Exploring Body Reservoirs with Pathways for Infection and How Healthcare Workers Can Minimize Risks

In this episode, we discuss methods on informing and educating healthcare workers on germ spread using the Body and the Healthcare Environment Reservoirs. Our first guest is Shay Drummond (MPH RN CIC), who works as an Infection Preventionist with the CDC Division of Healthcare Quality Promotion and is a subject matter expert on this topic. Our second guest is Evelina Y. Maho (MAdm., Diné), who is the Public Health Program Manager at NCUIH. Listen to the episode to hear more about infection prevention and control, including suggestions on how staff at UIOs can put what they have learned into action.

Transcript

NCUIH Podcast #3: Shay and Evelina  

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: Welcome back! We all hope you are enjoying NCUIH's Native HealthCast. Today is our third podcast. We will be reflecting and highlighting from our June 7th webinar on exploring body reservoirs with pathways, for infection and how healthcare workers can minimize risks. By the end of our time together, we are hoping that you are more aware of the body and healthcare environment, reservoirs, and how they interact with each other to spread germs. 

We also hope you know, how healthcare workers can minimize infection risk in the workplace. We have two guests today. Our first guest is with the CDC and is a subject matter expert on this topic. And our second guest also will be contributing and discussing suggestions on how staff can put the learning into action and also sharing resources and ongoing Project First-Line activities. 

So without further ado, I would love to introduce our first guest today Shay Drummond. Shay is a registered nurse and is Project First-Line infection control subject matter expert. Prior to joining Project First-Line Shay was an infection, preventionist quality management consultant for the VA healthcare system. 

She also has frontline nursing experience and disease surveillance, outbreak response, and public health. What an impressive resùme. I am so glad you're here. Welcome Shay to NCUIH's Native HealthCast on infection control. I would love for you to bring your voice in, welcome our listeners, and also share, something else about yourself, please.  

Shay Drummond: Thanks Vickie, it is so great to be here today with you on your podcast. It's like so many people I've actually had a very unconventional career. I actually did not go to college until I was 40. So I was a mother of three. And for me it was a sort of this balancing act of taking care of my children working full time. And unfortunately my education came in third at that point in my life. So I started my courses at our local community college in Quincy, Illinois to become a certified surgical technologist. And that was really my entry into healthcare. While I was taking these courses, I was actually working at our local hospital and I was doing jobs such as transporting. 

I worked in sterile processing, which, packaging, the instruments used in the operating room that I hoped to be working in someday. And I also had the fun job of cleaning GI scopes for the GI lab. So eventually I made it to that OR room. And was a surge tech and I decided to continue my education in nursing.  

It was during my last year in nursing that I did an internship in public health and I actually was the mosquito girl, my job, believe it or not was going around and setting up traps and collecting mosquitoes and testing them for west Nile virus in St. Louis encephalitis. And it was during that sort of interesting adventure in my healthcare career that I fell in love with population health. 

I realized that being able to help with interventions for the greater good to improve those health outcomes was really a needed, a needed. Situation in our local county, but overall, as I looked at the country and the nation, I could see the demand. So I ended up going to work for public health and was there for over a decade, working my way up through the different positions. 

When I started, they handed me a whole pile of hats and you ticked off a few of them that I did for sure.  

But it's where I also learned about infection prevention, infection control, and importance. That really kicked me off to go to my master's program for my Master's in public health and brought me up through the VA system eventually, as you mentioned. 

But really it's shoe leather epidemiology at its best. You know, it's working with the frontline staff, how can we prevent these diseases or how can we prevent those infections from happening and provide outcomes for our communities?  

Vickie Oldman: Well, you are not kidding when you said unconventional.  

Shay Drummond: Right? 

Vickie Oldman: Yes. That's a beautiful story. I appreciate you sharing a little bit more, about you and what led you to this place, in terms of Project First-Line’s team. So based on that unconventional colorful journey that you've had up to this point and all the work that you're doing, particularly your training experience, I'm curious about how your training experience has been so far during this national collaborative and curious about what you've learned and also what is confirming. 

Shay Drummond: Sure. Well, first of all, it's super exciting to be part of a program that is addressing the infection control training needs on a national level, especially during a pandemic. Just the fact that this even occurred during a pandemic is pretty amazing. Interestingly, I initially learned a Project First-Line almost at its inception. 

And this is when COVID was just coming onto the scene. So Dr. Carlson, who's our infectious disease physician with Project First-Line. She and I actually worked together at the VA in St. Louis, and she came on board with Project First-Line. So I was following the whole program from birth and as they were starting to bring this all to fruition after years of planning and I was thinking, "Wow, what a cool program. I really wanna be a part of this. And how neat is it that CDC and Project First-Line are providing free training materials online that can be accessed and used for all sorts of staff trainings or orientation." And I think where this really came home to me as an infection preventionist at the time was. 

