Educational Webinar: Lessons Learned from the Pandemic and a View into the Future of Safer Healthcare Delivery

Good afternoon everyone and thank you so much for joining us today. My name is Brandon martin. I am the customer engagement manager with McKesson Medical surgical. It is infection prevention week and I am very excited and pleased to welcome you to today's webinar lessons learned from the pandemic and a view into the future of safer health care delivery. Presented by our esteemed guest Dr Hudson Garrett Junior Before we get started, I would like to direct your attention to our disclaimer and while you are consuming that information I will share with you some background on Doctor Garrett. Doctor Garrett is the president and chief executive Officer for Community Health Associates, an adjunct assistant professor of medicine in the division of infectious diseases at the University of Louisville School of Medicine and a consultant faculty member for the newly created Norton infectious diseases Institute, which is a CDC funded training center. he holds a graduate certificate in infection prevention and infection control from the University of South florida, he has completed the john Hopkins fellows program in hospitals, hospital epidemiology and infection control. He is also a fellow in the Academy of National Associations of Directors of Nursing Administration and was selected as a lifetime member in the association, which is the highest honor bestowed upon a member, He is also a fellow in the American Academy of Project Management and a senior fellow and ambassador of the Management and Strategy Institute. He was inducted as a as a distinguished fellow and practitioner in the national academies of practices. Doctor Garrett is a graduate of the Institute for Healthcare Improvement 13 month Global patient safety Fellowship and is a graduate of the I. H. I. Patient safety executive Development program. In august of 2021 Doctor Garrett was awarded the prestigious fellowship designation by the Society for Health care Epidemiology of America in recognition of his work in infectious diseases and infection prevention and control. In november of 2021 he was awarded the fellow designation by the infectious diseases Society of America. and in 2022 he achieved fellow status and board certification in health care management from the American College of Health care executives, heels, graduate certificates and health care leadership from both Cornell and the University of Notre dame. He is an appointed member of the advisory committee for the design thinking and health care program at Rutgers University. He is a frequent international lecturer in the areas of infectious diseases, health care, associated infections, outbreak response and prevention and in infection prevention and control. He holds board certifications in patient safety, health care quality patient experience, vascular access antibiotic stewardship. uh Prehospital emergency medicine, Tactical medicine as a designated infection control officer in flexible endoscope reprocessing, critical care fundamentals, healthcare value analysis, health care management and as a director of nursing in post acute care and infection prevention and control. DR. Garrett served as the lead faculty member for the infection prevention and control, long term care echo collaboration program hosted through the University of Louisville, Traer Institute in collaboration with the Agency for Health care Research and Quality Institute for Health care improvement and the new Mexico School of Medicine, which delivers 16 weeks of infection prevention and control content to long term care facilities across the US. Doctor Garrett led the development of the First and only core infection prevention and control and antibiotic stewardship certifications and certificate of mastery programs in post acute care settings. He has also received the Association for Training and Development Master trainer designation, has served on international and national organizational boards in the areas of environmental sciences, so environmental services Dental infection control, infection control, acute care, infection control, post acute care, infection control and vascular access. He has served on expert panels related to disinfection and sterilization with the United States Food and Drug Administration, Centers for Disease Control and Prevention and the Environmental Protection Agency, most notably serving on the FDA S. Panel and working group for flexible endoscope reprocessing. He is a member of the Scientific advisory board for the Health care services Institute and dr Garrett has lectured around the world and provided testimony to government and regulatory agencies on a variety of topics related to infectious diseases, patient safety and health care leadership. I'd like to thank you. Uh everyone who has submitted a question during the regi registration process. If you have a question for doctor Garrett, please feel free to post throughout the presentation. Uh just locate the Q. And a panel in the lower left corner of your console, type your question in the text box and click send any questions we do not get to today. Uh we will forward along to Dr Garrett Today's presentation is being recorded and a link to the recording will be sent to you within 48 hours of the event. So once again, thank you so much for joining us on this infection prevention week. Uh and please join me in welcoming dr Hudson Garrett Thanks very much Brandon and good afternoon to each of you. We're so honored to have you join us during this special week. And as Brandon mentioned while this is infection prevention week, it is really just yet another day that you do this amazing work that is done regardless of the care setting in which you work. Um I happen to be broadcasting for you today, uh uh live here in Dc at the infectious disease conference um of America. And you know, it's interesting to see people both back together, but also some of the same conversations happening that were happening three years ago. and frankly some good conversations that are happening about moving forward. So I'm particularly excited to share this next hour and a half with you today. Uh As Brandon mentioned, if you've got questions, feel free to go ahead and drop those into the Q and a box and I'll do my absolute best to get to every single question. Uh if not you will have my contact information as well. Um and I'll be happy to respond to those on an individual basis. Uh just for those of you that are wanting to receive Ce credits for today's program. Uh If you're a registered nurse, you'll receive 1.5 hours of credit that does require you to stay on through the Q and A. Um, so make sure that you do stay on for that and the email address um, if you need technical support is listed there and it'll also be available on the the education at C A Associates dot com. Um, you will receive an email from us most likely later this evening, uh if not by first thing tomorrow. So just make sure you check your spam folders. Once you complete that evaluation, you will be able to instantly download your Pdf certificate for your uh licensure and our certification files since we're offering Ce for today's program, you can see my disclosure is available for you here. And we're gonna jump right into our content for today. I I think that this is such an important topic and particularly now as we wrap up 2022, which is just unbelievable that we're already almost at Thanksgiving. Um, but I really want to focus in on sort of three different areas. The the first is really what has happened in the past in sort of the area of core practices. We know that these core practices are really imperative to make sure that we keep ourselves safe, our patients and our residents safe and frankly, the the people that are coming in and out of our buildings. One of the things we can't do again is this visitor restriction stuff that happened before? Uh we all know how disastrous that was for our our patients and residents and frankly for us too. The second area that we're gonna talk about, which I think is very, very, very critical, which is health care resiliency. You know, when I look at colleagues that I talked to. Um I've seen folks that have completely left the field. I've seen uh individuals that are completely burn out. And I've seen folks that are very, very close on that very uh teetering point between uh sort of the the burnout and and really just the um the the max point of what they can take any further. And then last thing we'll talk about how we can sort of maximize upon what we have before us and and hopefully learn some valuable lessons as we move forward I happen to be a glass half full kind of guy. Um I think it's super important to approach life in a way that is optimistic and to talk about the things that we can do versus to focus on the things that we can do. And so I hope when you leave today's program you'll have that exact same attitude and realize that together we can do so many different things. Um and it's it's even more powerful than if we just do things in individual silos. Now part of today's discussion right, is to accept that there will be needed change and and frankly that is an absolute must that we have to to do and this is for every single aspect of what we do in health care. Um, I remember being asked the sort of first six months of covid and someone said Hudson, are you worried about Covid? And I said, well, that's a pretty specific question. I said, are you talking about the disease or are you talking about more of the impact on health care? And she said, well, I, I really meant the disease, but now you have me wondering should I be worried about health care And for me, even as an infectious disease professional, yes, Covid had its absolute worst parts of it for sure. Um, but the overall mortality morbidity was still overall, pretty low, right? Compared to other things that we've seen, right, It doesn't have the mortality of of Ebola or some of these other extremely serious diseases that we have. Right not to discount the the mortality that it did have. But what I was really worried about and what still keeps me up at night is what's happening in health care, right? We've seen supply chain challenges. We've seen people leave health care, we've seen burnout. Now we see these tremendous staffing challenges, not just in health care, but just pretty much in every industry. And yet. We haven't necessarily seen a federal debrief about? What have we done? Well, what are the things that we tried that didn't work and how do we sort of share all of these best practices, right. The more things that we do and the criticality of the situation as much as it was, we're gonna have mistakes and those mistakes can be turned into opportunities so that we cannot make them again. Right. There were things that we did really well. Um, you know, we saw a lot of folks in health care that came together to do what was right for the patients to do what was right for each other But we also saw some holes exposed. And the way that I sort of think about this as an analogy is if you've ever had, you know, sort of a bleeding wound, right. The first thing we wanna do is get a clot formed and while we have this clot formed in health care, it is extremely loosely adhered to the skin. And so all it takes is one little incident, one other staffing crisis, one other outbreak, one other, you know, uh unrest situation and we could have an explosion again. Right. And so our goal is to be able to manage change effectively both as individual health care practitioners, but frankly also as health care systems that are trying to to work together. So let's sort of take a step back and and go back in time and look at what's just happened over the last couple of years, Right. Because I think it, it sort of paints a global perspective of what is a sort of history told us. And if we go all the way up to where we are now, I don't have Monkey Fox on here yet. Um, but