Leading State Health: Joseph Miner
Joseph K. Miner, MD, is executive director of the Utah Department of Health. In addition to his work at the department, Miner currently serves on ASTHO’s Infectious Disease Policy Committee, which has identified antimicrobial resistance and healthcare-associated infections as one of several key priorities for their work in 2017. Additionally, Miner represents the state health department perspective on the Council of State and Territorial Epidemiologists’ Antibiotic Resistance Surveillance Task Force, which seeks to improve surveillance practices for resistant organisms. ASTHO spoke with Miner about his leadership addressing healthcare-associated infections.
Addressing healthcare-associated infections and preventing the spread of antibiotic-resistant bacteria often requires the cooperation of public health and the private sector. What’s your best advice for supporting these types of collaborations?
The best advice I can give is take every opportunity to call this antibiotic resistance crisis to the attention of policymakers, the general public, and healthcare professionals and organizations and keep it on their radar. In addition, it’s a good idea to have some suggested solutions to help policymakers take action to address this very serious public health threat.
You represent ASTHO on the Council of State and Territorial Epidemiologists’ Antibiotic Resistance Surveillance Task Force. What should other health officials know about your work with this group?
The Antibiotic Resistance Surveillance Task Force is working to establish and improve surveillance of the most dangerous organisms resistant to almost all antibiotics. The intent is to then mount more timely responses to prevent these organisms from spreading throughout our communities. This is particularly important in healthcare settings where patients are especially susceptible and where heavy antibiotic use and pressure results in the growth of the most resistant organisms.
Monitoring for antibiotic resistance and reporting needs to be systematic, convenient, and more comprehensive. Electronic reporting systems and health records could be utilized to collect and analyze data to alert authorities at the earliest possible times. Sharing this data on organisms and their antibiotic sensitivities should be shared throughout the nation to assist public health professionals and clinicians in recognizing the risk of potentially life-threatening infections in their areas. Monitoring for antibiotic resistance in agriculture where antibiotics are used to increase productivity is an area being considered for surveillance activities.
Given your experience at both the local and state levels, what do you think is needed to improve practices and policies at the local, state, and national levels for the prevention, detection, investigation, and control of healthcare-associated and antibiotic-resistant bacteria outbreaks?
It is important to regularly and frequently educate the public and prescribing clinicians to use antibiotics only when needed and justified. Antibiotic stewardship pharmacists are especially helpful in monitoring antibiotic use in healthcare settings to regularly advise clinicians on the appropriateness of their antibiotic use, addressing the type of antibiotic, and the length of treatment according to the organism identified and antibiotic sensitivity of the organism. Cultures and other means to identify bacteria, as well as their antibiotic sensitivities is critical to improving appropriate use of antibiotics. Just using shotgun therapy—i.e., therapy with the broadest spectrum antibiotics—for all infectious agents possibly involved is a very dangerous prescribing behavior. This antibiotic pressure selects for the most resistant organisms.
Strict isolation precautions followed for patients with serious antibiotic-resistant organisms should be adhered to. And of course hand washing by healthcare workers before and after attending to patients is critically important and still has relatively poor compliance in almost all healthcare institutions. Assuring that the insertion and care of intravenous central lines and use of ventilators strictly following identified standard sanitary precautions is critical. Removing urinary catheters as soon as possible is critical. They should never be left in just for the convenience of caregivers. Surgical site infections can be prevented by appropriately preparing the surgical site, and, when indicated, using prophylactic antibiotics for high-risk procedures.
Adding antibiotics to animal feed just to improve growth and productivity of livestock operations also contributes to the prevalence of antibiotic-resistant bacteria.
Can you tell us about a leadership challenge you experienced and what you learned from addressing it?
A very common leadership challenge I see is a resistance of rank and file staff to direction from supervisors. I believe this is commonly due to staff not feeling empowered to contribute ideas to the work they are involved in. Compounding this problem are potential threats from supervisors that their job might be in jeopardy if they work around their supervisor to express dissatisfaction about the way they are being respected or treated. This really stifles productivity and innovative creative ideas, and it leads to employees feeling dissatisfied with their work. I believe it is important to make sure all employees know they can make a difference and that they feel empowered to express themselves.