How Can Healthcare Workers Recognize the Infection Risks in Healthcare

Today's episode features subject matter experts Karen Kwok (MSN, FNP-BC, MPH) and Marie Zephier, MPH as they lead the discussion on infection prevention control tips for healthcare staff.  

Karen holds a Dual Master’s degree in Nursing and Public Health and is a nationally certified Family Nurse Practitioner. She has over 20 years of experience working in health equity, including coordinating care for UIO patients in San Francisco. She has provided direct patient care and service delivery operations workflow in infection prevention and control.

Marie is a member of the Oglala Lakota Nation and was born and raised on the Pine Ridge Indian Reservation in South Dakota. Marie serves as a consultant with the National Council of Urban Indian Health (NCUIH). As an ECHO support trainer, facilitator, and coordinator, Marie assists in the team’s presentation adaptation by NCUIH staff. She provides training and technical assistance to UIO healthcare and frontline staff on infection prevention and control.

Chapters

• 0:00 NCUIH Podcast #2: Karen and Marie

Transcript

Vickie: Welcome to the National Council of Urban Indians Health podcasts on infection prevention and control education topics for our frontline warriors and healthcare team members, serving American Indians and urban Indian health organizations. Yá'át'ééh Hello. My name is Vickie Oldman, your host for these podcasts. 

I am Diné Navajo a resident of New Mexico and have been working with native communities and nationally for over two decades as an independent consultant in these broadcasts, I will be interviewing leaders, advocates, and practitioners with a focus on infection, prevention, control strategies, and urban Indian health care settings. 

Ahéhee' thank you for joining us. Project First-Line is a national collaborative led by the U S centers for disease control and prevention CDC to provide infection control training, and education to frontline healthcare workers and public health personnel. The contents of this podcast do not necessarily represent the opinions or policies of CDC or H H S and should not be considered an endorsement by the federal government. 

Vickie Oldman: Good day thank you for joining us again. We are excited about our guests today. I just want to say, Yá'át'ééh hello, and introduced to you all our first guests who I'm really excited about hearing from, and her name is Karen Kwok and she currently works with NCUIH as a trainer and subject matter expert with the technical assistance division of TARC, which stands for technical assistance and research center in Washington, DC. 

So, let me just add a little bit of color about Karen. Karen has had over 20 years of experience, working in the field of health, equity and resilient communities, including care for UIO patients and has had direct patient care also has worked with service delivery operations, also a certified family, nurse practitioner. And has two degrees, dual master's degree in nursing and in public health and has several public service, , recognition, which I think is important. And is this tells you how hard she works and how passionate she is about this work, and so some of the recognitions she's received are from the following, the American nurses credentialing center, Robert Wood Johnson, Bill and Melinda Gates Institute, California Governor Gary Davis, President Obama and also a Full Bright Specialist. I am so honored to even have this conversation with Karen and I'm just impressed with the work. So thank you so much for joining us. 

I'm excited that you're here with infection prevention control podcast series. Karen, I would love for you to say hello to our listeners. And if you can just add a little bit more about yourself.  

Karen Kwok: Thank you for the kind introduction Vickie. I have always been so fascinated with communities of color, especially indigenous peoples in us history, in my university studies. 

Had taken a class in American Indians history. And with this opportunity, I'm caring for the ability now to put those lessons learned to practice with providing health services and coordinating safe patient care for clients at the San Francisco native American health center is a former public health department staff nurse practitioner, currently as a subject matter expert, I am fortunate to serve American Indian, Alaska Native communities seventy five partnership with CDCs Project First Line Collaborative. In this role, I support UIOs in their capacity to develop healthcare worker and program capacity in infection control. I'm privileged to be working alongside the dedicated NCUIHs staff, including Navajo and Sioux storytellers and community leaders. For my I work in post hurricane Maria, Puerto Rico. I was involved in disaster response and working alongside, indigenous communities on reemerging and new infections with disaster preparedness on this. I have a security subcontract. So again, very grateful for the opportunity. And I'm so fortunate to be able to learn alongside our UIO partners. 