you know, up through Covid, for sure, we've had Ebola, right? We've had zika virus, we've got, you know, avian influenza, we've got SARS, we've got, you know anthrax, we've got all kinds of stuff. right. You know, and so it really tells us that historically there is going to be something else that's gonna come down the infectious disease pipeline, right? Regardless of whether we know it or or want it, it's going to come. The question is, is when now, if you sort of look at the years, you can see that things are starting to happen closer together. Now, whether that's coincidence or not, we don't necessarily know for sure. But it begs the question of are we prepared for the next big one? Are we prepared for that next syndromic issue? That next epidemic um that next pandemic? Because this is really the first pandemic that any of us have ever experienced. And so it continues to be a challenge for for us. So what have we learned? Right, what are we gonna change? What are we gonna adapt? Have we become more agile as a health care community. And how do we make sure that we can maintain clinical continuity of care? Whether that's in a skilled nursing facility, an ambulatory surgery center, a hospital dental practice, It doesn't matter. Everybody wants to make sure that their health care can continue to be delivered So then Covid hit right And of course this caused all kinds of issues within the acute care and the non acute care environment. You know we saw big challenges in long term care because of the communal environment of the the resident population. We saw staff members that became ill. We actually probably saw more staff members contract covid in long term care than we did anywhere else. We saw issues with p pe availability and so people were not able to actually get what they needed or they didn't wear it properly. I can't tell you how many times I would walk through a nursing home and actually see people improperly wearing P PE um, probably my most favorite was see an N95 mask worn on top of surgical masks and and yet we still had educational gaps. We had folks that were leaving clinical education, So every single care setting had some type of challenge that we needed to identify and mitigate. But what it really told us was that it's more about people. And so when I look at sort of how do we fix this, how do we get more to the sort of the nitty gritty of this. It starts and ends with people. We have to invest in our personnel, we have to make sure we have the right people doing the right role. We have to have you know, role specific competency and we need to wrap our arms around the folks in which they deliver care because frankly without people we don't have health care. Um and that's what we're trying to do. Many of us went in this profession for a very specific reason. It was to help people, you know, I see patient care as not a right or a job or even a career. I think it's an absolute privilege to take care of another individual. Um and so we want to make sure we treat it as such now COVID-19 did not just sort of stop at the path physiological and the medical components. It had massive impacts on quality of life and quality of care. The thing that really moved me that still sticks out was AAA Gentleman that will just call mr smith and mr smith um was always outside of the skilled nursing facility. Across from one of the hospitals that I regularly worked with during the pandemic and it didn't matter if it was snowing it didn't matter if it was raining, it didn't matter if it was 100 and 50 degrees outside Mr smith was always outside that window making sure that his wife who had dementia knew that he was there Right? And it was because we wouldn't let him in, we would not let him in to go see his his spouse, his spouse of over 60 years of marriage. We would not let him in because we felt that it was going to be dangerous for us and for his, for his wife now his wife was in a private room. we could have issued p pe we could have you know had specific requirements that he could not have left the room. Right. There were all different types of things. Mr smith never went anywhere. Right. He he didn't go out. He he ordered his groceries online. He had family that delivered, he did all of the right things. But yet we in health care did not do the right thing by him by maintaining that quality of care and that quality of life so that his loved one could benefit from his presence. Right? And these are things that we have not fully appreciated now, does that mean that there wasn't some rhyme or reason, especially at the very beginning to do some visitor restrictions or there, you know, especially as we needed to initially understand transmission and how we could mitigate that risk. Absolutely. But to do that for a period of years was just inexcusable in many instances. We've got cost of care issues right? Where you know, patients are now going bankrupt because they can't afford care or there were there there were sort of care issues where people had delays in care, the amount of patients that missed diagnoses for new onset cancer. Um just as an example, I remember going and trying to schedule my very first dental appointment uh during Covid and it was an act of Congress. And I said well when can you see me next? And this is after I'd already missed my six month appointment. And they said we can probably see you in another 6 to 8 months. And I said so I'm supposed to come to you every six months. But you can't see me for another 6 to 8 months which would mean that it would be 12 to 14 months since I had my last visit. And they said yes right. And so we now have these challenges of even getting people back on their normal can it a preventative um sort of maintenance if you will. And then of course we're all dealing with what's happening in the economy and the market and supply chain and mental health. One of the things that was probably the most scary was the report that came out from CDC S. M. M. W. R. Last week. about how many Children were actually experiencing mental um uh distress during covid and still to this day. Right. So the impacts are far and wide. Now outside of that of course we've got things like long Covid syndrome, we've got delayed diagnosis and treatments. We've got sort of these both physiological and psychological impacts that are impacting not only the patient but frankly the caregivers the the the family members, the the broader you know family and even sometimes the workplace. And so this has created a whole staffing component. Um That has been been a big issue for us. Uh for sure Now I go back to sort of a progress report. Right. Are we making the right progress or are we not? And a lot of this is is really looking at both the data. Both pre sort of covid during covid and after covid. Now before covid we were making pretty historic progress at reduction of healthcare associated infections. Keeping in mind that the majority of these, if not all were preventable. So we can do things to actually prevent and eliminate these in our in our patient population. Um and this really applied for any health care setting, right? Specifically, if you were coming in for elective procedures, like an ambulatory surgery, you didn't want to come out with a uh an infection, right? That was not something you consent it to. If you're a nursing home resident, you certainly didn't want to get an infection and and then be isolated in your room. Um and in acute care in other places, the exact same thing. And so what we found is that we're actually losing a lot of that progress and momentum as a result of the pandemic things like antimicrobial resistance have gone up. right. We've actually seen increases in both prescribing and appropriately. Um and certainly resistance profiles. We've also seen increases in sort of weird organisms like waterborne illnesses, um things like ice makers and ice machines, which we certainly use frequently throughout health care by improper maintenance. Because what happened a lot of times was we sort of scaled down on the stuff that we thought we could skim by with by maintaining the water lines, making sure that we actually have the ice machine properly cleaned and disinfected just as an example. So when I look at these numbers on sort of the left of the acute care environment and on the right for the skilled nursing environment these are not good. Right. It doesn't mean that we're you know not gonna make progress. We we can certainly do it again. But what I worry about is do we have the right people that are able and have the right. mindset to be able to make more progress. Um You know the average health care worker right now is extremely stressed out. And and rightfully so and so we've got to sort of reset our expectations reset our our performance measures and really again wrap our arms around people. Um I was in a nursing home not long ago actually visiting a family friend and I walked in and I could just sense the sheer just stress in the building. and I walked up and and introduced myself to the charge nurse and I said I just want you to know how much I appreciate you taking care. Um uh of of this this individual I said she's very very special to our family. And for whatever reason the charge nurse just started bawling, she just started hysterically crying and she said you don't realize how much that means to us. She said sir, all we do is get yelled at. She said we get the complaints, we get the, you know the joint or not, the Joint Commission, the C MS assessments, everybody's coming in. They're filing complaints with the ombudsman everything. She said you're the first person in months that's actually said thank you. Um And she just literally was so appreciative, right? That small act of kindness, that small act of recognition from an outsider, a member of the public can go a long way, but it means even more when it comes from your leadership. Right? And so leaders have got to be present and and really in the the forefront of of our institutions. So how does this apply across the entire continuum of care? Well, you know, care is not just delivered in a vacuum, And even if you have somebody, for example who's a skilled nursing resident, they have to maybe go out potentially for dialysis. Maybe they have to go out for a specialist appointment at like a podiatrist. Um Maybe they go out to see their family, right? You know, they they may have to have some type of surgical procedure and go to a hospital. So the boundaries of health care are always evident flowing. And what this means is that the patient's risk factors are also going with them. And so it doesn't matter where they are in the continuum, it's all about the level of care that we provide and sort of making sure it's continuous. My little brother happens to be an attorney. Unfortunately, just with personal injury, which is a very difficult subject for for me to deal with as you can imagine. Um, but I have great and immense respect for his expertise and he frequently talks about something that I found very valuable in my career, which is Hudson, it doesn't matter where you deliver the care. The care is the same and the expectation of care is the same for my client right meaning his patients. And and that makes a lot of sense. So it doesn't matter if you're getting care in your dental office or if you're going to a blood mobile if you're at a nice skilled nursing facility or if you're in a hospital this the patient the resident has the same exact expectation their care will be safe. It'll be efficacious and it'll be cost effective. Right? That's our promise to our patient. And that really sort of centers around the Institute for Health Care and Improvements, AAA concept. Right? So we've got to make sure that we think more broadly and strategically through what can we do to implement these infection control measures. Well, as if Covid was not enough then we had monkeypox, right? And we're still dealing with monkeypox. Um, you know, and monkey pox for all intents and purposes