Taking Healthcare by Storm: Industry Insights with PA Project Firstline

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Merewyn Sheeran, BS, RN, CIC, LTC-CIP, an Infection Preventionist with PA Project Firstline, a program under the Pennsylvania Department of Health’s Bureau of Epidemiology, Division of Healthcare Acquired Infection Prevention.

Merewyn Sheeran discusses Pennsylvania Project Firstline, an initiative in partnership with the CDC that aims to bolster infection prevention knowledge among healthcare workers. The program features innovative tools like translated resources and escape rooms, highlighting success in hands-on training, comprehensive outreach, and tailored education for diverse healthcare settings and workers.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-052325-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

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Hello, everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director of Quality Insights. And we have a very important topic to talk about today. I am joined by Merwin Sheeran, B. S. R N C I C L T C I P, all of those abbreviations, all of those letters after her name so you know she is very smart and important.

She is a infection preventionist with the Bureau of Epidemiology at the Pennsylvania Department of Health. She is part of the Division of Healthcare Associated Infection Prevention, and she is a subject matter expert for PA Project Firstline. So, PA Project Firstline was developed in partnership with the CDC.

It is an innovative initiative focused on building foundational knowledge in infection prevention and control for frontline health care workers. Through their comprehensive activities, this program is strengthening Pennsylvania's health care workforce, empowering workers across hospitals, clinics, dialysis centers, and nursing homes to combat infection.

disease, infectious disease threats, and ensure a safer health care environment for all of us. So we are going to explore the impact of this essential program and hear firsthand how it is making a difference in the fight against infections. Mary, thank you so very much for joining us today. Thank you so much, Dr.

Storm. It's a pleasure to be here. Thank you for inviting me. Great. So tell us how you came to do what you do. Okay. Well, it's a roundabout story, as they mostly are. But I started my interest In health care infection prevention. Actually, during college, I was a biology major. And I had an internship at a local acute care facility and had the opportunity to work with both the risk manager and the infection preventionist.

And that's where I discovered. Patient safety and that and the importance of patient safety new in the back of my mind. I really love that. But I also loved microbiology and I spent about six years at a medical school. My first job out of college. I was a researcher research assistant and teaching assistant in the microbiology and immunology department.

 And that's where I started. earned my nickname, which I still have today. People will see me from my past and say, Hey, micro Mary. So microbiology definitely stuck. And it was at the medical school, I decided to pursue my nursing degree. So I went to nursing school and did research at the same time.

And when I graduated from that program, I started as a charge nurse and supervisor at a skilled nursing facility. And I Decided, okay, I love aging services. I had that's where I developed my passion for that. So while in that first role Within like a year, we were JCO certified and had to have a full time infection preventionist.

So I had the background in micro and nursing and I became my first job as what we were called infection prevention nurses back then. So, and my nursing director encourage me to join our local APIC chapter. APIC is Association for Professionals in Infection Control and Epidemiology, and I co founded and chaired the long term care focus group in our chapter, and I've been the chair of that intermittently for the last 25 years.

 I also Worked as a long term care C. I. P. In charge nurse until during the covid pandemic. I was offered the opportunity to become a part of the Pennsylvania Department of Health. It's a big name.  Infection control assessment and response project or I car project for skilled nursing facilities. And I had the opportunity to provide reports and training to 40 long term care facilities in Southeastern PA.

And that led me to my role with um, my current role with PA Project FirstLine. I really love that education piece. So. Yeah, it all your journey was a long one, but it all came together really to put you right where you are now, which is interesting. Yeah. So can you provide an overview of Pennsylvania Project FirstLine and how it aligns with a national CDC initiative?

Right. Well, because we are grant funded through the CDC  We're pretty much aligned with the goals of CDC project. First line. We aim to enhance infection prevention and control knowledge, as you said, among all frontline health care workers, but in P. A. Specifically  and our main goal is to build that workforce expertise and infection prevention and control to protect our patients and health care from infectious disease threats.

 And since infection prevention and control actions can prevent it. The spread of potential pathogens and also infection prevention and control is most effective when all team members are consistently trained in basic infection prevention and control principles. We use that approach with our education.

Our aim is to provide infection prevention control information that is both understandable and easily incorporated into the day. Yeah, absolutely important. Uh Huh. So we use  so this is how we incorporate the CDC um, resources. They have so many amazing resources that have been created through the last  gosh, I think they started in 2021.