The lack of time that infection preventionist and frontline healthcare workers and all healthcare workers in the midst of a pandemic had to even begin to create trainings or provide those educational opportunities. So for my IP mind, this was an amazing opportunity and program to get involved with. 

Vickie Oldman: Thank you for that. And as you're continuing to be in this space, what else are you learning?  

Shay Drummond: I'm learning about these wonderful, diverse and collaborative relationships. That Project First-Line has with all their different partnerships. We're also learning how to deliver education in ways for adult learners of all different learning styles to receive information, and then being able to take that information back. To whatever area they work in or whatever community that they live in.  

Vickie Oldman: Mm. Yeah, we could definitely, probably unpack about the unique ways and how to teach adults. And, one thing that I'm appreciating, through observing Project First-Line is incorporating indigenous ways of storytelling and using the values to emphasize the importance of the work that you're doing. 

 I assume your experience so far has been great with the team.  

Shay Drummond: Oh my gosh. Yeah. My NCUIH experience has been positive. And to your point about the storytelling, I always look forward to the facilitators that are helping, weave in their own experiences. And that really, to me, carries over into teaching and how the information that if we can share our own experiences, our challenges that helps retain that knowledge and also builds trust with one another to share and to reach out to each other in between these sessions, even as, as a local resource or a mentor. 

And it really does demonstrate and support NCUIH's culture of safety in keeping the community at the forefront, which is so important. 

Vickie Oldman: Thank you for that. I appreciate the additions that you've added to that. Thinking about the webinar that happened on June 7th to the Urban Indian Organizations on "Exploring body reservoirs and pathways for infection and how healthcare workers can minimize risks", I'd like for us to unpack that webinar and break down some of these pieces that you had shared during that time. 

So let's start off with you sharing with us what it means to recognize risk infection.  

Shay Drummond: Sure. So being able to recognize risk to me is really like the first step in fighting infection. By focusing on in training others, what risk is and what to look for, maybe where it starts. And really what we're doing is beginning to develop that situational awareness. 

And it really can become almost eye opening. So I like think about if you saw someone that was beginning to fall. Our natural instinct is a human would be to rush over there and try to help them before they hit the ground. That is the kind of muscle memory that we're hoping to work to instill in our healthcare workers to see infection control through a different lens. 

And then all of a sudden they'll start to see potential risks and proactively respond to prevent those events or risks from even happening. 

Vickie Oldman: Thank you. I love the terminologies you're using here in terms of the outcome, the hopes of more situational awareness and really strengthening muscle memory. So it becomes natural. Right? Right. The goal is that becomes natural and you're not overthinking. You just naturally know how to prevent things, infection from reoccuring. 

So based on the webinar, I know that you all had talked about, reservoirs, what are reservoirs as it relates to germs?  

Shay Drummond: Sure, sure. Well, simply put the reservoirs are really the home or the habitat. So this is where you can envision the germs like to hang out. And this is where they survive and thrive given the right conditions. 

Vickie Oldman: And when you're thinking about the our healthcare workers and the community healthcare workers, what do you think that they should take away from the presentation you had conducted to help them understand the interactions between those reservoirs? I know that you had talked about there, there were two, like the body and the environment. 

Shay Drummond: Yeah, that's right. So the commonality between all these reservoirs is, is that the germs or organisms live everywhere. So in and on and around all these different reservoirs, whether it's our body or the environment that we live or work in. So by breaking them down into the groups of body and environment, I think it can help the healthcare worker visualize how these different body systems can be impacted or be that source of infection or germs or what environmental settings might be more likely to be sources of infection. So by giving them sort of these visuals and these categories and buckets to think about and recognize, then they start to see the pathway of the germ coming from maybe the water to the patient or the blood to the healthcare worker, potentially creating these pathways that we talked about in the webinar that the germs have to travel, to infect the patient. 

And then once they start to see that the healthcare workers can actually take those steps and recognize what actions they need to do to prevent infections.  

Vickie Oldman: Yeah, I appreciated the session because I know that you really helped folks to think about the environment and the body. 

And I know that you broke it down more, can you share examples of germ spreading between these reservoirs?  

Shay Drummond: Sure. Yeah, that I always enjoyed doing this part. So let's use skin for example, this is a body reservoir and I'd like to share this because skin is our biggest body organ. And a lot of times people don't think of skin as even in organ and too so much of germ spread as through touch. 

So that touch is that pathway for the germs to spread also because skin is a reservoir and touch is a pathway for those germs to spread. It may also include reservoirs of the respiratory system. Our GI or the gut system and blood. So those are those other three body reservoirs that we did talk about in the webinar.  