is really more like a sexually transmitted infection. Right? It is not the same as Covid. It is very, very different. We absolutely know how it's transmitted. We actually have a fairly effective vaccine, we have diagnostic capabilities. And so in many ways we're way ahead of the game in terms of this. Now that being said, we've also seen a lot of pushback especially to CDC for some of the stigma and the communication surrounding this. So think about sort of Covid as an example, right? We had some mistrust associated with that And now we've got some anger and mistrust associated with monkey pox. Right? So this tells us that we've got to do a different type of job in our health care communications. We also unfortunately just saw our first masoum transmission that was occupationally expired in the state of florida where a nurse unfortunately had a needle stick and has now contracted monkey pox. And so this is the first time we've seen this in the US. Right this. goes again back to the term safety, Right? We've always used the term patient or resident safety. I'm no longer using those terms. I sort of stopped doing that mid uh covid because it's really now about health care city. I need to make sure that you as my team members are safe. I need to make sure that I'm safe. I wanna make sure my my patient or my residents safe. And I absolutely want to make sure that any visitors or family that are coming in are safe as well. Right? Because at the end of the day, it takes all of us to provide that proper care um for that person. and that's what we're really trying to achieve. So how can we really take this back to the basics? Well, the very first six months of covid, I remember walking through the hospital and people because they knew I was taking care of of covid patients and folks would just think I was like the human plaque. Um, I, I absolutely distinctly remember taking the very first patient through the emergency department. Uh, and I, I turned around and I smelled bleach and I thought, why do I smell bleach? And I'm in full p pe the patients covered mask everything that needed to be done. And I turned around and there are three of these very, very quick environmental services professionals that are chasing me down the hallway with. mops and rags bleaching everything that they think that we've touched right now. Keep in mind we didn't touch anything. The patient was on a stretcher, we were holding just the stretcher. We had gloves on full. You know, P pE we actually had a runner that was opening doors for us and pressing buttons and all that type of stuff. We were touching nothing. But the perceived perception, right, was that there was this risk to the environment and that we were going to transmit this plague, if you will, uh to others In reality that was not at all. What we needed, what we needed was a more comprehensive approach to good p pE management, certainly good communication and and sort of care standardization. And really going back to those basic competencies, things like washing your hands uh wearing a mask appropriately, uh making sure that we isolate patients as quickly as possible if we suspect that they have any type of communicable disease. Right. These are all common sense things. They don't require a textbook or specific policy. It does however require critical thinking. Now, if we sort of take this a step further, then we've got sort of a different layer of the onion to peel back, which is our regulatory, you know, I'm here in DC, uh actually about two blocks down the street, the FADA exists? Um and then about you know 15 minutes from here the EPA is is and I present it to both of these organizations both very very different same types of roles within um the federal government but they just function very differently. You know FDA likes to to say that they're a public health agency. Whereas Epa is definitely AAA sort of different animal but they have complete jurisdiction over all of our disinfection products. Um So anything that's gonna be used on an environmental surface is gonna be there. Whereas FDA is gonna have certainly jurisdiction over medical devices um certainly P pe uh all of your drug products both over the counter as well as R. X. And your high level disinfectants. The challenge is that there's not a lot of collaboration between these two agencies. So CDC is sort of the conduit between them. Um, because CDC is also a public health agency. Uh, they don't have any binding guidance. So anything that CDC tells us to do in health care, we're not required to do it. And so that creates sort of another little um issue. Right? Do we do it? Do we not do it? Do we take what we want from the guidance all of that type of stuff? And so I think one of the lessons learned is that all of our federal agencies including F. T. A. Epa CDC and the Department of Health and Human Services have to truly be more functional, more agile and more like a a responsive public health agency. What we've seen with some of these agencies is they become more bureaucratic and more academic And the challenge with that. You know, it's not to say that our academic partners don't do great work, they do right. But their ability to respond quickly is more limited by some of the the sort of infrastructure internally. And so we need to be more agile. Just as a health care system. Now. One of the things that CDC put out that was particularly helpful I thought was sort of the I call it the stoplight approach to crisis capacity and sort of managing different capacities related to products. And so if we think back at the very beginning of the pandemic, I remember getting the email we are no longer gonna have P pe effective at 12 tomorrow if we don't get a truck in. Right. That created a lot of alarm. And I also remember being made fun of when I bought my own papper very early and it was almost the first month of the pandemic. And I sort of saw the writing on the wall and I immediately started calling around the suppliers and said I want to get some mappers. And so I ordered one for myself uh and and some other people that were in my department and people said well why would you why would you do that? And I said because I want to be able to guarantee that I have my own respiratory protection so that I can continue to care for patients. because there will come a point where we don't have the supply chain infrastructure in order to maintain that. And sure enough, that's exactly what happened. And so CDC created this sort of stoplight approach which was green was conventional, yellow was contingency and then red was crisis. Right? And we're really not at crisis capacity for very many things with the exception of a few drug types. products right now, um we've got that that sort of with a couple of per operative items that I'm aware of as well, but those are typical um sort of intermittent manufacturer delays. But what we did see was many, many health care facilities were functioning in sort of the contingency crisis, right capacity where they're able to get some products, but it was not necessarily the products that they actually wanted. So it was either different brands, different types. So maybe you could get gloves but you couldn't get the type of gloves that you wanted. And conventional is essentially where everything is hunky dory, right? You're able to get your supply chain, there's no problems. You can get the products that you want. I knew that we were running into a challenge and many of you may remember this when CDC put out guidance about reprocessing gloves. And I I remember opening that email and I sat back down and I said oh my goodness right, this is now the place that we are, we are potentially concerned with having to actually reuse gloves in the United States of America right? And thankfully due to you know many, many different suppliers being amazing partners. Um and doing everything that they could we were able to avert that crisis. But that should be something that we play back on our head to make sure that we're working proactively with our supplier partners to make sure that we're forecasting what we need on a routine basis, right? And anything that's in the red category CDC is really defined as not part of the US standard of care. So this is not something that we should ever see happen here. This is really for less developed countries. We see a lot of this with the world health organization guidance documents as well where countries just simply don't have the resources and maybe they do have to reprocess things like needles and syringes and stuff like that. But here in the US we do have the capacity and certainly our standard of care is going to be sterile and disposable for many of these types of items. So now that we've talked a little bit about the historical perspective, I want to talk really about what we can do to enhance our ability to be able to respond to some of these things Now if you look at this slide, right, you may be able to instantly relate to this. The dominoes are starting to fall. The pressure is on, you're holding up that one domino trying to prevent the rest of your team from falling as well. Maybe that domino falling represents staff leaving or uh an overburdening patient load or a difficult, you know, relationship with your administration. It could be multiple different things. But what we find is that health care workers are doing this both visibly and invisibly. Um I was talking to a good friend of mine that's a neighbor um happens to be a neonatologist and I I actually rarely inter uh sort of interact with this person about work stuff. It's more personal stuff. And I I looked at him and I I I said are you ok And he said, I'm not sure right now. This is somebody who I would say is fairly stoic, generally emotionally. And that was a red flag for me. And about 20 minutes later he said, no, I don't think I'm OK. And I said, well, what's going on? And he started telling me all these things and they represented individual dominoes that were falling in his N. U. It was staffing, it was supply chain, It was sort of the animosity and sort of the mistrust with leadership. Right? And so these were all things that he was dealing with as a leader that uh really sort of bankrupt us. So the way that I look at sort of resiliency, especially in health care is I I treat it like a bank account, right? When we get up in the morning, we wanna have a positive bank account. We wanna make sure that, you know when you get that text from bank of America or whatever bank you choose to use that. It says that you have a positive balance. Nobody wants to get up and say you've overdrawn or anything like that. But yet that's what we do sort of verbally every day in health care, uh particularly the nursing profession being the number one trusted profession, right, Many years in a row. The reason for that is that patients know that the nurse is gonna advocate for them and they really rely upon that that safety net that's present there but in some circumstances this is also done at the expense of the health care professional. We see this with physicians and nurses and technicians and C. N. A. S. And pretty much anybody. Um And so that combined with the impacts of the pandemic has essentially left people completely out of gas. And so the way that I address this is you have to treat it like an ATM deposit in an ATM withdrawal. so let's say that you go in and you're understaffed. That's a withdrawal. You have a really rough day with your performance review. That's another withdrawal. You have a a tough situation and you lose a patient, that's another withdrawal. So how do you then get yourself back up to a few uh you know, to to full status? So that when you come back the next day, you're able to give that patient or that resident or your team members exactly what they need, Right? And this is particularly important for leaders um taking that opportunity to sort of reset yourself is gonna be really important because what we found is that we understand the impacts of