 18 sessions per year on a variety of basic and advanced topics over a two year curriculum.

Practical training opportunities

Opportunities exist for upper level fellows to acquire advanced training in infection control and prevention, antimicrobial stewardship and quality improvement. Research opportunities also exist in these areas:

Antimicrobial Stewardship
  • Antibiotic Subcommittee: A subcommittee of the Pharmacy & Therapeutics (P&T) Committee at the medical center, this group evaluates new therapies and brings forward formulary and policy change proposals to the P&T Committee. Fellows are encouraged to attend these meetings.
  • Antibiotic Approval Pager:
    • All first year fellows will complete two sessions of antibiotic approval pager coverage with supervision and directed feedback during an antimicrobial stewardship/infection control elective rotation.
    • Second year and more senior fellows may choose to carry the pager for additional hours to gain hands on experience in antimicrobial stewardship, under the supervision of the Antimicrobial Stewardship team (AST) members. 1:1 directed feedback sessions occur regularly after these pager sessions.
  • AST initiatives: Fellows can participate in the design and evaluation of AST initiatives, such as preoperative antibiotic prophylaxis and C. difficile treatment guidelines.
  • AST education: Assist with curriculum development and lecture design for 18 sessions per year with ID fellows on AST topics. Participate in development for general prescriber education and patient education on AST topics.

Infection Control

  • All first year fellows complete a two week-long antimicrobial stewardship/infection control combined elective giving them exposure to both fields and BIDMC faculty.

Additional learning opportunities include:

  • Infection Control/Hospital Epidemiology (IC/HE) staff meetings: Weekly discussion of daily operations and major project work impacting both the team and the medical center.
  • Daily Huddle: A quick overview of current issues of the day and discussion of difficult surveillance issues and progress on quality improvement projects.
  • Hospital-level committee work: Attend Environment of Care Committee, Infection Control Steering Committee, Pharmacy & Therapeutics Committee, Medical Executive Committee and Patient Care and Assessment Committee, as appropriate.
  • IC/HE interventions: Fellows can participate in the design, implementation and analysis of infection control interventions such as bundled interventions to prevent HAIs, improvements in detection of and surveillance for organisms such as influenza or multidrug resistant gram negative organisms, and impact of policy development.
  • Leadership development: Attend key meetings of hospital leaders with one of the hospital epidemiologists (Medical Executive Committee, board meeting, QI Directors meeting) and compare and contrast how data is presented in each of these settings. Learn techniques of meeting facilitation by attendance and participation in several multidisciplinary meetings.

Quality Improvement

  • Health Care Quality department meetings: Quarterly meetings of the entire department with updates on quality issues throughout the medical center and off sites.
  • QI Directors meetings: Opportunity to attend twice monthly meetings of the QI Directors of each clinical department/division at BIDMC.
  • Participation in quality and process improvement projects related to IC/HE and AST are available.

Training paths for senior fellows

  • 2 year opportunity with a focus in Infection Control or Antimicrobial Stewardship: Fellows completing a 2 year ID fellowship may participate in infection control and prevention and antimicrobial stewardship activities. This track is structured to provide training for fellows pursuing a clinical career with a small infection control or AST component or fellows interested in a small academic project in IC/HE during fellowship. Additional activities tailored to each fellow’s career interests.

    All fellows in this track will:

    • Participate in IC/HE staff meetings and daily huddles to gain familiarity with the material
    • Participate in AST Subcommittee meetings
    • Participate in a related focused project, in either IC/HE or AST. The project may be traditional epidemiologic research or a quality improvement project under the mentorship of Infection Control and/or Pharmacy faculty
    • Additional opportunities available to gain experience in AST through carrying the approval pager one to two times per week with feedback
  • 3 years and beyond Infection Control Fellows: Fellows completing a 3 year fellowship are eligible for this track, which is composed of two options: Track A geared toward a career in academic IC/HE, as a hospital epidemiologist with or without healthcare epidemiology research; and Track B for those planning a career in healthcare epidemiology research without the hands-on and administrative components.

    • Track A:
      Fellows are expected to dedicate at least 50% of their time to service to the medical center. This service time also serves as hands-on training in the practical aspects of infection control and stewardship work, provides understanding of the clinical and environmental sides of infection prevention, and real world practice in surveillance for HAIs. Currently, funding is available for one fellow per year in this track; selection is by IC/HE leadership.

      • Participate in IC/HE staff meetings and daily huddles
      • Attend Antimicrobial Subcommittee meetings
      • Attend quarterly Department of Health Care Quality meetings
      • Perform hand hygiene evaluation by direct observation
      • Participate in nosocomial bacteremia surveillance, including for catheter-associated infections
      • Learn and apply surveillance definitions for resistant organisms, surgical site infections, and catheter-associated urinary tract infections
      • Understand techniques for evaluation of efficacy of environmental cleaning
      • Complete a mentored research project in a healthcare epidemiology topic and submit for publication
      • Complete basic course work in the Summer Program in Clinical Effectiveness at the Harvard School of Public Health (HSPH), if no prior training in epidemiology and statistics. Currently, an educational stipend is available for one fellow per year in Track A. More information is available on the HSPH website
      • Lead/facilitate at least one meeting during the course of the year related to infection control project work (IC/HE staff meeting or multidisciplinary meeting)
    • Track B:
      No hospital funding exists for this track; faculty work with fellows to apply for local and national funding.

      • Participate in IC/HE staff meetings
      • Complete a mentored research project in a healthcare epidemiology topic and submit for publication
      • Consider pursuing funding opportunities for formal training in epidemiology and statistics through the Summer Program in Clinical Effectiveness at the HSPH or the equivalent. More information is available on the HSPH website.
      • Consider submission of national or foundation grant to fund larger research project
  • Antimicrobial Stewardship Fellows Fellows completing a 3 year fellowship are eligible for this track, which is aimed at those training for an administrative role as Director of Antimicrobial Stewardship or as a clinical researcher in the area of stewardship. This fellowship does not have dedicated funding but faculty of both Infection Control/Hospital Epidemiology and the ID Division work together with the fellow to explore local and national funding options.

    • Participate in IC/HE staff meetings and daily huddles
    • Attend Antimicrobial Subcommittee meetings
    • Attend quarterly Department of Health Care Quality meetings
    • Complete a mentored research project in a topic related to antimicrobial stewardship and submit for publication
    • Increase practical knowledge of pre-prescriptive review by carrying approval pager 2-3 shifts per week with focused feedback from AST faculty
    • Develop or update an AST guideline
    • Utilize automated workflow system for antimicrobial stewardship to guide pre- and post-prescriptive review
    • Lead/facilitate at least one meeting during the course of the year related to antimicrobial stewardship work (AST Subcommittee meeting or multidisciplinary meeting)
    • Complete basic course work in antimicrobial stewardship through online offerings or the SHEA Antibiotic Stewardship Training Course at the SHEA Spring meeting.
    • Consider pursuing funding opportunities for formal training in epidemiology and statistics through the Summer Program in Clinical Effectiveness at the HSPH or the equivalent. More information is available on the HSPH website.

Research Projects

See attached list of ongoing Healthcare Epidemiology research projects.

Past Trainees

Past fellows who completed healthcare epidemiology training at BIDMC during fellowship and are currently in IC/HE, AST or related HCQ positions.