Our hands with our skin really come in contacts with all of the body reservoirs. And we are constantly touching. We're touching people, our faces, ourselves keyboards and cell phones, all those devices that we work with in healthcare. So these germs can spread very easily. good example of how this might look like or work in a healthcare setting would, oh, let's say a nurse or a healthcare worker had just done helping a patient with some toileting. 

 The patient's on precautions for C difficile and the healthcare worker forgets to wash their hands. That healthcare worker then goes and picks up a food tray and delivers it to the next patient's room. It's dinner time. And that patient happens to have an immune compromise system. The healthcare worker has contact with the patient sets the food tray on the stand helps the patient undo the silverware, opens the milk carton, takes Saran wrap off of the food hands, the patient, the silverware. Well, the patient now has come in contact with everything that the healthcare worker did in the previous room. So bam. Now you have C diff that has gone from the healthcare worker and transferred to the patient. 

Who's now eating, which is the fecal oral root of transmission for C diff. So it can happen very easily. It can happen innocently. That's why I feel so strongly and passionately about helping healthcare workers and, and folks that work in the healthcare communities understand. It's the simple things that we all can do to prevent the infections. 

Vickie Oldman: Thank you for that example, like I literally can visualize following a, a practitioner in a room, right? And then going to the next room, I know hygiene's important, but I never saw the level of it until I personally, had a family member go through cancer. 

And I was very vigilant, like anytime, a nurse or a doctor came in, I would say, "You didn't wash your hands." I was like on it, you know? And, and when that happened, because it happened to me personally. 

Shay Drummond: Mm-hmm  

Vickie Oldman: It made me much more aware of like the doors, the escalator, the elevator button, so it, it really just brought my awareness and bringing this up because I know that we're talking about our healthcare workers, but I also feel like it's important for our patients, our relatives that come to these facilities to also be aware. 

And I think COVID 19 has definitely shed light on the importance of clean hands and not to be touching everything. So anyway, I just wanted to just add that because I could visualize that happening and being in the facility for a big chunk of time for my little one I could see, but I didn't know the language, now, I, as I'm working with you while I'm understanding the language and I'm like, oh, that's what that is. So thank you for that.  

Shay Drummond: Absolutely. Right. That's a, that's a great real world. Your personal experience with the importance of infection control.  

Vickie Oldman: Yeah, it is. 

And it's bringing a lot of light to me in terms of, how much work and in the last podcast I was talking to them. They, I had mentioned about pace, cuz we're so busy and I know practitioners are jumping from room to room, working with people. And sometimes you have to really slow down to just take that 15 seconds to wash your hands and that can really help.  

So thinking about our healthcare workers. And earlier you were talking about the different learning styles and knowing that people learn differently, what do you think some of our healthcare workers will most likely connect with and remember during these trainings?  

Shay Drummond: Oh yeah. It's and that's a real challenge. Adult learning , is completely different, but I think, by starting with these core trainings of Project First-Line and using the time in these webinars, for example, for participants to share their work experiences, just like you just shared your personal experience and then using activities within that webinar, such as breakout rooms or, case studies that are brought forward that are actual real life scenarios that maybe a UIO had experience with in connecting and engaging with what they are dealing with really gives the participants that confidence that they can go back and make a difference in infection control. 

And I think encouraging, if you see something, say something really giving them confidence in the decisions they're making, when they're in their work environment, or as you pointed out it's for everyone, it's not just the workers, it's guests, it's contractors that come in the facility it's. Really how we interact even in our communities now, we've learned that with COVID certainly.  

I also believe that, the participants need to connect to each other and realize they're not alone in the challenges of infection control. 

And I really hope they see and connect with not only our Project First-Line resources, but also in finding maybe some mentorship in each other, that connection to their local healthcare community. And also for them to know that CDC, infection control experts and our project first line program we're there too is a resource, you know, it's, we just, aren't gonna show up at your webinar. 

We're we're there. If you need to shoot us an email or have things that, that you have burning questions about. So I it's, to me, it's that connection that I hope they really take away from the trainings and knowing that we're gonna provide them with those resources and tools to connect with.  

Vickie Oldman: I love that you had mentioned it twice, the word connection. And I, I firmly believe that, just as humans for us to be able to say and call out what you see. That takes courage. It also takes knowing, like I'm doing this for the greater good. And hopefully my partner, when I say partner like practitioner my colleague, when I call it out, they're not gonna take it personal.  

They're gonna say, "oh, thank you. yeah, I'm moving too fast. Thank you." So I think connection is key here. And part of that is. Learning to understand each other, learning to communicate, learning to also not take things, personal, that we're all in it together. Right. So I really appreciate you sharing that and really mentoring each other, I think, is also important. 