stress, We know the impacts of cortisol. We know pat physiology how this happens. But that sort of manifest with with long covid syndrome and comorbidities can be particularly challenging for our staff members, right? If you've got somebody, for example that struggles with migraines, well, guess what? When they get really stressed, they're gonna trigger a migraine. Maybe somebody who has already got some cardiac issues, you're gonna, you know, send their blood pressure high high Um This is this is something that people don't even think about, right. Some people eat a lot when they're stressed, some people don't eat at all. Right, I wish I was one of the people that did not eat at all, but I'm not right. And so everybody's brain chemistry and sort of their response to stressful stimuli is going to be different, but what we have to do is figure out a way to manage that and help recognize this. Don't be afraid to walk up to a colleague or a friend and say is everything ok? The power of that simple sentence, That simple asking of that question can be hugely hugely influential. frankly in saving lives. So I I like this particular graphic because it sort of shows us the overall continuum in terms of performance management. Now, if you sort of think about where we want to be, that's gonna be our intended performance at the very peak um of that. But what we find is a lot of people are sort of hovering right now at that point of exhaustion. really teetering towards breakdown and burnout. Right? And what's happening throughout that entire fatigue process is that when that's when people's health starts to break down, you really lose the momentum, you lose morale. You start to see more mistakes as well, right? And then once they get to that point at breakdown, that's where we don't have a lot of chances of recovering them. So, think about this almost like a hemorrhagic shock, right? There's multiple different stages of shock, but once you get to stage three and stage four shock, it's very, very difficult to reverse that because not only is the body lost too much blood, right? We've got that hypovolemic shock going on, but it's also turn off the entire body's chemistry that homeostasis is lost and it's really difficult to really repair that. So I think that that's definitely going to be an important element that we have to consider, right. You know, it's, it's definitely something that we have to be aware of with our colleagues and our friends and our patients as well. If something doesn't seem right. It probably isn't and we have to have an opportunity uh, to address that. And so my advice here is that when you see somebody that's teetering in these dangerous areas, invest in them, spend the time with them. Because you would hope that they would do the same for you. and also invest in yourself, right? It's very much like when you get on an airplane and they say our first priority is your safety and our second priority is your customer service, right? Our first priority for you as health care workers is to take care of you and our second priority is for you in a good condition to be able to take care of our patients and our residents, right? But they can't, they can't be done independently. They have to be done concurrently. And so compassion fatigue is what many of us are experiencing. I I tell you, it's it's scary. I experienced this um you know, several months ago with a particular case and I I think God recognized it right? And said, OK, I need to take a step back from this. This is a particular case that For whatever reason, it just got me, um, it happened to to do with uh child abuse and some other things and it just really, really got under my sin for obvious reasons and I had to take a step back and get another provider to get involved in this, right? And the same is gonna be true as we see more and more folks in some cases, making decisions that we don't agree with, right? Maybe you are super pro vaccine and you're upset with that patient because they didn't receive a vaccine or maybe you're the complete opposite. It doesn't matter, right? I'm an equal patient opportunity person. So if you come to me and you need care, I'm gonna provide you care. Right? Our job as health care professionals is not to judge. It's to care for. Um, if you're looking for a really great video, um, following today's program, I would encourage you to go on youtube. Um, there's a, if you just type in the search bar, there's a video called the difference between care and caring. Um It's out of, I think Alberta Canada and it is one of the most moving videos that I have ever seen, it's quite short, it's maybe four minutes long. And essentially it's a a video of where health care workers that were already doing a difficult job actually were able to do something pretty special where a a husband and wife came in independently through the emergency department, uh both were not gonna survive. Um One was already admitted and placed into a room and a a an astute nurse said this sounds like a patient with the same name that I took care of earlier. I wonder if they're related, went into the chart, figured out they were related and was able to get bed control to move them together so that they could be together, right? And I'll tell you it's just an amazing representation of what we can do to influence caring, right? We can all provide good care but to provide caring is a different level, right? And it will also help us get away from this compassion fatigue that we're many times experiencing because resilience is almost like a bounce back still. Um Think about it like jello you know if you throw jell on the ground, it's it's not necessarily just gonna shatter. Um You know it's gonna also have the ability to still survive to a degree. It has that ability to sort of absorb shocks and we need the same thing in health care. We need people that are able to absorb and roll with what's going on. But we also have to invest in them heavily to make sure that what we're doing is going to be effective in managing their needs as well. Um And and really just define what their boundaries are right? Everybody has sort of a threshold. And once that threshold is exceeded. That's sort of the point of no return. And so a lot of people don't even know what that is. But for me, resilience is is really a critical thinking skill. It's something that allows me to use a mindset to say it is possible it is going to happen. I can do this right? So that it can be done either for our team members or for our patients and our residents that we serve, And there's lots of different ways to do this right. You know, if you look at sort of what T. S. A. Does and and I'm not saying that T. S. A. Is by any means perfect. But you'll notice it always seems to be when you get to the front of the line that they have to rotate. I I know this happens to me every time I travel and it kills me I'm waiting in line, waiting in line, waiting in line and then they they actually have to to change roles. The reason they do that is they rotate positions for two reasons. One is from an ergonomic standpoint, but they also want to make sure that vigilance is maintained because they're doing security operations. And so it makes sense not to have somebody parked in a chair right where they're not moving for for hours, we don't want to do that. We wanna make sure that somebody is moving and rotating. And so they get them standing up, blood flowing, they put them on the x-ray machine, all of that type of thing, Consider things like wellness stations. Uh, one of my my dear friends that's now chief nurse and executive for hospital did something I thought was brilliant. She said, I can't give up, you know, people a lot of money. We don't have a lot of money. But she said, what I can do is I can give them something that they won't give themselves, which is self-care. And so for several weeks she actually hired around the clock massage therapist to be available. So she had five or six chairs at the employee entrance. You can sign up anytime during your shift. Um and they would do 15 minute chair massages. And it ended up where they would actually go unit to unit. Um as as needed as well when they had staffing to do so. But it was all about making sure that the staff had something done for them. right and and when you left, she had a a nursing leader that was present every single shift when you came in and when you left that had a thank you card and told you personally thank you for your efforts and thank you for what you did the day for those patients, right. That's a true example of both leadership and taking wellness to a next level. It also allowed sort of that self-care to be present. There another facility that I walked in had a AAA sort of a a phone in a hallway and it had this interesting sign and it said for help pick up the phone and call here. And I thought well what does that mean help? And so I asked another staff member I said what what is this help? I said is that like the internal code um you know are they is it for calling a code? And they said oh no that's for our our our um our mental health department. And I said your mental health department. And they said yeah they said we open this during covid and and if you pick up the phone they'll connect you with a licensed uh social worker or a psychologist that's on call and available 24 hours a day. And I thought this cannot th this can't be possible. And so I picked up the phone right, I didn't work there but I I thought I'll test the theory. And so I picked up the phone and called and sure enough they it was I got hospital security and they said just hold for just a moment. Uh They asked just asked me for my first name so they could transfer the call and lo and bald. And two minutes later I was talking to a mental health professional right? And I said are you on site? And she said I am on site and I said oh I said so you actually will see people in person. She said absolutely and she let me know her office was I ended up going up and just introducing myself and I said just out of curiosity, how busy are you? And she said we probably see 15 to 20 people in a 12 hour shift. Right to me that's a successful strategy. right? And this was somebody that was already on staff at the hospital already knew many of these people already had a relationship with them. And it only made sense to do something like this because from a human factor standpoint, that human element of compassion, that human element of saying leadership cares right and is providing this resource is really, really important because when we get resilience down we can actually do many different things, right? We can staff better, we have lower absenteeism, we don't have some of these bad behaviors where people go to the wrong things for stress management like overeating and use of substances and things like that. And frankly we see a decrease in mortality and morbidity, right? Not just for our patients and our residents, but also for us as well. You know, this is definitely something that we have to be much more acutely aware of. And so that sort of clinician well-being hub is a way for us to approach things differently, right? To understand where people are coming from and frankly to use many different modalities and tools to say we're with, we're we're with you, we are completely invested with you. Um I remember reading an article and I can't remember where and it was a story of the C suite of a particular hospital system. And I I think half of the uh C suite has some type of clinical background, either physician or nursing, but the other half did not And the Ceo was not a clinician and he got some feedback from a nurse that was brave enough to do a survey and he remembered reading it and and the feedback was, we've not seen our leadership the entire time during covid And he actually saw that one night was so upset by it. He actually came into the hospital went and tried to find this nurse. Now you would think well maybe he was gonna go scream at