Vickie Oldman: I appreciate you also just giving us context about what led you to this work, your curiosity, and, continued learning about working in our Indigenous and our Native communities. So much richness. Thank you so much for sharing that. In March you all did a virtual webinar training. It was called, "Recognizing infection, risk and healthcare and taking action to protect staff and patients within our Urban Indian Organizations UIOs," during that webinar, you all provided training on recognizing infection risk. Could you remind us what we need to be looking out for, what we need to be, aware of in terms of recognizing risks and why it's important in the healthcare settings? 

Karen Kwok: Risk recognition is something that we do every day, whether that's looking on each side of the street before we cross, and this is so important and healthcare as well, where we recognize when risks could potentially bring on a problem before it happens. And you see this, that, things we do in the home and at work and we're always trying to minimize that, but it tells us too that each of us play a role in this important work and all of us are able and responsible to take steps to minimize it. With healthcare, the risk for germs to spread can happen at any point, but it's a different risk than might occur in other places. 

For example, in a grocery store, we might have a risk for germs to spread. but it's different in healthcare because patients who are already sick come here for care, and so they are more vulnerable. With healthcare workers and patients, there are also closer interactions, then might typically occurred in a community setting, so that, in addition, we put patients and healthcare workers, but for the patients who are already ill or weak, that leads them to be more vulnerable to infection. It's not just the patients, who are at risk is if there is a breakdown in the body's defenses, even a healthy healthcare worker could also be at risk. And for my UIOs and healthcare workers that are attending these trainings in risk recognition. 

It's so important that we know that basic tools and strategies and resources for how we can reduce that risk everyday. 

Vickie Oldman: Karen, I appreciate you responding to that and letting us also be aware that, risk happens everywhere, grocery store, home, and the work setting and why it's more important in a healthcare setting in terms of, patients who are there to get better. 

And the staff that are working in those settings need to be much more mindful and aware of how they may be spreading that or seeing that and calling that out. Right? As I'm listening to you makes me think about pace and mindfulness and calling out when you see things and addressing it right away. Do you want to say anything to that before I ask the next question?  

Karen Kwok: Absolutely. I agree with you where, it's all hands on deck and each of us have a role and a voice in maintaining safe patient care and infection control. 

I completely agree with you. 

Vickie Oldman: Thank you. So building onto the training about risks recognition, how can our healthcare warriors apply risks, recognition strategies during their workday, and so this is sort of a two-part question. And how will this change based on emerging and reemerging disease threats? So thinking about pre pandemic and post pandemic. 

Karen Kwok: So actually it's the same for both every day in the workplace, as well as emerging and reemerging disease threats, because, we might not put the whole picture together when something comes up like with COVID. So our risk recognition strategy. It's something that we're going to layer on and all the work that we do in the approach that we take to keeping infection at bay health care workers can learn to recognize these risks with identifying those moments every day, where there's opportunity for germs to spread and make people sick. 

Certain things that we can continually remind ourselves of in recognizing these opportunities are where to germs live those reservoirs and how can terms move from place to place or to people to cause infections.  

First look at where germs live and these common reservoirs in health care include the body, whether that be, on or in the gut, the skin, the respiratory tract or blood, or in the environment, what surfaces, dry surfaces, dirt and dust or devices. 

Next, it's thinking about pathways, how germs can spread and can cause infection. Some of these common pathways include, if you ingest something such as contaminated food, but, how we're actually going to focus on pathways in health care would be. Through touch being breathed in through splashes and sprays like water and body fluid or by bypassing or breaking down the body's natural defenses like Saru, uh, the set up of an IV. 

If you're drawing blood, for example, Healthcare workers can continually ask themselves these questions throughout their Workday to help recognize risk and to apply these infection control actions. So we'll, we'll think about where do germs live? What are those reservoirs involved? What pathways might move those germs in and out of each reservoir? 

Is it possible that specific tasks that I'm doing is going to actually cause the germs to spread from the reservoir? For example, hand the universal pathway of touch. So hand hygiene so important. And lastly, number four, what other actions can I take to help stop the spread of germs and prevent infections and protect patients myself and my coworker. 