And all of that is relationship building and it takes time to do that and to develop that. So those are some great strategies and ways for folks to be thinking about any other strategies that you feel that our healthcare workers can, consider in terms of actions besides what you've noted here. 

Shay Drummond: Well, really back to your example, you brought up about the hand hygiene. That is one simple action. It doesn't take fancy equipment. It's for everyone. And that action alone is if it's done every time that it's needed, it really is impactful. And will reduce the spread of germs and healthcare associated infections. 

So that is one singular action that we can all do. Doesn't matter what you do. You could be the insurance intake person, the medical assistant, you could be the visitor. Um, and, and as you said, have encourage so shifting from a culture of fear or reprimand in our organizations to a culture of support and the ability to comfortably speak up with our coworkers and, and know that it's okay to remind someone to clean their hands. 

And I even like the idea and you pointed this out, actually is encouraging our patients to speak up and, and say, "Hey, could you lean your hands please? "And, and having the conversation with those providers, um, You know, if we could move that one needle alone, we'll made huge strides. It really, it's amazing. 

Something that seemingly seems simple is often difficult, but, and as I've said, the sea states see something, say something is another one of my favorites. You don't need to know what germ or organism you're dealing with, but maybe you see diarrhea in a patient room. So, you know, there's gonna be cleanup involved, you know, that you need to be getting the right PPE, whether that's gown, glove masks, the Project First-Line training, part of that is designed to give the healthcare workers. We wanna give them that educated confidence to make choices, not only to protect themselves, but just to prevent the spread of germs. So part of this is just really instilling educated confidence in healthcare's choices, healthcare workers choices. 

Vickie Oldman: Yeah, I love the culture of support. I wanna just underscore that for folks. Mm-hmm , you know, to really sit with that, what would that look like? Within your team having the culture of support? I think that's really beautiful. , I had mentioned, that about pace and it also relate to how our workers are busy. And then I know that short staff, is an issue in some of our facilities. Using COVID 19 as an example, guidance changes happen frequently. You've mentioned some things about what the training content can look like and when we're reinforcing it, anything else you wanna add to that? 

Given sort of those external pieces that I've mentioned about busyness and short staff, maybe even turnover, right? and then just changes externally.  

Shay Drummond: Yeah. Well, COVID certainly challenged us. It totally changed our paradigm and thinking about infection control. And one of the things, all my varied healthcare career roles really taught me over the decades is the frontline staff are the essential cogs in everything that is needed to support whatever size facility you're in. And what COVID brought to the forefront is we quickly realized because this was so different than anything we did. And we're dealing with all those other shortfalls that you mentioned that we needed to provide training to all the frontline staff. So the EVs workers, the CNA staff, the allied health professionals, anyone in the healthcare environment, the members of the facilities management team and those that are responsible for the buildings environment. 

So part of the beauty of Project First-Line for me, when I really learned more about the program was that the materials are really geared at educating the frontline staff, but they also are available at your fingertips.  

So if you have access to a computer, you can access an amazing variety of materials. And there's things like YouTube video blogs that are three to five minute videos. So I know people are short with time, so, but maybe they could watch one video on how to properly sit their PPE to their face or learn how viruses spread on a video blog. A lot of staff enjoy social media, Twitter, Facebook, we have accounts on all of those. 

I think rumor has it. We're gonna be on Instagram soon. So look for us there. So providing things that interest adult learners, and then for maybe more serious or formal education, having actual training tool kits that educators can tap into and tailor to their audience, tailor to their coworkers or their needs in a huddle and use our materials through project first line that are free and readily available to do a quick, lesson that's appropriate for the group that they're teaching. 

So we're constantly developing new material in the background. We're actually working on some pretty cool micro learning, and these are like little small snack bites that can be used for huddles or in the moment coaching. So those are gonna be coming soon. Um, and we really count on feedback from NCUIH and the participants on the webinars. 

We wanna know, what do you need? What are your challenges? What are your struggles? What's not working with our materials so we can continue to evolve it for our broad audiences.  

Vickie Oldman: Beautiful. Thank you. I appreciate everything that you've shared with us and you giving some time here to share what you're learning being a subject matter expert in this area. 

And I know that we're always learning. That's what's beautiful about being in this sort of environment is. And I think in all environments is we're constantly learning and trying to shift behaviors, shift how we think about things. As you continue to be a part of this project, I know that you're gonna be presenting and future PROJECT FIRSTLINE events. What do you hope to bring to these collaborative events?  

Shay Drummond: Oh yeah. I I'm always look forward to them. It's, it's an opportunity for me to dig in and do a little more research and learn myself, but we really wanna bring and provide materials that meet the mission of NCUIH um materials that are innovative that address the needs of the urban Indians and really things that are accurate and timely, usable guidance. 