her. No he was not. Um he actually met with her, he he knew she was on night shift based on the survey results and spent an hour talking to her trying to learn where she was coming from and said what can we do to fix this? And she said be with us be with your people. And so every um week. the C suite uh committed to spending 1 12 hour shift in a unit. And so I think there were about 20 people in the C. Suite at this institution. All 20 people they picked the day of the week they wanted to do um and they would all go out put on scrubs, do everything from bat patients to help the nurses. Um You know basically do anything that was needed feed patients. These were the C suite, the executive suite of a large hospital right now. Imagine the impact there on clinician well-being because it was really putting the the the the staff first. Now as we think about what we can do for future pandemics, right. A lot of this gets down to having syndromic surveillance to know that something is happening before it truly happens. It's almost like that automated early warning system to say that hey, there's a potential hurricane coming. There's a potential earthquake coming. We need to know when there's potential pandemics or outbreaks coming. so that we can take additional steps. There's prophylaxis options in the form of vaccination or other um pharmaceuticals that we might see. And we've seen a tremendous development uh in this area. the M. R. N. A. Technology um has a lot of promise for many different things well outside of just the covid platform. Uh And so it'll be quite interesting to see what comes out over the next few years for sure. And you know just in the last three years alone our therapeutic options for things like antivirals has exploded. And I I'm very thankful for that and I'm sure each of you is as well, but remember that there's not a one size fits all solution, every patient is different. And so we can't just be overly reliant upon one single thing. Now, what about our health care workers? Right. You know, part of this starts and ends with leadership. If you don't have good leadership, you're never gonna have the right level of support and nothing will be truly sustainable. And so it all goes back to frontline visible transparent leadership, Imagine if health care leaders had said something like we actually don't know when we're gonna get the next shipment of P. PE. But here's what we're doing in the meantime because your safety is really important to us. That's a different conversation than not telling people that P. P. Was not available at the time or giving them very subpar P. PE. And not explaining what was taking place right. These are all things that we need to be a lot more aware of. Uh from that perspective So this is something that we can be a little bit more vigilant with for sure. And then also making sure that we are sort of advancing the the, the pendulum here and the needle by getting folks out to the front lines of leadership wherever care is being delivered. Because the innovation doesn't happen in the executive suite, it doesn't happen in the administrator's office, It happens at the front lines, right. And a lot of this is gonna go back down to cross training, you know, why is it that we laid people off during a pandemic? I I don't understand. Um I had several friends that worked at a pediatric hospital that were all anesthesia providers. They were all furloughed for two or three weeks during the pandemic. And I thought to myself, so let me get this straight. So this is the first year of the pandemic. This was when everyone was getting intubated. So they were all in ventilators and we have this set of ex airway experts that we are furloughing simply because they're in a pediatric hospital Right. And so at that time we didn't have a lot of pediatric patients um, you know, thankfully, um but they could have absolutely been repurposed to adult care hospitals, We could have done emergency privileging and things like that to be able to do that. We need that cross training, you know, we also have folks like paramedics that have a very unique skill set that can be explored to to be leveraged and not just in hospital emergency departments but acute care settings. And uh our uh I'm sorry, uh long-term care settings in other places. We saw a tonn of fire departments step up and be part of mass vaccination uh processes because they can give vaccines. A lot of people didn't even think about that. And unfortunately we've seen a big exodus of public health for mass vaccinations. They're just simply not doing that work due to manpower, So our interp profession teams can include a variety of different people, right? We've got to also make sure that we have the ability to communicate with folks, so we need interpreters. We've got to change away from sort of this just in time. um you know, a delivery system for products and move to something that's gonna be a little bit more robust from pandemic preparedness. But re recognizing that if we can't get our products that we normally use, we need to have a process in place for just in time in service so that folks can still use these products but do it safer than Reliably. Right, just because you switch a product does not absolve you of the responsibility of still training on it. And so that's gonna be an important element that we've got to con uh sort of consider, so how do we advance capacity? Right, well this is a big one, you know, I I always get worried, I happen to be a big chick-fil-a fan. Uh this is an example. I live in Atlanta. So it's where they're headquartered and I knew something was awry with staffing when I would start to go to chick-fil-A s and they would say we can't staff, our we can't staff our organization. We can't do curbside our our drive-through is slow because you know obviously they've got some drive-through challenges in general. But they would say our drive-through is so slow because we don't have enough people cooking right? And that told me something. The same was true when I went to a waffle house, right, which has historically been a lean organization, but you know, if you know anything about waffle house, they also have sort of the pandemic preparedness or the emergency preparedness barometer. When a waffle house closes, like it did in florida during our our most recent hurricane. That is a true testament that a disaster is occurring, right? Because most waffle houses can actually sustain, so they have the capacity. So what can we do in health care to maintain the capacity that we need to be able to deliver upon on our promise to our patient Well, part of that is we've got to rebuild trust and this is at every single level of health care, right? And it doesn't matter sort of what your views are on this. It's all about going back to the point of data transparency and sharing all of the data, right? We can't just pick and choose the data that we share. It's got to be really uh much more robust. This includes vac scenes as well. We've got a lot of questions right now around some of the bivalent vaccines because of data transparency. And those are fair questions to ask. Right? We want our patients to feel extremely comfortable knowing the medical decisions that they're making and our job is to give them the data to allow them to make those decisions and to frankly answer all of their questions. Um I have spent so much time answering vaccine questions. I I my head probably wants to spin off but it's important and it's important and it's the right thing to do for our patients to be able to take that time to do that. How do we analyze adverse events? Right. So that we can then share that information with our medical community. We can learn from that both here domestically in the United States but also globally. There's a lot of great data. Um some of the best data that I've read has come from Israel where they published a ton of stuff in the peer reviewed literature that's been extraordinarily helpful in understanding what are the right ways to treat therapeutically. How should we look at this diagnostically? What should we do in schools? Uh, that type of thing. And that helps us get ready for new novel pathogens that might come down the pike in the future. Right. And and my thing with a novel pathogen is I don't have to know a ton of detail about something. But what I must absolutely know is its route of transmission if I know if it's contact or droplet or airborne or vector. Then I 100% know how to stop transmission from person to person, right, whether that's from us to the patient or vice versa or from a patient to a patient. And so if we know how to stop it, right, then that's what we need to focus on for sure. And as far as rebuilding trust that really is in every echelon of our health care organization, both here in the United States as well as globally. Right on a national front, I'll just give you one example that I think we can all relate to, right, if you think back to sort of that first year and a half of the pandemic all of a sudden, OSHA came out with a guidance right? That was going to be this interpretive statement related to health care worker safety for covid. And they got a lot of pushback and rightfully so because that guidance was so um delayed by coming out that pretty much every facility was already doing the things in the guidance. They were already taking those steps. And so as OSHA's, you know, primary and only job is to protect the worker, right? They really didn't meet the mark here. And so this is a uh an opportunity if you will for us to go back to our fundamental responsibilities, right. Whether that's us at the local level delivering care. Um, maybe it's in a nursing home, maybe it's in public health all the way up through the national and the global uh perspective, right. All of us have a role in doing that and it allows us to really rebuild the trust with the public and frankly with each other. Um, that's an important element there for sure. and and I like to focus on sort of three pieces people processing product in that order. If I have the right people doing the right task that are empowered, right, supported by senior leadership and given the ability and the runway to do their job, then so many different things are powerful. There's a great book out there. I encourage you to read. It's called the patient comes Second. Uh It is a book that frankly I struggled with the title because everything about us as health care providers has been the patient comes First, Right? And, and I remember the CEO, um, I had the opportunity to meet him that wrote it and he said, Hudson just read the book. Just forget the title. Just read the book. And I read the book and I thought I'll be dang. This is exactly what he meant. It's all about taking care of the folks that take care of the people, right? Because again, without health care workers, there is no health care. And so he had a brilliant strategy of my job as the CEO is to take care of the frontline leaders and make sure the front line leaders take care of the frontline team. And then from that they will receive good patient care. And part of that also requires highly reliable, sustainable processes that are designed to do the right thing. You know, we've seen an unfortunate incident recently with the uh nurse in in Nashville, right. Where a system was overridden. We had a a patient adverse event. We saw a AAA patient harm. Unfortunately from that. uh um in the form of a death, and now we've seen both civil and criminal responsibility associated with that, right? That tells us that that process failed, right? That entire process failed. And so what do we learn from that? How do we make sure that that is not blamed on an individual, but really blamed on a process and making sure our processes are designed to get success uh versus designed to allow folks to to skirt them. And then lastly, is the product right? The product may be a widget. It may be a process, it may be an electronic health record, it could be all different