Healthcare Epidemiology

Infection Prevention/Control, Antimicrobial Stewardship & Healthcare Epidemiology

Faculty in the Division of Infectious Diseases

Preeti Mehrotra, MD, MPH, Senior Medical Director/Hospital Epidemiologist, Division of Infection Control/Hospital Epidemiology

Sharon B. Wright, MD, MPH, Chief Infection Prevention Officer, Beth Israel Lahey Health Network; Past President of the Society for Healthcare Epidemiology of America

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

Dana Pepe, MD, MPH, Medical Director, Associate Hospital Epidemiologist

Matthew S.L. Lee, MD, Medical/Associate Hospital Epidemiologist; Medical Director of Infectious Diseases & Infection Control, BID-Needham

Westyn Branch-Elliman, MD, MMSc, Investigator/Physician Scientist (Healthcare Epidemiology)

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

Faculty in Department of Pharmacy

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

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

Ryan W. Chapin, PharmD, BCIDP, Clinical Pharmacy Specialist, Antimicrobial Stewardship/Infectious Diseases

Kendall L. Donohoe, PharmD, BCIDP, Clinical Pharmacy Specialist, Antimicrobial Stewardship/Infectious Diseases

Description

The dynamic relationship between Infection Prevention/Control, Antimicrobial Stewardship, and Healthcare Epidemiology has never been more important. The Infection Control/Healthcare Epidemiology (IC/HE) and Antimicrobial Stewardship (AST) teams are multi-disciplinary teams that offer additional learning, training, and research opportunities to any ID fellow interested in these fields.

All BIDMC ID fellows will receive basic training in infection prevention/control, antimicrobial stewardship, and healthcare epidemiology starting with a two-week, first-year Infection Control/Antimicrobial Stewardship rotation. During this rotation, fellows 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 stewardship under the guidance of antimicrobial stewardship team members.

Senior fellows with interests in infection prevention/control and antimicrobial stewardship have opportunities during their second- and third-years of fellowship (if applicable) to have additional focused education and training opportunities that can be customized based on interests and career goals (see below sections for additional details).

Didactic Training

  1. Formal Coursework in Infection Prevention/Control: 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.

    Senior fellows with a specific interest in healthcare epidemiology and infection prevention/control will also have the opportunity to participate 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 3-4 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 Team Friday Conferences: All fellows attend approximately 16 sessions per year on a variety of basic and advanced stewardship topics given by physicians and pharmacists on the antimicrobial stewardship team. Fellowship "Alumni" also participate with talks highlighting their unique interests and career paths.
  4. IDSA Antimicrobial Stewardship Curriculum: All first-year fellows complete the IDSA Antimicrobial Stewardship Core Curriculum for fellows. Senior fellows have the opportunity to complete the Advanced IDSA Antimicrobial Stewardship Curriculum under the direct guidance of an ID faculty member.

Additional Education and Practical Training Opportunities

Antimicrobial Stewardship
  • Anti-Infective 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. Senior fellows with an interest in antimicrobial stewardship 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 the first-year infection prevention/control and antimicrobial stewardship 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 stewardship team members. 1:1 directed feedback sessions occur regularly after these pager sessions.
  • Antimicrobial Stewardship Initiatives: Fellows can participate in the design and evaluation of stewardship initiatives, such as preoperative antibiotic prophylaxis and C. difficile treatment guidelines.
  • Antimicrobial Stewardship Education: Fellows can assist with curriculum development and lecture design for 16 sessions per year with ID fellows and pharmacy residents. Fellows can also participate in development of provider/prescriber and patient education on stewardship.

Infection Control 

Additional learning opportunities include:

  • Infection Control/Hospital Epidemiology (IC/HE) Team Staff Meetings: Weekly discussion of daily operations and major project work impacting both the team and the medical center.
  • Daily Huddle: Daily overview of current issues 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 Initiatives/Interventions: Fellows can participate in the design, implementation and analysis of infection prevention/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); 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.
  • ID Quality Improvement Committee: Quarterly meetings with the ID division to discuss quality improvement initiatives, including guideline development.
  • Participation in quality and process improvement projects related to IC/HE and antimicrobial stewardship are available throughout fellowship.

Training Paths for Senior Fellows

  • Two-Year Scholar Track in either Infection Control/Hospital Epidemiology or Antimicrobial Stewardship: Fellows completing a two-year ID fellowship may participate in either Infection Control/Hospital Epidemiology or Antimicrobial Stewardship tracks. These tracks are structured to provide training for fellows pursuing a clinical/clinician-educator career with a small infection control or antimicrobial stewardship component or fellows interested in a small scholarly/research project in these fields during fellowship. Additional activities can be 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 BIDMC Anti-Infective Subcommittee meetings (monthly)
    • Participate in an IC/HE or stewardship-related project. The project may be traditional epidemiologic research or a quality improvement project under the mentorship of IF division faculty members.
    • Participate in Beth Israel Lahey Health Infection Prevention and/or Antimicrobial Stewardship Meetings to see first-hand implementation at a network level.
    • Complete the Advanced IDSA Antimicrobial Stewardship Curriculum under the direct guidance of an ID faculty member.

  • Three-Year (and beyond) Infection Control/Hospital Epidemiology Fellows: Fellows completing a three-year fellowship are eligible for this track, which is composed of preparing fellows for a career in academic IC/HE, as a hospital epidemiologist with or without healthcare epidemiology research.

    • Fellows are expected to dedicate at least 50% of their time to infection/prevention/control related 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 (fellow is selected by IC/HE leadership). Education and training opportunities may include:

    • Participate in IC/HE staff meetings and daily huddles
    • Attend Antimicrobial Subcommittee meetings
    • Attend quarterly Department of Health Care Quality meetings
    • Participate in Beth Israel Lahey Health Infection Prevention/Control network meetings (bi-weekly) to see first-hand how infection prevention/control is implemented at a network level
    • 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) 

  • Three-Year Antimicrobial Stewardship Fellows: Fellows completing a three-year fellowship are eligible for this track, which is aimed at fellows with potential careers of being a Director of Antimicrobial Stewardship or 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
    • Participate in Beth Israel Lahey Health Infection Prevention/Control network meetings (bi-weekly) to see first-hand how infection prevention/control is implemented at a network level
    • Perform hand hygiene evaluation by direct observation
    • 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 at least 1 shift per week with focused feedback from AST faculty
    • Develop or update an antimicrobial stewardship guideline
    • Utilize automated workflow system for antimicrobial stewardship to guide pre- and post-prescriptive review
    • 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.
    • Complete the Advanced IDSA Antimicrobial Stewardship Curriculum under the direct guidance of an ID faculty member (if not completed in second-year).

Examples of Scholarly Work

See attached list of recent scholarly work from fellows and attendings.

Past Trainees

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