We wanna show you where those links are, where you can go and find things quickly, in the busy Workday. And we also want to continue to help everyone build that capacity between our public health workforces and our clinical communities. Um, really it's to me, it's together. We have that power to stop infections. 

Vickie Oldman: Wonderful. My ears struck to was the materials that you're creating that are relevant and that are timely, that's important because things are always shifting and new information. Thank you. Any final thoughts before I bring on our next guess  

Shay Drummond: Only that as we evolve our guidance and training, it's not necessarily that the previous guidance was wrong. But it is that we have learned more and we continue to bring the science to the guidance. So, um, I know these are challenging times with information overload. 

So I always like to just bring that point and I so appreciate the opportunity to be here with you today and, and to partner with NCUIH and thank you.  

Vickie Oldman: Thank you hang back because we definitely wanna bring you back at the end and you all heard it. Science to guidance. So keep that in mind. All right. 

So I wanna introduce our next guest. She is no stranger to me, and I'm sure to some of you all, our next guest is Evelina Maho also known as Evey. She is Diné, Navajo, my Diné sister, and she serves as a program manager within the technical assistance division with TARC the technical assistance in research center at the National Council of Urban Indian Health. 

Evey is not new to this work, she's been in this field for many years and in the healthcare industry, which I think gives her a landscape of seeing things in a very micro way, but also in a very broad way. And when I say broad in the community perspective and in programming. Definitely has amazing skills in terms of engaging, really bringing in community, bringing in practitioners and expertise, and is a really good conduit of those ecosystems, excellent project management skills, she does it all in terms of program development, fiscal management, policy evaluation. So she has that landscape and is really making sure that, values are in place and as well as, making sure things are participatory. She has a master's and also an undergrad degree and in various fields related to health. 

So I wanna bring on Evey I would love for you to say hello, welcome our listeners. And I just wanna welcome you to NCUIH's Native Healthcast on infection control. So, please greet our listeners, Evey. 

Evey Maho: Greetings everyone. Yá'át'ééh I am from the Coyote Past people clan, born for Zuni Edgewater, my maternal grandfather's clan come from the Rock Gap clan and my paternal grandfathers come from the Towering House clan. And so as Vickie has shared, I am Navajo and those are my clans. So in Navajo it's said as so….(introduces herself in Navajo). 

 That's how we greet ourselves in Indian country and greetings to all those that are listening to the podcast today.  

Vickie Oldman: Ahé'hee thank you. We are not related, so I can't hit you up for any free food or a loan. but I'm so glad you're here. Thank you for sharing and introducing yourself, in our mother tongue. 

So why don't you tell folks, our listeners a little bit about what you do at NCUIH.  

Evey Maho: Sure. I work at NCUIH as a Public Health Program Manager, and I bring to the table at NCUIH the different public health perspectives into the many projects that NCUIH is involved with and so it may vary from a broad public health perspective to a perspective from the community grassroot level, tribal perspective.  

My goal and my position is really to help implement projects and ensure that they're completed to the very end. Most importantly, that the work that I do at NCUIH also is to help with my colleagues support 41 UIOs that serve an estimated 65,000 American Indian, Alaskan Natives people per year. According to the 2010 US Census, it shows that 71% of our American Indians and Alaskan Natives live in the Metro areas. Served by our Urban Indian Organizations across the United States.  

So when we think about the work from a national landscape, and lens, there's so much to be done, and our UIOs provide a wide range of healthcare services under one roof. And so services can be tailored to combat the specific like health disparities of the urban Indian population, which is key in preventing serious health problem and diseases. 

 Our 41 UIOs may provide primary care behavioral health services. Some may offer such thing as traditional healing and medicine and social and community services as well. I'm a part of the team at NCUIH and at NCUIH those are some things we do, for our 41 UIOs.  

Vickie Oldman: Thank you for reminding us the number of UIOs that we have, but also giving us the picture about where majority of the the population of folks that are using these facilities in the Metro area.  

Evey Maho: Mm-hmm  

Vickie Oldman: In our last two podcasts we talked a little bit about NCUIH and the background, and some of the services, I would love for you to broadly elaborate a little bit more of some of the other services that you feel the Urban Indian Organizations provide in terms of various roles that the healthcare workers fall into and linking that to the Project First-Line trainings and how they can benefit from that.  

Evey Maho: Sure. Not all of our Urban Indian Health Organizations, are primary care settings, we have behavioral health settings where they're inpatient or outpatient. 