So again, the pathway of touch and hand hygiene, so that action that I can take to prevent that. A specific example I have would be using skin as a reservoir and the germ Murcia methicillin-resistant sStaphylococcus aureus. It can be spread through touch. And so making sure that I'm careful with hand hygiene, that when I am going to start an IV or my colleagues if they are involved in surgery, that we're really ensuring that technique is clean or sterile. If it's surgery that we're using our hand hygiene, even at the very beginning of it all and using proper PPE selection to keep those reservoirs clean and sterile and prevention of any spread. And when you think about this, um, the next you will think about is infection control actions to reduce the risk. 

 Speaking to you, the good hand hygiene appropriate glove use and safe injection practices and cleaning and disinfection. So it's a multi-step process in which we are always on the ready or staying alert and thinking about our daily tasks and employing a layered approach of risk recognition in standard precautions 

Vickie Oldman: Sounds simple the way you broke down, what workers need to be mindful of and doing. And at the same time, what comes to me is like this is a real behavioral change and how workers need to be navigating themselves. It's going to take some time to stop, pause, reflect, and address. 

Everything you're describing is about keeping the space clean and preventing infection to affect anyone else in the space. When COVID happened, I saw an increase in any facility that I went into. It was like super clean. I could see when you walk in, it's smelled clean. Like anytime anybody went in, it was wiped out constantly, and people were using hand sanitizer and things are opening up now. things are getting a little bit more lax. 

I went to a facility recently and I saw the colorful poster, 15 seconds wash your hands. It was just a gentle reminder, 15 seconds. It's not a lot of time to clean your hands. I feel like this webinars, a good reminder to folks, like we've got to keep on it and, preventing potential infection spread. Have you noticed the difference, , during the peak of COVID to where we're at right now, in terms of spreads of infection? 

Karen Kwok: That's a good question, Vickie. I think that there definitely is a general fatigue with the pandemic the continuation sustainability of a vigilance and, cleaning and disinfection and safe patient care are still the same. And it's so important for healthcare workers because actually the BA. 2 sub variant strain of Omicron is even more infectious than the previous strains beforehand. 

And the work that we do for prevention of germs spread is always important, equally more important as we hear about other things that are coming up in the news and current events right now. So keeping everyone at the table invigorated and, empowered in their responsibility, no matter what their role is a key thing to have, even now that we're on year two and a half of the pandemic and making sure that we have a, role that has a methodology who has the ongoing reminders. Like you mentioned, the posters that we have, and CDC has other tool kits for ongoing training for each and everyone. The health care team that it is important, no matter what, the situation that we are recognizing where infection can occur and how we can play a role in not just the reservoirs and the pathways, but standard precautions with staying on top of our hands the hygiene, like you mentioned. And I'm using the proper PPE of gloves and making sure that we are utilizing good, needle use responsibly. So this same risk for germs just spread, is different in the health care. That's why we do need to stay vigilant that higher chance for germs to spread, especially when patients are vulnerable and are already sick. 

Is it our duty to protect not only our patient, but other staff so that our community stays safe and that we can beat COVID because certainly there has been a resurgence with BA.2 these closer interactions call for us to stay vigilant in that same responsibility. So I think that it is definitely important healthcare even more so. 

And even now into this, second year and not losing steam as we continue to battle COVID. 

Vickie Oldman: Mmm thank you for answering that question and also just iterating why this matters to our healthcare workers. I appreciate that. So you had mentioned in responding to this last question that, we are pass two and a half years into this and thinking about Project First-Line. It's in its second year, you were here during the first year of training, what would you take from year one? The experience you had in year one and build on to year two, as you continued to train, as he continued to learn and grow with this collaborative? 

Karen Kwok: I'm so glad to be a part of this year, a project first-line the first year. It was amazing. Absolutely. I was enthusiastic about the model of community engagement and public health leadership, and in infection control the model was elegant because there were public health graduate student fellows who were paired with UIO clinic champions on delivering a robust curriculum on standard precautions, like disinfection and PPE selection. 

But it was building this leadership pipeline and witnessing it in its infancy and through its fruition with community leaders, from indigenous communities, being at the table, just incredible privilege to be a part of and to be involved in the journey. Many of the same UIO sites were in the process of, or planning ahead for their institution’s application for accreditation, and actually some of these same champions are now actually in that process. And so it's great to see how comprehensive those trainings with first from focusing on infection control, but looking at how that subset of accreditation, eligibility and training has moved their organization to those next steps of their capacity in better serving Native communities. 

