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Learning to Expect the Unexpected: My First Year as an AEF Fellow

Posted By Heather Dubendris, Friday, November 6, 2015
Updated: Tuesday, October 27, 2015

The past year as an AEF fellow has afforded me a plethora of opportunities. From site visits and outbreak investigations to data validation, coordinating the implementation of a surveillance system to taking calls, I quickly learned that working in a state health department keeps you on your toes, as no two days are ever the same.

I started my fellowship in the midst of the Ebola crisis. My first day at the office I was met in the lobby and quickly swept upstairs to an incident management team meeting. From there, I began working with the guidance team, developing guidance materials (even filming a contact tracing trainer video), and then later in a data management role monitoring an average of 40 travelers returning from Ebola-affected countries on any given day.

Presenting at the CSTE Annual Conference in Boston, MA –June 2015

As a healthcare-associated infections (HAI) fellow, I get to work closely with highly knowledgeable public health experts from both public and private sectors on emerging public health priorities, such as antimicrobial resistance. This year, I developed a protocol and designed a surveillance system to better understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) in North Carolina. This project requires collaborating with seven major healthcare facilities in our state and the state laboratory of public health. By collecting epidemiologic information from cases and conducting resistance type testing on isolates, surveillance will provide information on the incidence of CRE in North Carolina, identify common mechanisms of carbapenem resistance and identify common healthcare exposures related to CRE. Preliminary results show that of 55 isolates tested, 35 (62%) are positive for Klebsiella pneumoniae carbapenemase (KPC). KPC is a common mechanism of resistance first identified in North Carolina in 2001. Most patients, 51 (84%), have taken antibiotics in the 90 days prior to their positive result, and hospitals have reported an average of 3.7 (95% CI 2.9-4.5) surgeries or devices (such as a central line) among these patients. Final results will be available once surveillance concludes next spring.

CDC's National Healthcare Safety Network (NHSN) data are used at the state and federal level to report HAI events. North Carolina law requires the reporting of five HAIs. The government and hospitals rely on NHSN data to assess improvements over time and make comparisons between states. Therefore, it is essential that the data are valid. I am currently conducting an external validation of two reportable HAIs: central line-associated blood stream infections (CLABSI) and LabID Clostridium difficile (C. diff) events. We selected twenty-eight hospitals throughout North Carolina for validation. I used the first few months of my fellowship to learn from other states’ validation experiences and adapt items from the CDC validation toolkit to create a North Carolina-specific validation protocol, forms, medical record abstraction tools, and database. Next, I conducted a pilot validation at a hospital in March. And after making some minor changes to the validation tools, I began traveling to the selected hospitals and working with infection prevention staff to extract data from medical records. The quality assurance provided by validation is essential, as these data are used for setting public health priorities to protect patient health. Traveling for site visits has been great way to explore the different regions of North Carolina!

NC Division of Public Health HAI Prevention Program with Evelyn and Tom McKnight
(HONOReform) and Dr. Joe Perz at the NC APIC Conference–September 2015

While I am primarily an HAI fellow, I sit in the Communicable Disease Branch, so I learn about a variety of infectious diseases and associated events. I serve as epi on call and conduct outbreak investigations. When on call, I provide guidance and recommendations to local health departments, providers, and the public about a variety of reportable diseases and conditions. Last February I worked with our Epidemic Intelligence Service (EIS) officer to investigate an outbreak of late-onset group B Streptococcus in a neonatal intensive-care unit, and I have also assisted with investigations of hepatitis, Legionella, and a fungal brain mass.

In my current position I get to travel to a variety of trainings and meetings, including trainings in infection control, SAS programming courses and national conferences focusing on infectious diseases. Being part of a cohort of fellows provides a network throughout the country to reach out to for support and insight when a new perspective is needed. The professional relationships developed during this fellowship and the experience gained at the health department have set me up to succeed in a future career as a public health epidemiologist. If you are a recent public health graduate and are interested in a career at a public health agency, I strongly recommend the CDC/CSTE Applied Epidemiology Fellowship to you.

Heather Dubendris, MSPH is a CDC/CSTE Applied Epidemiology fellow at the Communicable Disease Branch of the North Carolina Department of Health and Human Services. Learn more about healthcare-associated infections by joining the CSTE HAI Subcommittee. Do you want to be a fellow like Heather? The application is now open for the CDC/CSTE Applied Epidemiology Fellowship.

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