types of things. But is that process gonna actually help us do our role more effectively, whatever that role may be. Right. Electronic health records are a perfect example. They're a double edged sword, right? You need them. But you also hate them at the same token because we we get so entrenched in documentation and charting that sometimes we forget to just be there with the patient. Uh, when I had my recent physical, um, I remember pushing the monitor out of the way because the internist who I just love, he was not looking at me at all the entire visit. He did not look at me, he was only typing in as I was talking. And I finally just pushed the monitor out of the way and I said, hey, I'm over here and he said, oh my gosh, that's and he said, I'm so sorry. He said we're just just such on a time crunch to chart. He said, if I don't do it, I'll forget it. And and while I respect that our job is to be present for our patient, right? And that's really important. So finally, I wanted to explore an area that really looks at forward thinking pandemic preparedness, your survival kit, if you will, and what we can do. Right? So a lot of this revolves around what can we do differently and how do we make sure that we're ready for that next big one? And we've really talked about people and teams, uh we know that we need to invest in in in in individuals and and wrap our arms around them and build stronger teams for sure, But one of the things that I did was I got reusable p pe right? I have reusable gowns. I have a papper. I have elastomeric respirators. I've got my own face shields right? We could absolutely do things like that so that every single clinician has respiratory and eye protection. This is not something that's super expensive and elastic respirator is an example cost about 15 to $20 right? A face shield. Not very expensive at all. That's something that we could give every single health care worker Right. And and allow them to have that protection. Now, that may not be our first sort of go to. But when we run out of supplies, right? And we have supply chain challenges, we always have a backup plan. The same is true with stockpiling, right. Stockpiling, that is not strategic is not good because then we have sort of hoarding. But when we have really good stockpiling and we work with our manufacturing and distribution partners to say, here's what we think we need based on our patient utilization. And our historical information, right? We've now got almost three years of pandemic utilization. We should be sharing that with our distribution partners so that we can really prevent any product continuity gaps and then figure out how you can do a more team based approach whether that's getting involved with your materials management folks. Uh certainly our occupational health colleagues are a big part of this conversation, especially after this pandemic. Uh we've got our infection prevention. If you're fortunate enough to have one of those full time or have a a consultant in that area, And another area that is big right now is human factor engineering to make sure that we take ourselves out of the problem. Right? When we are involved, there's gonna be lots of variability and inconsistency and that's just the nature of the beast because we are imperfect, right? None of us is perfect. And the more we can either automate or eliminate the risk from the equation, the better off we will be. And that allows us to really put that patient and resonant back at the center of what we do But it also says that this is an interconnected sort of moving uh amoeba almost to a degree where it's not just us, it's not just the accreditation bodies, it's not just the the manufacturers, it's not just distribution but it's also things like regulators and our accreditation bodies to make sure that we have the right tools and resources, you know, putting something in Ac MS regulation for skilled nursing facility without providing the resources to do. It doesn't really help anybody. It just makes C MS feel better right? What we do need to do is do things that make a difference that actually help residents that help the the the the team and long-term care facilities that help the team in a. S. CS that help the team right? In primary care and other outpatient settings. Because we know that so much of our care is not delivered in a hospital and it's got to be an opportunity for us to be better prepared. What about continuity of care? Right. We've talked about the value of cross trained health care providers but we also can be using tools like what the CD C'S published their pandemic preparedness calculator where you can actually use your P PE utilization and share that and actually calculate that out for a period of of months and up to a year. right. That allows us to have more redundancy in our supply chain operations. But it also gives us sort of a scalable approach where we're not gonna be caught off guard and again have different levels based on those CDC sort of yellow light, green light and red light approach. You know, if you've got tons of disposable mask, great, but there may be a time where you don't. So what is your next level, protection um in order to provide respiratory protection to all your teams. And that sort of leads us into this sort of new era of the infection prevention. Right? And again, every single sort of setting is gonna require customization. We know that the regs are different. Some places don't have regulations. So really like outpatient care for the most part doesn't have a ton of regulation. Um and they're not gonna be in expected. You know, A. S. C. Certainly are skilled nursing is and certainly hospitals. Um But we know that there's gonna be challenges in areas that are not regulated heavily. And even in places where there are regulations we still see some of the exact same challenges, but we need to make sure everything is individualized and gonna approach the clientele that's being served there and also based on an infection control risk assessment. And so this new infection prevention is in my mind is a totally different looking person. right? It's not just based on data collection or public health reporting or sitting behind a desk. It's got to be somebody who is much more at a leadership level. Um you know, an individual that understands quality and finance and and really speaks to patient experience and understands change management and and leadership theory and is really deeply rooted in patient safety. You know, that's one of their reasons I got board certified in patient safety, health care quality and patient experience because I thought it was important um you know to be able to talk to those different aspects of care is pretty unheard of right. You don't see people that jump across those fields very often. But I thought that that was something that was unique um and that we needed to do in order to advance the way that we could solve these complex problems and that skill set then becomes even more evolutionary, right? It's not just understanding the science and the bugs and the isolation precautions, but you're gonna see some additions here with understanding more implementation science and behavioral science. Being able to customize that for specific audiences, right. You know, if you're talking to physicians, it's different than if you're talking to Ac N. A. If you're talking to environmental services colleagues, it's different than if you're talking to physicians as an example. And that concept of change management is really gonna be an important element here for sure. And just as an example, look how things have changed in just the last five years, five years ago there was one certification for infection prevention, it was the C. IC and it was for hospital based personnel for the most part. Now you see two actually in skilled nursing facilities, you see one for ambulatory surgery, you see one for emergency medical services and now there's one for dental. Right? So that tells you that the interest in sort of advancing the profession and professional certification right? In infection prevention world is is high, but it also tells you that customization is key. We have to make sure that people don't just use certification as sort of a stopping point. It's really a stepping stone, right? Because board certification is a minimal competency based on the nat national Job analysis. So that means that based on a national job analysis, you are deemed cognitively competent on a set of of questions. right now, what does that mean? Exactly as an employer. Well if I'm if I'm hiring people and I have one person that's board certified and one person that's not, and all your other qualifications are equal. I'm hiring the board certified person every day of the week, just like if you were having brain surgery, you would go to a board certified neurosurgeon. I don't think anybody on the webinar today would say, let me go to a non board certified person that didn't do a fellowship, right? You want to go to that expert in that area? And so as we sort of summarize it all goes back to taking things to the next level, right? We've talked about our role, we've certainly talked about more of that national role, but these government agencies that are listed here have also got to turn a new page right? They have to listen to the people if you will. Um, and make sure that the guidance that's coming out is much more pragmatic, it's it's gonna be easy to implement, it's gonna be thoughtful in its approach so that we can actually be successful with it. And it actually is gonna measure success, right? Because what we don't want to do is waste our time with things that don't work. Um, you know, that's that's definitely something that we don't want to see. And we've seen examples of this where folks are driving down the road in their car alone wearing a respirator, right? This is an example of information that's got misconstrued. And so we've got to do a better job of communication, sharing data and really, again, advancing the evidence based practice. You know? Most importantly, there are so many wonderful things that have come out of this pandemic with people stepping up. Uh people much like yourselves that have done amazing work every single day and that's why I'm always hesitant to celebrate infection prevention week because it's really infection prevention day is every single day. Um and so I'm extremely thrilled that McKesson took the time uh to host today's program because it's it really is a great recognition um of the amazing work that each of you do every single day. Remember though that it's it's a journey, right? It's a stepwise journey that's always on the move. I always treat this like a a moving escalator in the in the the sort of airport, right? You're always continuously moving and as you continue to move it it allows you to grow professionally and personally and be ready for that next pandemic. It also allows your facility to be better prepared, right? Having that cross training, have that preparedness and it all comes back to leadership? with leadership investment. You can do so many different things without leadership investment. Your your sort of success will be very term limited. And so engage with your senior leaders, invite your board, if you have a board of directors to get part of some of your meetings uh and use those things to your advantage. Uh As mentioned before. If there's questions that I don't get to uh during today's uh program, feel free to send me an email and I'll be more than happy to respond to you? Um If there's a particular tool that I referenced during the Q. And a. Uh and you'd like a copy of that, you're welcome to shoot me an email. And I'll also try to respond to those um as quickly as possible uh as well. So with that Brandon I'll turn the program back over to you to get our Q. And A kicked off. Excellent. Thank you so much. Doctor Garrett. So uh we've had a number of questions come in during the presentation. I'm gonna start with the ones