Brittain Wood, BSN, RN, CIC
Meet Brittain, a liaison infection preventionist with the Duke Infection Control Outreach Network (DICON). In this role, he serves as the primary contact for several community hospitals within the network, as well as assists in the program and research goals of DICON and its umbrella organization, the Duke Center for Antimicrobial Stewardship and Infection Prevention. We spoke with Brittain about his experiences in infection prevention and life outside of work.
Tell us a little about your background in infection prevention. What did you do before you became a DICON consultant?
My passion for infection prevention began early on in my undergraduate career where I discovered the “unique underground” of microorganisms. Having been born & raised in Raleigh, I wanted to stay close to my roots and invest in the wonderful educational opportunities we have right in the heart of North Carolina. After graduating Summa Cum Laude from North Carolina State University with a degree in Microbiology, my career path landed me in the Infectious Diseases department of LabCorp at Research Triangle Park. This was a unique experience which allowed me to put my Microbiology skills to great use where I performed both qualitative and quantitative assays to detect Hepatitis B, Hepatitis C, HIV, HTLV, and oversee many clinical trials within the department.
After discovering an interest in healthcare and infectious diseases, I decided to change careers and attend nursing school at Duke University School of Nursing. As a “second career” nurse, it was very enlightening to see how dynamic the profession of nursing has become. After graduation, I pursued critical care nursing where I worked with intensive care patients for several years at one of our sister hospitals, Duke Raleigh. Duke Raleigh Hospital has been very good to me! While working within the intensive care unit, I took a strong interest in reducing ventilator associated pneumonias (VAPs)- a gateway to the world of Infection Prevention.
As I inquired more and more, I became influenced by the Duke Raleigh Infection Preventionists who took me under their wing. Time away from clinical care allowed me to gain further focus on quality improvement initiatives, data analysis, and process measures. Soon after, I too became part of the Infection Prevention team at Duke Raleigh Hospital.
Luckily, I had the opportunity to take a leadership role as the Program Manager for Infection Prevention at Duke Raleigh Hospital. Having started my nursing career at Duke Raleigh and transitioned to a leadership role, I had the unique advantage of utilizing my previous relationships with staff and my knowledge of facility operations to bridge gaps in infection prevention practices throughout all areas of the organization- this was a truly rewarding experience!
All the while in infection prevention, I had the blessed opportunity to receive Infection prevention assistance from the Duke Infection Control Outreach Network (DICON). Everything I know and love about infection prevention has stemmed from my relationships built through DICON. Whether it was answering my phone call at 10 pm regarding a question or lending a helping hand during a regulatory site visit, my DICON Infection Preventionist was always there, 24 hours a day, 7 days a week. Over time, you become bonded, like family. After leading the Infection Prevention department for an acute care facility, I was graciously given the opportunity to join the DICON family as an Infection Preventionist. To work with a group of extremely bright and talented Infectious Disease Physicians, Infection Preventionists, and Clinical Research Staff has become the pinnacle of my career. I have not only enhanced my infection prevention expertise but I have come to really enjoy the relationships we build with our member facilities. Being a DICON Infection Preventionist is continuously challenging due to the uniqueness of each of our member facilities and the ever-changing landscape of infection prevention.
How is infection prevention different in a large tertiary care center like Duke vs. smaller community hospitals?
DICON is unique in that we thrive on relationships we build with our community-based, member facilities. This advantage has allowed us to continue to grow and provide expert guidance on infection prevention practices worldwide. What I like most about infection prevention at community-based hospitals is the variety of tasks the IP must be proficient at to maintain a successful program. Whether it be microbiological surveillance, data analysis, construction risk assessments, water management, environment of care activities, or cleaning & disinfection practices, community-based IPs are well-versed in all areas.
Tertiary care centers typically have much larger infection prevention departments due to the sheer number of square feet they must cover compared to community-based facilities. Not to mention, you typically see unique infection prevention gaps at tertiary care centers due to the variety in patient population (e.g., NICUs, transplant units, novel technologies, cystic fibrosis patients, etc.).
Has the increasing threat of antimicrobial resistance changed the way infection control is done, or do the same strategies still apply?