There might be some community public health work that might be occurring, using community based participatory type of programs and community services. And so whether it's clinical or, in a public health type of approach, setting outside of the clinic walls, it's really important for, NCUIH that we support all of our 41 UIOs in bringing them, science evidence based and promising practices that are proven to be effective, to keep our healthcare warrior safe in order to deliver the appropriate and comprehensive and safe healthcare that our American Indians and Alaskan natives deserve across the United States. It's really important work and we're excited to do the work and help to support these Urban Indian Health Organizations across the country. 

And we don't do this alone. We are in a cooperative agreement with the Centers for Disease Control, and we have other national partners that also contribute to the content. The way the training is gonna be delivered, how it should be delivered. Content is really important. Um, so that it's flexible and used in all of those different types of healthcare settings that we, we mentioned primary care, behavioral health services, , community health, or broad public health type of work, social and community services. 

Vickie Oldman: What came to my mind as I was listening to you is you all don't have a one size fit, all approach. 

You can't, there's just no way you can't because all the 41 facilities, offer different things. I'm sure the sizes are different. The budget is different, and even where they're located. So it, it put perspective to me and how you all have to be thinking creatively in these products and services backed up with science and evidence as well. 

So it made me think about this next question how has your team adapted, training content to meet the needs of the UIOs staff. 

Evey Maho: Our team at NCUI envisions infection prevention control as, those practices and procedures that when implemented at the Urban Indian Healthcare Organization level, and there are applied consistently that we reduce, or we eliminate the threat emerging or reemerging disease threats within those UIO settings. 

So when we envision that, we also see that these practices are evidence based and they're proven to be effective against pathogens and will protect definitely our front line warriors, our healthcare workers. Our patients and the community at large and how we have done that is NCUIH has held five listening sessions and they've resulted in some publication in our Frontiers Journal, titled "Perceptions and experiences of frontline, Urban Indian Organization, healthcare workers with infection prevention and control during COVID 19 pandemic." 

What we were able to publish and also gather from these listening session is really, the words, and the concerns and, understanding. The capacities of our UIOs, their needs and what they also envision what they would like to see. When we're talking about developing training materials, it was a comprehensive approaches in that sense. 

 NCUIH also hosts during annual conferences. An opportunity for Urban Indian Health Organizations and others to come to the table to also talk and hear about some of our own NCUIH Project First-Line, what we deem champion sites, where they have an opportunity for much more of an intimate collaborative working relationship with NCUIH, where we offer the training, and then we go through a peer to peer environment where the organizations are able to take key learnings and make those into actionable items where it's, whether it's policies, changing procedures or updating those and training the staff. And making sure that the staff understands, you know, some of the fundamental lessons to be learned from that and hoping that all of those things goes into actual practice and it's day done on a day to day basis. 

Ultimately, of course, protecting the staff. So annual conferences, we try to convene and bring folks together and share some of those key learnings, their experiences, and also hear from them. What are some things that NCUIH could do to improve those learning opportunities so that they're able to grasp those key themes that we're trying to convey. 

We also do ongoing evaluations of all of our NCUIH trainings that we offer to our UIOs. We solicit definitely our participants. 

The other thing is we network and we collaborate on a national level with CDC, our national partners, there are over 35 plus partner organizations, including universities, public health organizations, medical organizations, community colleges, state, local, and territorial departments. 

We come together actually at a NA our national partners meeting, and we're able to learn from each others, what methodology, what platform modality, and approaches, have worked and what doesn't work with our healthcare workers. There's this whole effort around making sure that we adapt training content to meet those needs of our UIO staff. 

The last final thing I wanted to mention is that this year we did something a little bit different at NCUIH. We wanted to infuse the American Indian, Alaskan Native content. Approaches, methodologies, and thought and mindset around, protecting our ourselves, as warriors. Right? We do that in our homelands with our people that same thought process, that same, culture based approach. 

We also wanna bring that and infuse it and marry that with CDC content, with the current science. And making sure that we have cultural adaptations. And so we're really trying to bring in that storytelling element to bring that and it's important. And I say that it's important is because all of these urban Indian health organizations across the country, they were founded by grassroot American Indian, Alaskan Native leaders. 

They knew very early on that their relatives would be coming from the reservation lands into the urban setting and that they wanted to have places where their people could also be serve whether it's behavioral, health services, primary healthcare centers, community centers, a place to gather a place to connect. 

So it's really important that we honor that and we also at NCUIH try to bring those elements into the work that we do through different and various training platforms and opportunities.  

Sounds like a lot of success stories and what you guys are practicing and experimenting. Right? I feel like that's important when in any setting is to experiment, to try things out and to see what do we learn from this? 

What can we do to improve? How else do we need to pivot if at all, do we need to slow down a little bit? Do we need to speed up a little bit? Anything that you wanna share about maybe, particular success story. 

