I completed my MPH at Queen’s University with a specialization in Epidemiology. It was there during my communicable disease, epidemiology, prevention and control course, that I developed an interest in infectious diseases and the application of epidemiological tools with regards to transmissibility and disease spread. It also introduced me to the basics of key clinical pathogens which proved to be essential in the world of an infectious disease epidemiologist. The core concepts for the evaluation of infectious disease processes, specific analytical skills, and assessment of disease trends and outbreaks that an infectious disease epidemiologist would need can be introduced and developed while pursuing a general epidemiology degree.
My co-op placement during my masters was at Public Health Ontario as a student epidemiologist. It involved epidemiological analysis of chronic disease data, as well as the application of analytical tools, writing of manuscripts and presenting the findings to key stakeholders in the organization.
It was only when I graduated and met with fellow MPH alumni, that I learned about the Infection Control Practitioner’s role in hospitals. It was a perfect blend of clinical infectious diseases, which interested me greatly, and applied epidemiology, which utilized my MPH knowledge.
I found my current role with the Infection Prevention and Control department at the University Health Network through working in another department (Patient Safety) and sitting on the Infection Control & Patient Safety committee. This role felt as if it suited my background and interests perfectly, so I joined the Infection Prevention and Control department in 2016 as an Infection Control Practitioner, covering the surgical portfolio at Toronto General Hospital.
Although the analytical epidemiology aspects of the infection control role are very basic, it does rely on applied investigative aspects such as identification of cases, contact tracing, epi-links between cases, case counts, rates, surveillance of infectious disease trends, and conducting outbreak investigations. The clinical knowledge of not only infectious diseases, but patient assessment gained through this role is comparative to those of frontline healthcare practitioners (such as nurses or medical students). It allows you to be a part of the healthcare team for patient cases, to not only prevent the spread of infections in patients and staff but to have direct impact on patient care; as well as involvement in tasks and projects external to patient care (examples include: consulting on medical device approvals, construction projects, quality improvement, policy development, staff education, consulting on Occupational Health & Safety issues and the Medical Device Reprocessing department). The wide range of opportunities results in a satisfying career, as well as the ability to expand your role and personal development in the healthcare field.
Epidemiology expertise is crucial to my role when dealing with an influenza outbreak. The threshold of nosocomial flu cases in a hospital ward is quite low; it only takes two or more cases of acquired flu to enter a possible outbreak scenario. A nosocomial case of influenza is characterized by a patient who develops respiratory symptoms after being in the hospital unit for 72 hours, and a positive lab test for influenza. Once multiple cases are identified (more than two), the infection control practitioner loops in IPAC leadership, key stakeholders in the organization and Toronto Public Health to declare an official outbreak. The unit is often closed off to new admission and transfers, ill patients are isolated and treated, others experiencing like-illnesses are isolated pending their laboratory results, and the staff are routinely reminded to self-screen and maintain their immunization status. Infection control practices such as isolating, testing, enhanced cleaning, adherence to immunization, and the cleaning of equipment, among others, is paid special attention to for the duration of the outbreak. Patients on the unit are then monitored for new signs and symptoms until a full 10 days have passed without any new cases, at which point, the outbreak is declared over. In these instances, infection control practitioners are leading the outbreak management which include case detection, surveillance of symptoms and new cases, monitoring the trend of cases, immunization rates, and post-outbreak analysis of cases.
This role has given me many opportunities to develop my career: to lead committees (such as the hand hygiene committee, risk assessment committee, and the ambulatory care committee), to liaise with internal and external stakeholders, to provide expert consultation to the Joint Health and Safety committee and external hospitals that have contracts with UHN, and externally, and to sit on the board for Immunize Canada as an Infection Control Specialist with IPAC Canada (an infection control professionals association).
Read Part 1 here.
Read Part 2 here.
About the author:
Alice Silva is an Infection Control Practitioner in the Surgical Program at Toronto General Hospital, University Health Network. Alice has her MPH in Epidemiology from Queen’s University. At UHN, she is a part of a Quality Improvement working group within the General Surgery department that looks at how NSQIP data can be used to identify areas of concern and implement appropriate interventions. Alice has experience working with health organizations at local, provincial and federal levels. She has interests in infectious disease epidemiology, infection prevention and control, quality improvement, and cats.