So it's been over the last four years  or 2020. Yeah, it was 2021. So  we use easy to use, accurate and no cost. That's what I love about the CDC Project Firstline resources. They are no cost, and they have training toolkits, they have interactive computer based scenarios, infographics micro learn training resources, and there are fact sheets That we use when we're developing our in person and virtual education and that includes our escape room that we offer.

 In addition, our team has added to poster campaigns. We're about to come out with our third, hopefully within the next few months.  We have a virtual long term care or we hosted a virtual long term care facility learning series and we offer weekly infection, print prevention and control. That's a big word text messages.

Okay. which include our PA Project Firstline quarterly newsletter. So we have all those resources available and they are all new cost. That's great. And that's what people want to hear that the best price is free.   So Project Firstline aims to address gap, longstanding gaps in infection control knowledge.

So what were some of the most significant gaps identified as. especially within Pennsylvania's health care community. Okay, so we did do a learning needs assessment. But as and most of the gaps are those basic infection  prevention principles. So they are our focus of PA Project FirstLine. And as I mentioned, that's where we find the most gaps.

Common things like what is contact time? That  that's a universal gap. But project first line. We have that unique perspective on the needs of our health care community because we get our requests directly from the providers themselves.  We offer unique content on a range of those foundational topics.

So things like standard precautions and these  you come out of a worldwide pandemic and we've all been focused on one thing. So it's  that's part of what Project Firstline is about. Making those building blocks of basic infection prevention control principles are standard precautions, which include the hand hygiene, cleaning and disinfection, personal protective equipment, and we also have some very simple.

But the science of viruses so that we can understand the science behind our actions. So we have identified there's clear need for new, interactive and engaging types of trainings and education for these basic topics, such as and we do that through our own site trainings and our escape room. So the great thing about project first line and that I love is that we can use all of those.

CDC Project Firstline resources to create our educational sessions, and we tailor it to the audience  and the facility. So we keep it  very current in this dynamic healthcare environment. So very important. Yeah and I think gaps are  we know what happens when there's gaps, it's catastrophic things, especially in long term care.

So really important. So how does Pennsylvania Project Firstline adapt its infection control training the diverse needs of health care workers? We have many different types of staff working in facilities, nurses, environmental services technicians. So how does the, how does Project Firstline adapt its infection control training?

Well, we offer both that virtual and in person education to meet there are many diverse needs of all of the health care workers.  We have to keep things concise and our message concise because there are time constraints. But our education includes individualized topics that are chosen by the facility and the focused education we make us make it.

Our education focus for specific departments when a specific gap is identified. We also use plain writing and keep it adaptable for different audiences so we can meet our health care workers where they are and build upon their existing strengths and knowledges. So, our modules that are on the CDC website, they cover they build on this whole thing of risk, and then that builds into where do germs live, the reservoirs, and then we build on how germs spread, and then we talk about the actions to prevent the spread  which are our standard precautions.

So, as I mentioned, we teach the why behind the recommendations as Much as the what and how.  I love the micro learns that are available.  I have the minute they came out, I started incorporating them into my education because they have it's like a picture and then it has content.  The second page.

It has all of your content right there. So an infection preventionist or any educator can have concepts, infection prevention concepts with immediate practical value.  And this helps our health care workers recognize infection risks and take action to stop that spread of germs. So As I said, we build upon those basic concepts so that our health care workers understand in all departments the purpose of why do we add transmission based precautions to the standard precautions and when are enhanced barrier precautions required.

So that's one of the new topics that we've been able to. to offer is the enhanced barrier precautions. And our Pennsylvania Department of Health, we have a multi drug resistant  organism team, the MDRO team. And they developed our education related to enhanced barrier precautions. And we often collaborate with them.

They will go visit a facility and identify gaps and say, Hey We um, ask this facility to reach out to you for some basic IP training. So we work together and coordinate and we offer any educational support that facility might need. I didn't know that there was an MDRO team. How interesting.

That is really Yeah, they do really neat work, so. You mentioned that one of Project Firstline priorities is to meet healthcare workers where they are. Could you give us examples of how the program tailors its training materials to different learning preferences and environments? Absolutely. So  and this is one of the things I love doing the most.

