A big part of his job is developing ap-
propriate procedures and policies to re- duce or eliminate preventable infections and diseases from occurring in hospitals and other acute care settings. “Hospitals across the nation are report-
ing more antibiotic-resistant bacteria during a time when we have fewer new antibiotics entering the marketplace,” he said. “Appropriate use of antibiotics across the continuum of care is an ef- fective way to prevent the occurrence of resistant bacteria.” Dr. Septimus’ group also tries to em-
phasize the importance of vaccination to prevent disease. In 2009, for example, HCA began
requiring health care workers who treat patients in its facilities to be vaccinated against influenza or to wear a mask if they choose not to receive the flu shot. Dr. Septimus says such policies are a positive first step in reducing the spread of preventable disease in health care facilities. Above all else, Dr. Septimus says his
position at HCA makes him a patient advocate. “My role is to educate my colleagues
on best practices they can implement to obtain better outcomes for patients. We look at compliance with best prac- tice and opportunities to improve com- pliance. It can be as simple as adding resources or making them more conve- nient for our caregivers, but we have to talk to frontline health care workers to figure out where the opportunities are,” he said.
Infectious disease specialist Charles J. Lerner, MD, epidemiologist for Methodist Healthcare System in San Antonio and past chair of the TMA Com- mittee on Infectious Diseases, says hos- pital epidemiolo- gists face unique challenges, includ- ing the promotion of hand washing and hand hygiene practices among health care workers before and after pa- tient contact.
Charles J. Lerner, MD
“In any hospital, when you ask man-
agers to report hand hygiene, they in- dicate compliance with hand hygiene policies is in the 90th percentile, up to 100 percent. In reality, when we secretly send employees on the floor to observe, known as secret shoppers, compliance is anywhere from 30 percent to 50 per- cent,” he said. Dr. Lerner uses this data to educate health care workers on hand hygiene procedures and to improve ad- herence to policies. The role of a hospital epidemiologist
is to focus on infection surveillance and control within the institution. This dif- fers from epidemiology at state and local health departments, which focus on the population as a whole. Dr. Lerner played a role in the investi-
gation of the 2010 Listeria outbreak that affected South Texas. It turned out raw celery was the culprit. In October 2010, DSHS ordered San- gar Fresh Cut Produce in San Antonio to
stop processing food and recall all prod- ucts shipped from the plant since Janu- ary 2010. Laboratory tests of chopped celery from the plant indicated the pres- ence of Listeria monocytogenes, a bacte- rium that can cause severe illness. The testing was part of a DSHS investigation into 10 listeriosis cases, including five deaths, reported to the department in eight months. Dr. Lerner collaborated closely with Methodist’s infection control department and with DSHS, CDC, and the San Anto- nio Metropolitan Health District. “Methodist Healthcare System had 60
percent of the Listeria cases. I did for- mal investigations with food culturing and kitchen culturing. I met with CDC, DSHS, and the Metro Health District to determine how to go about conducting investigations to ensure they were scien- tifically rigorous,” Dr. Lerner said. While the Listeria outbreak presented him with an opportunity to investigate a
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March 2012 TEXAS MEDICINE 53
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