 Sure. NCUIH, uh CDC IPC project here. Um, each year has had a program where any of the urban Indian health organizations could apply for a sub-award. And that sub-award when received. We deemed them champion CDC, IPC sites, and one of those sites was, is Bakersfield. 

And they continued to work with NCUIH into year two. And, during our recent national conference, they shared how they took their participation in the ECHO learning series, the webinars, and As a champion site, how they learn and took those materials. They developed their own IP C infection prevention control training at that local site. 

 They've improved their policies and procedures. They've were able to set clear processes, and policies. For example, around hand hygiene around proper PPE usage. And most recently they shared how they've had, implemented a mandatory training. That's centered around biohazard waste disposal, disinfection, cleaning, scheduling, blood borne, pathogen training and has comp training. 

So there's just a lot of great things and ensuring with all of those training that there's a process and, and a flow in place where accountability is also a part of the culture and become norm and thus making that a day to day practice and really beginning to foster collaboration about infection prevention control as staff members at that particular facility. 

 The last point that Bakersfield has done is, you know, here's. Here's an ask. And that ask from CDC from NCUIH is take this training. And, um, how do we take that learning and make it practical at an Urban Indian Health Organization? They've been able to do that, but they took a step further than that. 

They wanted to make sure that they, created an environment, right? Where this is now a part of the culture, that's safety and precautions and, and how we protect ourselves as healthcare workers is critical to them. So, um, I, I think that's one of the things that's really important that I wanted to share and say that I think that's a great story and evidence that this can happen in a continuous basis and to continue on, to help, keep our healthcare workers, warriors safe and of course, ultimately our patient and our community.  

Vickie Oldman: Wow. I'm curious, do you know if Bakersfield is looking at doing a best practice? Overall, what it's making me think about is this particular organization, Bakersfield took something that you all have done. They implement the training. They really thought through things. The reason why I'm bringing this up is because I know in other settings, when you do training, like training the trainer, what I see happening is a lot of organizations get stuck. 

They get the training, they get certified. Then they go back to their facility or their organization. They're like, now what? What do we do? So it, that's why I'm curious about the best practices and sharing the story of how they did it, because it took time and also took commitment probably from the board too, to, you know, have buying about what we're doing. 

And, and so it doesn't happen overnight. That's for sure. Bottom line question is, are you all gonna do more with that learning from Bakersville?? 

Evey Maho: Definitely. I think that, Bakersfield and also Denver Health Center actually has done the training and the ECHOS and the webinars and done similarly things that Bakersfield's doing. I bring up Denver because one of the things that our UIOs are, are really actively, involved with is making sure that if they are a, a center that provides primary healthcare and it's that type of primary care healthcare setting, that they become an accredited type of organization. 

And that requires rigorous preparation to make sure that, not only the policies or the procedures are done, but the staff follows it, and that they're abiding by all healthcare, regulatory body expectations and regulations. there's so many things that go into it. 

And I think that for our CDC, I P C project through NCUI and working with our UIOs , it's really helped in that sense of helping them, understand why this is as important, but it also aligns with some of the work that it's trying to do as an organization. And yes, this is where the board of directors support really comes into play senior leadership C-suite leadership. 

 They play a key role in supporting the staff. And that mobility and that growth and development and sustaining and making sure that there's a sustainable healthcare system there for the people. So this little component that we're talking about, training, that is one of the key things and there's many other key things to ensure sustainable healthcare systems in Indian country. 

This is just one avenue. This is just one pathway. so with Bakersfield and I also mentioned Denver, but there's many other UIOs. They had to work at least the core leaders that were implementing the CDC, IP C training projects at their centers. They really have to work closely with their quality division, safety division, the director of nursing, the director of clinical services and so forth, facilities and management. So there's all these different important components that at that local level, at that U I O level, everybody has to come together to make sure that all the different components within the healthcare system is working in unison. 

 So then we can apply for any type of accrediting, type of opportunities. And that in and in itself will ensure a longstanding sustaining healthcare system.  

Vickie Oldman: Speaking of the training pathway I wanna underscore cuz you said there's only one pathway, right? There are many ways in how organizations UIOs can look at shifting tightening or improving what they have in place, hearing the presentation that Ms. Drummond messaged on June 7th how can staff in various service areas put it to good use? 

Evey Maho: So the training titled "Exploring body reservoirs with pathways, for infection and how healthcare workers can minimize those risks." The training was really around equipping and helping healthcare workers understand the importance of recognizing risk and seeing where these potential problems might happen. 

So at what point do we take action and to keep something from bad happening at that clinic level or at the public health community or or community health service center, whatever type of U I O we have, I think it's important that our staff are first able to understand what a risk is, what could potentially could happen and how do I, as a healthcare worker take action. 