And so it's priceless. Um, I don't have the full spectrum of words, to have the pride in the organizations and seeing them and their development. And now in year two of the project first-line cycle, I'm able to work alongside community leaders. So I'm coming up would be, one of my Sioux community leaders and it's wonderful to see how we've built in the importance of storytelling, how those lessons learned from the community's voice is continuing to be on the front line of championing and of developing the curriculum and show as we are wearing in beyond standard precautions, but risk recognition that it's coming from the voice of the community. And we're looking at how that will be pivotal. And emerging and reemerging infections. So a great opportunity to be involved and amazing and very much a proud moment to see UIs moving into the future for infection control, thank you. 

Vickie Oldman: Mmm, how exciting I could definitely hear through your voice, how you are really excited, passionate, and continuing to want to do this collaborative work, also is this says a lot about partnership and how everyone shows up and people arrive at the table and it shows when things are moving in that direction of creativity and ideas, that people are really listening that the practitioners are open to take risks. 

"Hey, let's try this. What about that? " That just shows, what sort  

of relationships you all have built to create trust. That's the hardest thing with organizations is to create trust and respect because that takes time. And so kudos to you all for that. And then also really hearing the voice of the community because that's what matters. 

That's who we're doing this work for. Any final thoughts, Karen? I just, I'm excited for you all and just thank you so much for sharing what you have at this time. 

Karen Kwok: I just invite UIOs and other IHS organizations to continue with this on this journey for the upcoming webinars and ECHOES that we have. 

These teachable moments for learning has been presented by the UIOs and our community members in the audience. And we'll  

building upon this community of learning together for, and with our Native communities. So what a privilege and great to continue participating together in this. Thank you. 

Vickie Oldman: Nizhoní (Beautiful). Thank you. I want to introduce our next guest folks. Our next guests that we have here is Marie Zephier who is also a contracted ECHO facilitator and quality improvement subject matter expert. And I wanted to just give a little bit more background about who Marie is. 

She is a member of the Oglala Lakota Nation and was born and raised on the Pine Ridge Indian Reservation in South Dakota. She is a mother of one daughter. Numerous nieces and nephews and enjoys crafting during her free time. She has over 15 years experience of tribal health quality and has tons of experience and quality assurance, facilitation, strategic planning, data analysis and process improvement expertise. She's received her bachelor's and her master's in public health policy and management. Currently she serves as a consultant with NCUIH and what else? She's humble. She's also just my brief interaction with her. Lots of energy. 

So welcome, Marie. I'm so glad that you're here. Love for you to say hello to our listeners.  

Marie Zephier: Hey It actually took me three different tries to get on the NCUIH and I'm now part of the ECHO support consultant. Initially I had applied in year one for a position that they ended up eliminating and then decide it in the second position that I couldn't take a full-time job at that time. Due some other contract obligations, but those are done now and now I'm on the NCUIH, that makes me happy. One of the things I really loved about NCUIH is that it gives you a chance to give back to health care warriors on a large scale basis, Vickie, so often, like for me, I know I have many family members relatives. And even just people I know in the community that our patients are Urban Indian Organizations. And for me, like being able to save the healthcare warriors time, valuable time that could be spent with patients. That's so invaluable because we could help them and support them by helping them with these infection control practices that will reduce the chances of them getting. 

And for me, my education was always, I wanted to give back to the community and NCUIH just gives a large scale chance to do that because we serve so many urban Indian organizations.  

Vickie Oldman: Marie, I appreciate you introducing yourself and speaking your mother tongue to us, and also letting us know your role. I also appreciate you mentioning a little bit about the community, right? Who you're serving and I believe also you've said at some point or another, that in preparation of our call that you too, at one point, have been a user, in the services? And so I think it's a great, addition to like really understanding why it's important to do the good work and to see things from a cultural perspective. And to be mindful of that. I'm still curious. 

I'm sorry, go ahead.  

Marie Zephier: Oh, um, well you mentioned being mindful and to me, mindfulness is really a practice that our indigenous ancestors like naturally had, they innately had this practice of mindfulness and to them, it was like, paying attention to our part in the earth and then the sky. And I feel that really plays into these infection control practices. 