that were submitted uh during the registration process. So um let's see uh our first question, do you think there will be a Covid and flu vaccine combo in the future? I think that's a high possibility for sure. Um You know, the the M. R. N. N. A. Technology particularly would lend itself to be able to do that pretty quickly. Um The advantage of the M. R. N. A. Technology uh is uh multiple different fold, but one of the things is the production capacity. So you you should be able to see something like that, you know whether or not it it happens in the next year or two, who knows, there will be some specific testing required for that. Um That is one though that I I think it's we've got to be really diligent about. There's already a lot of confusion and frankly mistrust about vaccines and even with the bivalent boosters because there were no clinical trials right that were released prior to the emergency use authorization. This is one that you know if you're going to combine a vaccine, we need to be very very transparent with this and ensure that those human trials are conducted prior to their release and that that data is published. That allows folks to be able to have a conversation with individual patients and be able to share that data. Um There's there's so much data, you know the uh I think value in that data sharing. But I I would definitely say that's probably gonna be in the future Excellent. Um We've had someone asking about uh if there have been any side effects uh of the covid vaccine reported. Uh Certainly so I mean with any medication, you know, including aspirin, there's always gonna be uh side effects. Now the question is are there side effects that are intended, right, intended um impacts or effects or are they adverse events? Those are two different things. So for example, if we give most vaccines, there's gonna be localized erma at the site that's pretty normal. Um that is that is not an adverse event. That is an expected response that we would see um with the Covid vaccines. For example, it's it's widely known that you might have a little bit of a low grade fever. That is an expected reaction. That's not something that's an adverse event. Um You know, but there have been absolutely adverse events um associated with this. My own little brother had an adverse event uh and is actually not allowed to receive any further vaccines um in this category from that. So there tho those are actually tracked by both F. T. A. And CDC. But CDC is the one that holds that data. Um So you can actually go to the CD C's website and you can actually search that data. Um It is a little bit of a complicated database, I'll tell you that. So um if there's something specific that you're looking for, if you wanna shoot me an email, I'll try to help you find it. Um But there there is definitely information out there also in the peer viewed literature. uh as well and and like I said, you know, any medication has risk. Uh we need to make sure we disclose that as I treat this like an informed consent. Um and there's gonna be some patients frankly that are excellent candidates for these vaccines and there's gonna be other patients that may not be. Um And I think that that's ok as well. It goes back to individualized medicine, It's not one size fits all. Um but we definitely need to be more familiar with the data that's out there so that we can provide those recommendations to our patients. Our patients are asking for help. Um and we want to do everything in our power to do that for sure Excellent. Thank you. Um Our next question is covid causing other infection agents to become more antibiotic resistant. So we have we have seen that. Um So just in the years, probably 2 to 3 years leading up to the covid-19 pandemic. If we looked at our overall H. I. I rates right as well as our um antibi stewardship sort of compliance and our resistance rates with antibiotics. They were they were actually doing much better. We had a lot of positive momentum and progress and I actually just um. attended uh a presentation by the deputy director of CDC where he talked about this specifically and he was, you know, rightfully so um obviously upset that there was so much great momentum going and then Covid hit and it sort of de derailed that. So during Covid you are correct in your question that we have definitely seen an increase in in these more multi drug resistant organisms. We've also seen like I said, some weird outbreaks that is associated with things like water. um as well. Now part of this with Covid treatment was that we saw a lot of sort of concurrent secondary bacterial infections. Um and so there was some appropriate use of antibiotics in those patients, particularly those that had the covid pneumonias and things like that. Um but there was also some Emeric use uh for sure uh as well. And then of course everything else that we normally have uh circulating didn't go away either. So uh we've definitely seen that um as well. So that's that's definitely something we're watching carefully. I would say we're probably looking at, you know, 4-5 years before we get back to some level of normal uh because it does take some time to to deal with that. And and keep in mind that antibiotics are unique as a drug class. Uh, I used to say they were the only category that impacted the community. I can no longer say that for obvious reasons because now we have to include opioids. Um, but antibiotics do have a community impact. So when there's misuse, right, it does impact others around that one patient. And so it's important that we really are judicious about our use of antibiotics. Um and and are really doing a good stewardship program. Uh Absolutely. Excellent. Um Let's see uh Uh still uh asking about uh as far as vaccines, how can we um confidently tell our patients that these are safe and effective vaccinations. Uh and I'm gonna go ahead and combine uh another similar question uh about motivating employees to embrace uh Covid related changes when some have personal beliefs and opinions on the disease or on government mandates to vaccinations? Sure. So I I mean that's that's a pretty loaded question. Um I I I think you know, again it goes back to what's the risk benefit equation and and let me just give you an example. So this this came up as a question about a year and a half ago when when there were these discussions about mandates and of course, you know, we saw uh even some of the hospitals now have actually gone away from the mandates because they just can't run. They they they simply can't operate. We saw this with one of the hospitals in texas recently And I asked this question to CDC and I sort of phrased it and I said, so do we agree Right that providing someone with a well fitted medical grade mask that is properly, you know, functioning right, meaning that the filter is functioning and all that type of stuff is as effective at keeping the patient safe as being vaccinated. Right. And this was before we knew all the information about the effectiveness of the vaccines and actually preventing infection. and the answer was yes. We we feel that that is an adequate means, right? And so that being said, that tells us that there are different ways to skin the cat. So our goal, right as a health care institution is to protect the patient and to protect each other for sure. And so it depends on how we're able to do that. So if I'm able to give, let's just say a non vaccinated health care worker the opportunity to wear a mask that I provide, right? It's not gonna be some cloth mask or like that's gonna be a medical grade mask that I provide um and they are required to wear it, then I'm able to protect the the health care team members around them and I'm able to protect the patient or the resident. Now, if we sort of take that a step further and look at the initial thought with the COviD-19 vaccines versus what we know about them now. Right. The initial thought of course was that they were going to decrease the the development right of of COviD-19 as an infection and that's not been the case. We've not seen that uh especially with the most recent variants. Uh for sure. Now, as far as reducing severity, mortality morbidity. Absolutely. There's there's, you know, unparalleled data um, for that, especially for our patients that have those risk factors. Uh, and those are patients that we would strongly advise vaccination for as well as health care workers. Um, but we've got to be careful at what we say and what we mean and what we expect. Um would I rather require someone to wear a mask versus terminate someone? Absolutely. I would I would do that every day of the week because I can't afford to lose the brain trust that I have in health care workers if I have another option right And my other option can still be safe. Um And so I'm a big fan of trying to put all the different cards on the table figure out what cards you can use uh what's gonna be right both for the health care worker as well as the patient as well as for our institution. Um And do that. Uh That being said we've also got to make sure that we are sharing the information. The good bad and the ugly um Just like with any medication. Uh I mean, you know, if we were to send the F. T. A. Um aspirin today for a new drug approval, uh the F. T. A. Has flat out said and they they sort of say this jokingly that they would probably not approve it. It would not pass the F. T. A. Scrutiny now, right? Doesn't mean that aspirin is not safe by any means. I'm not trying to say that I'm simply saying that that the scrutiny that we have today is very different than even things that we've used on the market for 2030 40 years. Um And so there's always that risk benefit equation. Uh for sure, you know, most vaccines have a huge history of safety and efficacy. Um, and so we we need to sort of carve out the brand new vaccines and talk about the process, what we know about them, the clinical trials, the adverse events, um, the efficacy data from morbidity. That's all very helpful. But it can't be lumped into things like the flu shot, which we've had around for multiple different years and have excellent efficacy information and safety data on for periods of time. I mean, that's that's something that I think we got to be realistic with for sure. Um You know that is that is definitely something now with the new Covid-19 vaccine. Because I see the other part of your question. Um That is that is correct that the the the new bivalent vaccines were released without human trials. Um The human trials are finishing right now one of the human trials, I believe if I'm not mistaken. I'm actually here at the conference um is complete. Uh So that data should be forthcoming pretty soon and another one should be complete. Uh I believe by the end of november. Um So that is not, necessarily unheard of in terms of something like a flu shot, which is an annual vaccine. But again, we've got to be realistic in that the flu shot is something that's been around for a long period of time. And so the trust in that is much, much different. And so I I completely respect where you're coming from. And again, these are all conversations that we just have to have openly. Um I I think it goes a long way. And I've I've got friends that are very pro vaccine and I've got friends that are very anti vaccine. and I love them all the same because I I always treat everybody with the respect and also try to answer any questions that they have Well, um, you mentioned in there uh about uh masking and we've had a we've got a couple of questions here on uh masks, uh Maybe just kind of speak to like uh workers that may have to wear them uh 40-plus hours a week over uh over a long time frame. And there was also a question about um people having to reuse masks. Um Sure. So keep in mind that masks are are not tested for reuse. Uh Number one. So that's that's that's just a that's just a fact. Um none of this has nothing to do with the mask manufacturers. Right. This was something that the F. T. A. And the CDC certainly