 I find it a challenge to Kind of dial up and dial down my education based on that audience So we can our materials cater to all health care workers at all learning levels And then and as I mentioned, I think we build upon those existing strengths and knowledge by using scenarios small group problem solving Because health care is a team so I like Working with small groups.

 And I have that a lot because not a lot of people can come down at one time for an education session, and we repeat them several times throughout the day so that  we can get the largest amount of people at one time. We use small group problem solving, as I said, visual examples to create a learning experience.

Experience that supports all type of learners. So lots like it's not just lecturing. We use all of the germ enhancing products and really have all kinds of props so that we can show and work with the team to let them see how infection prevention works and how germ spread. So, for example, not all of the health care team has the same responsibility.

So working in the kitchen poses different infection prevention challenges than providing direct patient care or cleaning and disinfecting the health care environment. And we use different approaches than when we provide that education. So we have One of the training modules about risk in the healthcare environment has an image of a medication room, and it shows different risks, including an overfilled sharps container, which is positioned over an overfilled trash can.

And in the image, one of the needles has fallen into that overfilled trash can since it's positioned right over the trash can. And so, when I'm addressing a group of nurses. I'm going to say the key points are using a needle with a safety device when available  dispose of sharps immediately after use, never force needles into a sharps container, and change that sharps container when it's three quarters full.

But if I have an environmental service team the key points would be avoid positioning a trash can. under a sharps container, know who to contact, report a full sharps container, consider changing trash cans in high traffic areas more frequently, and then most essentially never reach into a trash can with your hand to avoid that sharps injury.

So  our most popular training that Project first line infection prevention escape room, which has a respiratory theme right now, but I'll get into that toward the end. Utilize scenarios. We have games and team based learning to engage multi disciplinary teams of health care workers and it really brings that teamwork and communication because they're all crucial elements to ensure that entire team learns to support each other with everyday infection prevention challenges.

Sometimes teams experience challenges with communication. So we have adapted the original Project FirstLine Escape Room model to include current recommendations and text supported with images to support visual learners and those with limited English proficiency. And when we identify communication challenges within a team we've adapted the stations to include more interaction, allowed more time for groups to complete the challenge so they don't feel trapped.

Pressured by that time constraint, I will pause the timer and all of our IPs do when there's a teachable moment or to answer a question. And then we ask facilities to form teams sometimes with either someone who speaks in the team's native language and can translate or who can read the written parts of the stations in English for team members who may not be comfortable with reading.

So it's so rewarding to see the teams work together and take that teamwork forward into their daily work.  And I think that's my. One of my most favorite parts of being an IP with Project Firstline. Yeah, it sounds like it's very meaningful and you make a huge difference. So how has Pennsylvania Project Firstline engaged with frontline health care workers in shaping the educational content to ensure it's relevant and applicable to their daily practices?

Okay, so let me think. So the project first line and we're a whole team of board certified infection preventionists.  We have our C. I. C. S. And we all have diverse health care backgrounds as well. So   I mentioned I'm long term care is my background. Our I. P. S. Have acute care public health experience.

One has worked in corrections and a couple of worked in psychiatric settings. So we can bring all of that experience into our trainings for different groups of health care workers. And actually I'll use a lot of content. We kind of share content because it also reaches different types of learners.

So our training resources are developed with health care workers specifically for those health care workers. So, and they're all based on CDC recommendations. So they are the most current recommendations. We incorporate infection prevention, best practices and we also address feedback. From in person and virtual education evaluations, as well as we get direct feedback from frontline health care workers and their leadership.

So  we want that feedback so that we can improve our program. So we're constantly improving and updating our materials. We just came out actually with a  It was just  put into place, our modification document for the original escape room, which  was approved by the CDC. And it just, it had, takes some of those concepts and makes it a more visual experience.

So, and less reading needed. So, in addition, our Project Firstline content undergoes a comprehensive review process. So this is what I love. from working at the state level, we have so many subject matter experts. So when we put out a product, so many eyes are on it. And  I feel really very proud of the products that we put out.

 Cause all those subject matters experts in our bureau add their input as well. So that's really nice, especially I was a loan IP, so I didn't have that support before. So it's really It's a privilege to have that. Yeah. Input and feedback is super important, right? So in the context of infection control, what role does healthcare equity play in Pennsylvania Project Firstline's approach, and how do you ensure that the materials reach and resonate with healthcare workers from underserved or minority communities?