Earlier. You mentioned with Karen, how we have to like stop and slow down as healthcare workers and realize what our role is and how we could help prevent not only ourselves and our patients, but everyone around us from getting. So to me, that was a powerful message as well. And it really connected with like, just my, , my experience as a patient. 

My daughter and I lived in urban Indian organizations as I got my undergrad and grad school degrees. So I was a patient for a lot of that time. And then I transitioned into interns and was even had the honor of serving as part of quality teams. So it's just been a cool opportunity to know that I'm helping to get this diverse and super talented team to create these materials that will help support that. 

Vickie Oldman: Ahé'hee, thank you. I could just see like the continuum of your education and your work experience. Tell us a little bit about how you became a part of the team here at and your role specifically with PROJECT FIRST LINES national collaborative.  

Marie Zephier: My role specifically, I'm an ECHOs support consultant and I help to adapt the peer reviewed journal articles and the information that the UIOs is provide us. 

One thing that project first-line is really unique and is that we could adapt materials that are specific to UIOs needs, and when they're so busy and patient care, it just provides the materials that could save them countless hours and improve, creating trainings or infographics and different things and has them available. 

And I'm sorry, I feel like I missed part of that question.  

Vickie Oldman: Just asking you about how you became a part of the Project First-Line collaborative.  

Marie Zephier: Yeah. So I have been on the NCUIH's listserv and they had all of these awesome opportunities available and I thought, "man, I want to be part of this team". And when I went, I had gone to the website and there was such diversity and talent. 

And I thought, man, this is like an excellent way. Ideally at something as a, when I then undergrad, that like I dreamed I would someday do to give back to my community on a large scale and the NCUIH helps indigenous nations across the nation. And it's just awesome because I felt I really see how the products that they create, positively impact our health care warriors. 

Vickie Oldman: Thank you. So speaking of like the materials, right, and what you've all created during. So you have year one of learning and seeing what worked. So thinking about your two, you all release some new content, uh, some new products and, and March actually pretty recent. Could you tell folks about some of CDC training materials and the resources that were mentioned during the March web? 

Marie Zephier: Sure. Project first-line has so many materials and what's awesome is they're adaptable and they could really fit the needs of both the individual and the UIO organization. For example, they have social media messages that somebody could just post on their page or an AR, or they have interactive trainings where somebody who not even necessarily an infection control specialist could provide the materials because those trainings comes with the facilitators guide and they have scripts. And it really helps people to develop that capacity within their own facilities. Additionally, during the ECHO we have case forms where UIO could, um, submit cases that they might potentially need help with. 

And this could really help us to develop individualized approaches to the issues they're facing. And one thing's about and NCUIH and PROJECT FIRST-LINE is all UIOs are invited to participate. So it's really a way that we could give back our indigenous facilities, their voice, because they get to give us the information and then we'll save them the time while they get to do the frontline healthcare warrior patient care. 

And they don't have to spend like the time in the office creating these materials, cause PROJECT FIRST-LINE has it done for them. "Here I go to sound like the sales lady." 

Vickie Oldman: Well, I think that matters, because when you aren't at work, you are constantly, it's like a revolving door. You're dealing with patients, your staff meetings. And so you all have carved out some time to create some beautiful materials that they can customize to their community, to the clients that they're serving. So I think. That makes a ton. I'm sure you guys are always looking for feedback and so whatever they can offer when they're looking at it, for future production of materials. 

Marie Zephier: Well, the ECHO interactive sessions really provides them opportunity to give feedback and they're not recorded. So we don't violate any patient health information, but it is a chance to really strategize in real time what that UIOs needs and adapt it to their needs. I think that's awesome because just that, even as a patient and professional, historically, I know that our UIO is, were underfunded. 

There were a few venues for people to have a voice, and that included, sadly to say, sometimes even the healthcare workers, we're not allowed to give a voice. And this really gives them that mobilization and lets everybody know that we could be mindful and work on these infection control strategies together.  

Vickie Oldman: So you all heard that, feedback is always open and, you can feel safe providing feedback on materials. You did mention the printed materials, which included, job aids. Could you elaborate a little bit more about what this entails and how these could be used by UIO's? 