pushed because there were supply chain challenges at the time. But really, AAA surgical mask is not designed to be wear worn all day. Um, an N95 respirator certainly can. Um As long as those, you know, it doesn't become wet or anything like that. but you know, if you're using a a the same surgical mask all day long every day, um that is definitely not a winning strategy. Uh for those of you that have, you know, respiratory issues like allergies, like I have allergic or anti all the time. I have terrible seasonal allergies. Um that is I I will tell you my allergies were crazy for um it had nothing to do with being outside because I was always inside in a mask in a hospital. Um And so there's definitely a lot of occupational data that's that's sort of being cold right now related to that. And and part of that's gonna be published through Nio which is sort of a uh that's part of CDC but they have a more strong affiliation with OSHA to to sort of evaluate that from that perspective. But it it's definitely not good for us to have our oral mucosa and our nasal mucosa covered like that continuously. Um because you are track tracking all of that in there. There's zero evidence what whatsoever. As far as like the uh changes with your carbon dioxide and all that kind of stuff that that stuff is not real. But there is definitely um some suspicion about respiratory issues. And we've also seen this with Children as well. So, you know, my my whole thing is I I don't wear a mask now um unless I'm going to be in a specific setting. Um you know, health care is a little bit different, but I'm very, very religious about my hand hygiene. I'm very religious about my, my daily Covid prevention regimen that I do. Um You know I I keep my surfaces as I could I wash my hands I wear my P. D. As needed. Um And I just try to make smart decisions. Uh There's so many different things that we're exposed to on a daily basis. You you've got you've got to be more holistic um and sort of strategic in the thinking with that too. So that's that's definitely a realistic uh question for us to consider. I have a question here um regarding um let's see. It says, what is the current trend regarding the need to covid test pre general anesthesia in an ambulatory surgery setting So my experience right now is that that's that's really fallen by the wayside. Um there there's really not any specific need that you need to do that. Now. If you were gonna be doing some type of respiratory procedure, like a bronch or something like that, especially in a high risk patient. Um you could certainly consider that. But remember that that COVID testing needs to be done essentially right before surgery. It can't be done before, you know, for for long periods of time. We were doing the 72 hours, you know, sometimes 96 hours before the procedure. That was completely worthless because the patient then went back to their daily lives. They weren't quarantining at home. They weren't isolated or anything like that. Um So that was a false sense of security. And even a test you can test positive at, you know, I'm sorry, negative at nine AM and test positive at five PM. I've seen it happen with my own eyes. Um And so that test is at one point in time. So again, if I'm gonna be doing something that's gonna produce aerosol generating. you know, procedures right? Like a bronch, then I'm gonna wear, you know, appropriate respiratory protection. I'm not gonna necessarily worry about testing that patient for covid. Um I I'm gonna again focus more on my core practices for infection prevention versus being over reliant upon a diagnostic that may or may not give me appropriate information. Um And it's also a better use of of time and money to just use the P PE as needed for those procedures. Uh for sure Uh this question um regarding uh new findings related to covid. This came in before the presentation. But any sort of takeaways that you could um offer as far as new findings related to covid that we should be aware of to just take anything away from from today's talk. So, I mean, the good news is that overall mortality morbidity continues to to remain low, which is excellent. I mean, we we don't want a single patient or family to suffer from this. Um I don't care if it's severe, you know, mild, mild. It doesn't matter. I don't want any patient to suffer from this. But I think the big takeaway is the impacts of long Covid syndrome. and so 67 even eight months ago. We did not have a ton of treatment options for long covid. And now there are multiple different clinical protocols and algorithms that we follow to help remediate some of those long term symptoms. Um I have seen this with patients with my own two eyes that it is remarkable what they can do Um if we quickly uh get them on these protocols, right? Some some, you know, medications that we already have access to, some different treatment, modalities, exercise certainly helps for sure. Right. Very, very simple things that can get these patients to a much better condition than where they were before. You know. Again, we we we're so quick to pull the trigger on a medication and in reality if we just simply listen to our patients, understand what's going on and then help them make a game plan. It is remarkable what people can achieve. Um And and it's it's just really exciting to see that. So I think the big takeaway is don't let yourself get long covid. And if you're heading down that route, immediately intervene with a specialist um so that you can actually stop that process from occurring because that's really where the danger is right now. Certainly if you're really really sick in general. Um which hopefully nobody on the line is but our patients certainly can be we want to treat that accordingly. But to make sure that you know, we don't go down this long covid pathway which does have lots and lots of evidence around bad things happening to our tissues, right? We don't want that to happen. So be aggressive in the management and sort of prophylaxis associated with that. Uh This next question is uh a again related to the vaccine, I think um It may have uh been answered regarding side effects. But I just feel like we should address anyway. Has there been any uh findings of uh the vaccine causing uh anything like enlarged organs or a shortened life span? So there has been some anecdotal information related to those two topics. Um You know, again, it's anecdotal, we don't we don't know true causality and it it it's frankly, it's so hard to determine causality with vaccines. Um you know, there are multiple different ways that we can do that. You know, part of it is sort of an epidemiologic investigation, you know, talking to the patient. Uh if there was a patient death for example, they can do an autopsy and sort of look at that. Um a lot of this data is not just coming from the United States, it's also coming out internationally as well. Um you know, of course we've seen myocarditis and and some of the young adolescent males as well, uh we've now seen some data that's come out as far as menstruation with, with young females as well. So, you know, there there is data out there that we're still sort of going through. Uh again, it goes back to going to the right person and being able to understand the information. Um I I've I've I've learned the hard way that many people will tell you things and they don't actually know. And the worst thing that we can do is tell our patients information that we're not confident in. You know, our job again is not to make the decision for them and our job is to give them the information so that they can make the decision for themselves. And that does include giving them the good, bad and the uglies I referred to earlier. So if I'm talking to, for example, a young female that is trying to to to build a family that is um on birth control and maybe has another comorbidity, then that's a different conversation than someone who is not in that situation. Um And so I treat every single patient interaction slightly differently because every patient is different. And uh medicine is not, it is not just an algorithm, it's an art, it's a science and it's a it's a it's a profession of compassion. Um And so I think that that's that's where we need to go for sure. But there there is definitely data out there regarding um you know uh the enlarged organs is a little bit more of a stretch. But there's definitely been some some evidence out there anecdotally about some of the other pathos changes. Uh For sure. Uh we'll switch gears for our last question. Uh This is about uh clinical or patient exam rooms, how intensely should those rooms be cleaned and how much time should be allotted between patients. So cleaning and disinfection in general is excellent thing to do for everything, Right? And and keep in mind that cleaning is just gonna remove our burden or toilet. It's not gonna kill anything. Whereas the disinfection process is um And those are both very very important things to do. Um You know uh uh an Epa registered, what we call hospital grade disinfectant is is definitely gonna be an important element here from that perspective. Um But from a timing perspective, it really depends on the types of surfaces that you have. So let's say that you're in an outpatient primary care clinic. You're not gonna you're not gonna need that much time. to effectively do that. But if you're in a large ambulatory surgery center and you're, you know, cleaning a suite between patients. Uh that's definitely gonna take more time. So the best way to do that is a time and motion study to determine how long it should take, right without any time constraints to properly clean and disinfect that environment from stop, you know sort of stop to finish and then that becomes the time that you need. Um you know, you don't want to do it the reverse way, which a lot of people said well you get five minutes, that's that's not how it works, right? So I'll tell you in an average hospital room at terminal discharge, right? Terminal discharge. We take anywhere from 45 minutes to an hour. Um the same could be true in a long-term care facility and a long term care facility. It may even take longer because that's more of a communal environment. Right? And those, those residents and patients have been there for probably a longer period of time. Um and so it really just depends on the types of equipment in there, how many different surfaces are present, how soil the room is as well. Um And and but we want to make sure we do that between every single patient. That's a huge thing. And if you know you're one of the the folks that's in the outpatient setting and you have the uh I call it the Golden ta uh um uh table paper. Right. That has no value Um I hate to say that but it it does not provide any infection control value. It's an aesthetic thing. So, you know, remove that disinfect those surfaces underneath. Right? And and and don't rely upon that to provide any infection control value. Um We need to think really sort of strategically through this. Make make things that are going to work. Um disinfect those surfaces. You know use your P PE practice safe injection practices, wash your hands and and and really know your information. Those are all things that will always serve us well from any infection control standpoint Excellent. Well Doctor Garrett thank you so much for your time uh today and sharing your expertise with us and uh with our uh customers, we certainly appreciate it. Uh And again, thanks to everyone for attending today. Um I would like to go ahead and direct your attention once more to our disclaimer here. And I also want to remind you that you can view our upcoming webinar schedule and register for an event or possibly share an event with a friend uh at M MS dot dot com slash educational dash webinars. dr Garrett. Once again, thank you so much for joining us today. I really appreciate it. My pleasure. Thanks for the invitation. Excellent. Well thank you everyone and have a great rest of your day take care.