Okay, so one major thing, our education is available at no cost  and our IPs come and do the virtual education and on site education at no cost to the facilities. So  and that's for all types of health care workers and facilities, both. Profit and nonprofit throughout Pennsylvania. So in addition to facilities that reach out to our program directly because we do have our web page on the Pennsylvania Department of Health on their site, we collaborate with internal and external programs within Pennsylvania to identify facilities with specific training needs or challenges across the health care continuum.

So as I mentioned, like The MDRO team, we have that collaboration and we work with so many different state programs and they'll say, Hey, I really think you would, this would be valuable for this facility. We have an amazing healthcare workforce in PA and it's built of such a diverse group of healthcare workers.

 So our program definitely aims to honor those differences.   Yeah, really important. What steps have been taken to ensure that the Project FirstLine resources are accessible in multiple languages and tailored to different cultural contexts within Pennsylvania's diverse healthcare workforce? so our Project FirstLine from the CDC website those resources, so all of those multiple tools that I listed before they are available in English.

But the majority of them are also available in Spanish and To ensure that our education is accessible to health care workers who speak multiple languages, and I'm in southeastern Pennsylvania, and I will tell you I have, that's something that I have happened multiple times, so that was an early challenge for me  but we have partnered with our  other Project Firstline state groups, so we're PA Project Firstline, there's New Jersey Project Firstline, Virginia, Minneapolis Project first line.

 And I'm going to mention a couple other ones, but they have some of the groups have made it their mission to translate resources. So, for example, Rhode Island has recorded trainings available in Spanish because I have found that sometimes you might have something that's written in a language, but the health care worker can't read the language, but they understand it.

To hear it auditory wise. So Rhode Island has those available in Spanish on their website, Massachusetts. I've used these.  They have resources available in Haitian Creole translated into them. North Dakota has materials in Spanish and Nepali, which I have used, and Maryland we had original videos.

They were the first resources that came out from Project Firstline. They were videos With Dr. Abbey, who was the medical director of the whole program, and so Maryland has translated them into a multitude of languages  Chinese, all the um, the island languages  that Hawaii also  did a whole bunch of translations as well of the printable materials.

We can draw on those resources and we provide links for facilities that are in need and we conduct in person education for healthcare workers from those diverse cultures and who speak those languages.  I facilitated personally  education for staff using the Project Firstline translated resources and provided those materials to the infection preventionist.

We can provide those, but then we also have health care worker uh, that's when we do a lot of health care worker return demonstrations on the basic Concepts that were taught in the language, so we can make sure that there was comprehension because that's the main focus is to make sure Okay, yeah, I can read this to you in Spanish, but are you understanding?

Am I getting that to you? So we do a lot of return demonstrations. With hand hygiene, cleaning, disinfection, so forth. Yeah, important to make sure people understand what is being said. And I think it's so thoughtful that they're thinking that  maybe we just  not translate and provide the printed version, but also the spoken version for individuals maybe that understand  better that way.

So that, that's really interesting. My favorite part of talking about any initiatives or projects is to talk about the success stories. Can you share any specific success stories or notable outcomes from the implementation of Pennsylvania Project Firstline that highlights its impact on infection control practices or healthcare worker confidence?

Yeah, I'd be glad to. So as an IP working with Project Firstline, I would say one of my One of our biggest it's not just me, it's us  our biggest success stories is the success of our facility outreach program. We just ran the numbers.  So in 2024 alone, we conducted 361 onsite training sessions and that captured nearly 2000 healthcare workers.

So that just means so much. And that included physicians, nurses, EBS staff future health care workers, because we have college outreach now, administrators and more, and I will say nurses were  our highest number, and that makes sense because there are a lot of nurses, highest number of Health care professionals trained, but the second highest was EBS staff.

because they are one of those populations of health care workers that they just don't get as much concentration with education. So  it means a lot to be able to provide that education for everybody. Another true success story coming from the onsite trainings is the amount of interest in our train the trainer opportunities.

Great. Yes, we can provide the education, but we want this to be build resiliency for our healthcare workforce and facilities. So in 2024, we did the train the trainer as part of our onsite training with 32 facilities, and we provided them with tools and resources. To be able to facilitate the project first line trainings in the future.