Marie Zephier: One thing I appreciate about Project First-Line is it's respect for, um, just varying audiences. 

You know, sometimes content materials might adhere to one form or one audience versus electronic others. And we have that range. The job aids are printed materials that could be posted in your break rooms, they could just be posted throughout the facility, they could be shared via email. And there's also the opportunity for them to be used as training materials there. 

 These infographics, for example, they're very specific. Um, the infographic for skin, it will tell you not only. Um, where skin lives, but re what reservoir makes the risks, how you could address that risk, how healthcare workers could protect their own skin, as well as infection control actions that will help to decrease the risk of that skin reservoir. 

They're very detailed and it saves a lot of time and energy. 

Vickie Oldman: And great. How did the audience overall respond to the webinar in March?  

Marie Zephier: The audience was very interactive and super positive. It was good feedback. And they were able to integrate some of the situations that they face as far as infection control risks within their own environment, that their facilities. 

Vickie Oldman: That's great. I'm glad to hear that. So this is your first year working on the Project First-Line’s National Collaborative. What impact, do you hope to make this year? 

Marie Zephier: I just hope to encourage our healthcare warriors to use the Project First-Line materials, because they really do allow us the opportunity to not only provide the best patient care, but also to provides us opportunity for mindfulness, where healthcare warriors could really take the step back and do what's necessary to protect themselves.  

Vickie Oldman: Thank you. Well, you are the right woman for the job. I know that you have artistry in your family and thinking about our community and individuals, we are a whole being in that we're looking at all ways of learning, seeing, hearing, feeling, touching, listening, so using all of those senses is really helpful in helping to retain information, but also to help learn. So I also appreciate the cultural, , perspective in the materials that you all are creating, which I think is really important, and those things do matter.  

Do you have any final thoughts or comments about your role and what you all are doing? And then I also would love to bring Karen back as she was listening to what you had shared with us. But let me ask you first, Marie, if you had anything else that you wanted to add. 

Marie Zephier: You know, Vickie I just want to add that I'm really honored to be part of this team is so talented and diverse and I just, at first it was a huge learning curve. Then I kind of allowed myself to like, add, am I right for this? But then now I just see the real brilliance and benefits to the people across the nation. And I just think it's a great experience. Happy to be here.  

Vickie Oldman: Beautiful. Thank you, Karen. Any departing thoughts, wisdom that you want to share with us?  

Karen Kwok: We are always wanting UIOs to participate, to share their, challenging stories on the frontline and build up the Project First-Line curriculum as well as the community of learning. 

So we're all in this together and hoping to continue in this journey. We always, again, welcome everyone to attend. Thank you.  

Vickie Oldman: Mmmmm, thank you, Karen. Thank you Marie.  

Marie Zephier: Can I add one thing?  

Vickie Oldman: Absolutely, please. 

Marie Zephier: So ECHO stands for the "extension of community healthcare outcomes" and this is an awesome opportunity for our UIOs to provide their voice and help interact in some of these materials that could then be developed on their behalf. 

So it's a way that they could be proactive in helping us to get them materials they need..  

Vickie Oldman: Thank you for sharing with us what ECHO stands for, and Karen, I appreciate you to share, like, this is a journey, come with us, right. And we're always learning.  

And Marie, I appreciate you saying yes, we want feedback. We want your voice and doing it collectively is what I think makes anything that we do beautiful and much more powerful.  

So join and participate beyond the webinars. Come to the table. They're asking you to be at the table, so thank you so much. We appreciate you and all that you do and how you show up fully. 

And thank you listeners. Thank you so much for joining us. 

Today, we talked about the CDCs national collaborative project. First-line infection prevention and control training initiative and the work in urban Indian organizations to prepare healthcare staff on the front lines to battle emerging and reemerging disease threats. 

We discuss the key messages from NCUIH's hosted webinar in March titled "Recognizing infection, risk and health care and taking action to protect staff and patients within our Urban Indian Organizations."  

Finally, we also informed our healthcare warriors of new project, frontlines infection, control, training tools, and resources available to help protect themselves and their patients. 

To obtain additional training information and resources contact NCUIH Project First-Line team at ipc@ncuih.org.  

That is it folks. This is your host, Vickie Oldman. Ahéhee (Thank you) for joining us.