How Can Health Agencies Support HAI/AR Program Alignment and Structure Reassessment?

March 16, 2023 | Grace Lee

State and territorial health agency Healthcare-Associated Infection and Antimicrobial Resistance (HAI/AR) programs play a critical role in spearheading HAI/AR prevention, detection, and outbreak response. Throughout the COVID-19 pandemic, states have leveraged these programs for their expertise in healthcare infection prevention and control practices. This video, featuring the Louisiana Department of Health HAI/AR program, highlights the current landscape of HAI/AR programs, the benefits of having leadership dedicated to the HAI/AR program mission and priorities, and the need for alignment of HAI/AR program communications and structure with state and territorial health agencies.


Some answers have been edited for clarity.

Hello everyone. My name is Grace Lee, and I'm a senior analyst on the infectious disease infrastructure and policy team at ASTHO.

State and territorial healthcare-associated infection and antimicrobial resistance (HAI/AR) programs play a critical role in HAI/AR prevention and control. Several significant federal investments have been made for HAI/AR programs during the COVID-19 pandemic, which has reshaped how healthcare and public health professionals respond to HAI/AR threats.

HAI/AR programs need support from their state and territorial health agency leaders to meet the requirements of these new federal investments. That's why ASTHO has developed a report highlighting eight ways health agency leaders can support HAI/AR programs.

In this interview, I'm speaking with the Louisiana Department of Health’s HAI/AR Program Coordinator Erica Washington and State Health Officer Joseph Kanter to talk about three of the eight strategies highlighted in ASTHO’s report, specifically how health agency leaders can connect with program staff, reassess organizational structure, and align programs and activities with HAI programs.

Erica and Dr. Kanter, from your perspective, why is now the right time to assess the program operations for state health agency HAI/AR programs?

The COVID-19 pandemic made the gaps in infection prevention and control glaringly apparent. Also, we’re now unfortunately seeing a couple other fallouts, specifically with antibiotic-resistant pathogens.

Now is really the time to keep the momentum that we have with our public health infrastructure. We need to keep those tremendous gains we've had with increasing our public health workforce and continue the investment that we've made across the provider spectrum through competency building and trainings, as well as prevention and response efforts.

So many people worked so hard throughout the COVID-19 pandemic. It touched so many facets of our department. For example, the HAI/AR team is one team in particular that has been doing this type of work for years and years—oftentimes in the background, not getting the recognition that they certainly deserve.

The size of their team really ballooned during the COVID-19 pandemic. The team started with one or two people before the pandemic and now has close to 20 people. It’s been a real blossoming of the team as their work has really increased and as the importance of their work has become more noted.

That said, because of the requirements of the pandemic response and what the team was dealing with—helping healthcare facilities, hospitals, and nursing homes, in particular, control the spread of the virus—all the other work that the HAI/AR team has done in the past, perhaps it wasn't at the forefront that it had been before. But it's vitally important work. It’s the work of preventing unnecessary use of antimicrobials and preventing resistance. That type of slow, methodical work that we know is vital and that will pay dividends down the road needs to be reinvested in.

I think now's a great time to shape what that reinvestment looks like and what the team looks like to help do that work because those problems are not going away and were likely exacerbated through the course of the pandemic.

Thank you both for your answers. Strengthening HAI/AR Program Capacity (SHARP) funding provided states access to necessary resources for comprehensive HAI/AR programs, including outbreak response, prevention, training, laboratories surveillance, and stewardship. Dr. Kanter, how is HAI/AR program strategic planning being included or aligned with overall state health department strategic planning?

I think the challenge for us and departments like us is, first, how to use funds like this wisely, but then, how to integrate that in a sustainable fashion when the grant funding runs out. This funding is going to give a good relaunch to the team and help us bolster up and rebuild from the COVID-19 pandemic. It's on us to find a way to substantiate this work after the grant period ends, and that's the work that we're doing now.

If you ask healthcare institutions, they'll tell you that this type of work is incredibly valuable to them. What we offer to them through a program like this is non-regulatory, non-disciplinary technical expertise. Ideally, we catch issues and help with problems before they become regulatory issues. Healthcare institutions find that incredibly valuable. So, it pays for itself in that regard. It's up to departments to figure out a way to structure that so that the funding is there to support the work.

Thanks for providing those examples, Dr. Kanter. Erica, you’ve been involved in conversations regarding current and future responses to multidrug-resistant organisms and HAI/AR outbreaks within your jurisdictions. How is strategic planning within your HAI/AR program driving these conversations in Louisiana?