So we send training evaluations and follow up with facilities also after our trainings. And we've also had many facilities that request more than one educational training topic, and then they want us to come back. So we'll do like our basic educational modules. Then we'll come back and do the escape room a few months later.

So some of the comments I pulled some of these together.  But some of our comments and our evaluations note, I have seen an increase in hand washing amongst my staff. You always want to hear that my staff really does great with hands on education. This training was excellent and extremely helpful applying the knowledge to real life scenarios.

We realized there were more high touch areas than we ever thought. It was great to see my team understand each station and how their day can be impacted and how a breach can cause transmission of an illness that was written by an IP, my team enjoyed the non threatening environment Someone did say perhaps more time on cross contamination.

So we do get constructive feedback as well.  And it was clear and concise and staff feedback was positive. So they are just some of the things that came from evaluations. And we, as I said, we love to get those evaluations because it does help us, make the products that are healthcare workers wants  and need.

So  yeah. 361 on site trainings in 2024. That's. It's almost a training a day. Yeah. Now there are three of us. There were three of us doing that. So what does it say, like, it doesn't mean like no time off for holidays or we are busy. We do get across PA a lot.   I'm in the Eastern part of the state and I've been to Erie, which I had never been to.

So I kind of find that fun. I love visiting different parts of the state and just. Meeting different groups. Our state is so cool. So I've really, my love for PA has grown through this job. Yeah, it is really it is a I will say there's so many different parts and you know You go to Philadelphia and it's so very different like where I am now.

I'm right on Lake Erie Okay Yeah, right outside of Erie, Pennsylvania, and it's very different from Philadelphia very different from Pittsburgh I mean it is it really is a cool state It is. Now we have team out in the West, so I have not been to Pittsburgh itself yet. But I do, I collaborate a lot with as I mentioned, we have lots of state groups with Project FirstLine.

Pennsylvania, because we're so big, we have PA Project FirstLine and we have Philadelphia Project FirstLine. So since I'm in southeastern PA, I do collaborate a lot with Philadelphia Project FirstLine and have had the opportunity to go into Philadelphia a couple times. So I've enjoyed that perspective as well.

Yeah. Looking forward, what are some of the key priorities for Pennsylvania Project First Line in the next year? And how do you envision the program continuing to improve infection control and healthcare equity across the state? I can speak to our Programs are forthcoming programs. We have some really exciting projects planned for 2025.

So I mentioned our escape room.  And we have some new themed escape rooms that will be coming out. I personally am working on one.  And I guess I can mention them.  We have a diarrhea escape room coming out and they're based on their micro learns. We have a sharp safety and injection safety escape room coming out.

We have an EMS escape room that we worked on collaboratively with the M. D. R. O. Team. So we're really embracing the escape rooms because they are our most requested education. Mhm. And we have, this is very exciting  one of our IPs is working on a hand hygiene campaign that will focus on  it's for all of PA  healthcare workers that will focus on departments and healthcare worker types with unique work environments and hand hygiene considerations.

So not just a wash your hands PA, but What are your challenges in dialysis? What are your challenges here or there? All different health care worker types. So it's going to be quite exciting to see what comes out from that program. I'm excited to see. So the health care associated infection group.

Prevention division at the Department of Health. We're committed to providing useful training, resources and support to health care workers across the commonwealth. And we always welcome feedback and input to create those programs that  are needed for all. types of healthcare workers in all settings.

 I just wanted to mention our CDC Project Firstline materials. They are all available on the CDC website. And it's just type cdc. gov slash projects  slash Firstline. I'll just put that into your browser and you can reach PA Project Firstline by sending an email to ra dhhai at pa. gov if you ever want any other information about the programs.

We will definitely link those in the podcast and I'm just going to say those escape rooms sound very exciting and one probably a lot of people want to escape from is the diarrhea escape room. Yes definitely, definitely. So yeah, very much needed now  with all the norovirus that's going around, but  very important.

So, thank you very much for joining us, Mary Sheeran. I really appreciate it. I am, feel much better knowing that there's people like you in the world who are fighting the fight in infection control. So, continue what you're doing. Best of luck and thank you for joining us. Thank you so much. I appreciate the opportunity.

I, cause I love this program.   

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.