The increasing threat of antimicrobial resistance has not necessarily changed the way infection control is practiced, per se, but I do believe the threat has heightened the awareness of how important infection control is within healthcare. Basic infection control practices (e.g., hand hygiene, environmental cleanliness, safe injection practices, respiratory hygiene, appropriate wearing of personal protective equipment, etc.) have not changed over time. Hand hygiene continues to be the number one way to prevent the spread of microorganisms.
I do believe the threat of antimicrobial resistance has changed the way providers prescribe antimicrobials and the attention of antimicrobial resistance has reached many disciplines (e.g., Pharmacy, Medicine, Infection Prevention, Regulators). With the new regulatory mandate for facilities to have an antimicrobial stewardship program, I suspect we will see a shift from over-prescribing of antimicrobials to appropriate prescribing of antimicrobials. Meanwhile, attentiveness to basic infection control practices continues to be paramount and hopefully all these avenues will collide to demonstrate advances in reducing healthcare-associated infections.
Engaging patients in their own care can be an important strategy for infection prevention. What are some of your favorite educational tools for talking with patients and their families?
- Avoid jargon that really only means something to clinical staff and keep the message simple.
- The CDC has wonderful patient education materials for CLABSI, CAUTI, VAP, SSI, CDI, MRSA, VRE, and CRE prevention.
- Face to face interaction. When you meet with patients and families in person, you can show them you care. Empathy and compassion are integral.
Big data is a big deal in healthcare, and here at DICON we collect infection control information from all of our community hospitals to help enhance and benchmark their IP work. Could you give an example of how you have used all that data to create a personalized infection control strategy for a network hospital?
At DICON, we collect enormous amount of data to assist our community hospitals in strengthening their infection prevention efforts. In order to achieve such goals, the data must first be reviewed and validated. An instance where DICON data has made a personalized impact on infection prevention practices and rates occurred at Hospital A. During routine surveillance, a cluster of SSIs was noted during the first half of 2017. Through the use of our DICON surgical database, we were able to pull a personalized line listing for each of the 14 SSIs identified. Within this line listing, we abstracted several key variables from the procedures to assess risk. This detailed line listing showed several opportunities for surgical site infection prevention efforts such as consistency in preoperative skin antiseptic agents, appropriate weight-based antimicrobial dosing, and standardization of environmental controls within the operative suites.
In addition to identifying modifiable variable to prevent these SSIs, I assisted Hospital A by conducting two separate surgical procedure observations. These observations were designed to observe the actual practices that occur during a procedure within the operative suite. Utilizing our standardized DICON OR observation tool, I was able to succinctly capture additional opportunities for SSI prevention.
The results of our analysis and observations were compiled into a succinct presentation to key stakeholders at Hospital A. In addition, I was able to assist Hospital A in developing a robust performance improvement plan aimed at SSI prevention. Their PI plan included many factors such as standardization of weight-based dosing for antimicrobial therapy, re-education of staff related to strict adherence to OR attire, standardization of surgical skin antiseptic agents, standardization of staff performing surgical skin antisepsis, re-education of staff who perform surgical scrubs, procurement of new cleaning and disinfecting wipes for surgical services and conducting a course on terminal cleaning of the OR. The efforts put forth by the entire DICON and Hospital A teams has led to a significant reduction in SSIs, bringing them back to baseline. This performance improvement initiative demonstrates the value of DICON, our unique expertise in infection prevention practices, and our ability to maintain strong relationships with key stakeholders to improve patient safety within our member facilities.
Every once in a while, infection preventionists get a day off. How do you spend your free time?
Yes, every once in a while we have a moment of free time to participate in activities away from preventing infection. I am an avid traveler and love to experience different cities, cultures, and nations during my time away. In particular, I have a new found bucket list- to visit all 50 states. This interest spiked last year after my wife and I took my mother-in-law on a 10-day trip to New England to experience the beautiful Fall foliage. Ever since, I have been determined to see all of the United States. To date, I have visited 34 states. My favorite state, Hawaii, is where my wife and I had our honeymoon. We have vowed to return to a different island every 5 years. We have previously visited Oahu and Maui, Kauai is up next. I am very excited to be taking my father to Alaska this summer for his 70th birthday! This is something he has dreamed of and we are so excited to be sharing this experience with him. While I’m not traveling or planning to travel, I love spending time with family and friends. There is no better place to be than surrounded by the ones you love. In addition, I enjoy cooking and gardening, but I’m still waiting for that “yard of the month.”