So that was really that risk recognition component of it. The other pieces are reservoir, right? Shay talked a little bit about this earlier in your interview and in understanding where do germs live and where do they thrive?  

 So as a healthcare employee, it's really important for us to understand where that might be. 

 Then finally the pathways, you know, where, um, a way for germs to spread from their reservoirs to another reservoir or even a person to infect.  

So understanding those things. Is really important as a healthcare worker. If I know it and I understand what I need to do to prevent any type of infection, either to another coworker or to a patient or the community at large, I then should be also informed about what precautions to take, what steps do we need to take? 

 Understanding again, also other things as the body reservoirs, if I'm a healthcare worker that, definitely works with patients and their skin to skin contact or potentially, or a GI or respiratory, or even, , any interaction with blood, then I, a healthcare worker should really also understand what the risks are around that. 

 What should I be aware of and how to, how do I take proper precautionary measures? Those are some really important topics to understand as a healthcare worker. And as we all know, science is always changing and it's good to, to attend these trainings cuz the science will change. The recommendations may change. 

And we've learned that a lot, quite a lot this year through the pandemic. In addition to. Not just the healthcare workers, but we also have, supervisors, managers, directors, and C-suite leadership, and even board of directors that may attend these trainings. And it's really important to hear some of these because when we understand what we should look out for. 

What we should do to address a risk, a potential risk or an incident. Then we should really take a look at our policies and procedures and our protocols, and make sure that they're aligned with healthcare, regulatory agencies, accrediting bodies our, I PP seek, , , key learnings and recommendations, OSHA. 

 There's so many things to, to take into consideration. So these trainings are not just developed for healthcare workers, but a lot of the supporting, um, ancillary support programs as well, because we don't do healthcare alone. We've got multiple internal partners that we function with to deliver healthcare to our patients. 

 There's lots of things you can take away from it beyond just the key component learnings that Shay was able to deliver the other day.  

Vickie Oldman: Thank you, Evey. I appreciate you sharing how staff can take away the learning and put into practice. So I would love to bring Shea back into the conversation and we talked a lot about, of course, the topic itself, situational awareness, what can you do individually, what can the organization do as a large, we talked a little bit about connecting. We talked about best practices. We talked about different modalities and how to do this, implementing the learning that you're talking about. We talked about my favorite. I think this is the word I'm gonna take away is a culture of support. What does that look like? Anything else that you wanna add to Shay from what you've heard and what's bubbling up that you wanna emphasize to our listeners? 

Shay Drummond: Well, I think, Evie really hit on something in her last little bit there about the support from the C-suite in the managers and supervisors. And it really does take the entire team and having all levels participate in these trainings, gives them an opportunity to maybe see it from a different perspective, but also maybe they do need to change policies or procedures. 

And, but really. By them attending and being participants. It brings that support , that all healthcare workers need now more than ever. And it really does bring it back to the entire team to stop infections and disease spread.  

So, um Evey you really were speaking my language there and, and music through my ears on, on all of that. So thank you.  

Evey Maho: I think in healthcare settings, we get so, wound up right in policies and procedures and things of that nature. And sometimes to just take a stop and do a quick assessment of even how our I P C program is functioning within the quality division or department is really key and important thing to do. 

And that's one of the things we did in our first year with our five champion sites was to conduct a, a comprehensive, infection, prevention control, program asking the UIOs do we have one in place and all the key different components that go into that. And if the listening audience, those of you that are working with the UIOs, you're interested in that, please reach out to ipc@ncuih.org and get more information on how, you can get started to assess that. I think that tool allowed for a lot of our IUOs to express that it really brought team members from other departments that we don't normally work with in our healthcare centers to come together and that included C-suite leadership. 

And so that support and that understanding and be involved with that type of work and a team approach is really important. 

Vickie Oldman: Thank you both so much for your time, your commitment, your passion to this work, and also being. Open. That's what I get a sense, as I'm talking to you that you're both continuing to be open about what this could look like and bottom line, protecting our workers and patients in this work by education, by policy, by training, by collaborative work. 

So I appreciate you both being here. Thank you so much.  

Evey Maho: I enjoyed our conversation today. Thank you so much for allowing us to share the work that we do. Thank you.  

Vickie Oldman: Thank you both.  

All right, folks. Today, we talked about CDCs national collaborative Project First-Line Infection Prevention and Control Training Initiative and the work in the urban Indian organizations to prepare healthcare staff on the front lines to battle emerging and reemerging disease threats.  

We discussed the key messages from NCUIH's hosted webinar in June, exploring body reservoirs, with pathways for infection and how healthcare workers can minimize risk.  

Just wanna remind healthcare warriors about Project First-Line infection control training, resources and tools that are available to you to help protect yourselves and your 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 Ahé'hee, thank you for joining us. Be safe. Be well.