Strategic planning is driving the conversation in the Louisiana Office of Public Health HAI/AR program because having a multidisciplinary team is really required at this point. We have lofty goals that are achievable, but we really want to make sure that we look at our metrics and hold ourselves accountable to both our internal and external stakeholders.

We're fortunate to have a multidisciplinary advisory committee that helps us look at what goals we've set regarding antibiotic-resistant threats, how we're working to reduce those threats, where we're making prevention priorities, and how those threats are distributed within our state.

So, strategic planning is something that we check in on an annual but also a mid-year basis. It’s goal-oriented as well as metrics-based. We look at how we're making progress towards not only our statewide but also our national goals.

Thanks for sharing, Erica. Dr. Kanter, how does a state health official bring together the strategic plans from programs across the agency to be sure planning efforts are aligned and collectively headed in the same direction?

I think you have to make the investment. You have to recognize the need for HAI/AR programs and build them into a budget. But after that, I do think it's the role of leadership to advocate for this type of work and to advocate fiercely for it.

One of the challenges of HAI/AR teams is that when they're doing their job well, it often goes unnoticed because they’re in the background. It only becomes apparent when issues arise. If they're working at the top of their game, generally people don't know about it, and that's good. But that means you have to sell it; you have to advocate for it. You need to make sure that those who are trusted with funding decisions—legislators and so forth—understand the value of and understand the work that's being done, even if they can't see it.

Thanks for sharing, Dr. Kanter. Communication pathways between HAI/AR programs and state and island area health agencies are vital to supporting and promoting HAI/AR programs' capacity building and sustainability. The COVID-19 response further emphasized the need for robust two-way communication, which is one of the eight strategies outlined in ASTHO’s report.

Erica, what successes or challenges did your HAI/AR program experience during the COVID response, and how did you engage with the state health official?

For communications and response, we were fortunate to have a supportive and responsive state health official, Dr. Joseph Kanter.

I think that the biggest asset that we can really cite is our long-term care office hours. They kicked off in April of 2020 with the assistance of the Division of Healthcare Quality Promotion at CDC, the CDC division that really supports and provides subject matter expertise for HAI/AR programs. From there, I really carried it forward weekly. At this point, it occurs biweekly. The biggest success is having providers understand and know that someone is going to be available at this point every week in a very dynamic environment. Just being available to answer questions, provide content and knowledge, and review guidance and provide reinforcement of concepts.

The HAI/AR programs are being seen as important partners whenever anything happens in healthcare settings. I think that the expertise that resides in HAI/AR programs is understood not only within our health departments but also by our outside partners as well.

From the perspective of a state health agency, I would like to hear how continued engagement is crucial for HAI/AR program visibility, sustainability, and growth. State and island area health agency leaders play a vital role in amplifying and aligning with HAI/AR program priorities.

Erica, what is the most important thing you have learned about the role and value of the HAI/AR program and how it has helped Louisiana over the last couple of years?

The most valuable thing I've learned about the HAI/AR program is our attention to prevention. We are very proud of the fact that we launched a viral respiratory diseases detection and containment workshop in 2019. And that was because, before the COVID-19 pandemic, we were looking at flu disease burden and long-term care. It was a cross-cutting activity that worked with our viral respiratory diseases program and our infectious disease epidemiology section in the Louisiana Office of Public Health.

Our attention to prevention has really been a treasure for our program. I think that response is understood and valued as well, but how we really sew ourselves into facilities through education and constant training is a key component of our Project Firstline activities. We have professionals go out and do a lot of targeted trainings and assessments of gaps, and we use our outbreak data to address these gaps and do continued education.

The HAI team was integral to the COVID-19 response. One of the things that helped us was the way that we reached the stakeholders. The more antiquated way was just to connect with the main representative at a healthcare institution—the HAI program manager at a hospital, for example. And sometimes that was effective at reaching the folks that we needed to reach deeper into an organization, but sometimes it wasn't.

One of the things that we learned throughout the pandemic was to connect not just with our immediate counterparts in an institution but to build connections deeper into the organizational chart. For example, we made connections with frontline clinicians and made office hours and educational opportunities directly available to them. We didn’t just rely on the point of contact at that institution to delve deep. We made sure that we were connecting directly with frontline clinicians.

Thank you both for sharing your thoughts and experiences on how HAI/AR programs and state and island area health agencies can maintain and deepen their engagement to ensure the safety of patients, healthcare workers, and the public. The continued partnership between HAI/AR programs and health agencies is critical in spearheading infection prevention, detection, and response efforts, both for current and future outbreaks.

I encourage you to check out the ASTHOReport titled “Eight Ways Health Department Leaders Can Support Effective HAI/AR Programs” for more insight on how health departments can prop up HAI/AR programs.