Table of Contents
Credits
Host: Sara Dong
Guests: Shreya Doshi, Preeti Jaggi, Pam Lee, Shira Abeles
Content is based on the JPIDS article featured in this episode
Edited and produced by Sara Dong with support from the Infectious Diseases Society of America (IDSA)
Our Guests
Shreya Doshi, MBBS
Dr. Shreya Doshi is a second-year Pediatric Infectious Diseases fellow at Children’s National Hospital in DC, researching in diagnostic stewardship and healthcare sustainability. Originally from Mumbai, she was always interested in public health and concurrent with her fellowship, she is pursuing an MPH in Global and Environmental Health at George Washington University. She has been awarded the PIDS ASP fellowship award for her research project titled “Are follow-up blood cultures necessary in children with gram-negative rod bacteremia?”. Her Quality Improvement (QI) project for fellowship focuses on reducing antimicrobial waste generated at her hospital. Additionally, she is the co-founder of “Sustainabil-ID”, a group dedicated to research integrating environmental sustainability into infectious diseases. Shreya is also the co-editor of a supplement in JPIDS/OFID on healthcare sustainability and infectious diseases. She envisions and believes that our healthcare system can do better for our children and their planet.
Preeti Jaggi, MD
Dr. Preeti Jaggi is currently a Professor of Pediatrics at Emory University School of Medicine and the Medical Director of Antimicrobial Stewardship at the Children’s Healthcare of Atlanta. She is the chair for Georgia Clinicians for Climate Action. Currently the group is engaging and healthcare professionals to advocate for electric school buses as a climate and air pollution solution. She sees parallels between the advances in antimicrobial stewardship and healthcare quality improvement that could be applied to decreasing emissions in healthcare settings. She is partners with Shreya on both the Sustainabl-ID group and the JPIDS/OFID supplement.
Pamela Lee, MD
Dr. Pamela “Pam” Lee is an infectious disease specialist at Harbor-UCLA Medical Center. Much of her training took place in LA County’s Department of Health Services, and as such she is deeply committed to providing healthcare for LA’s safety-net populations. Her passion for climate work stems from knowing that patients like hers bear the brunt of the adverse effects of climate change and pollution.
Pam’s overarching academic interest is the intersection of healthcare delivery and environmental sustainability, with focuses on infection prevention and control and diagnostic stewardship. She is an IDSA/SHEA 2023-2024 Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health Fellow for her project “Quantifying the Environmental Impact of MRSA/VRE Contact Precautions in LA County”. She also co-leads the Healthcare Sustainability Team for the California-based advocacy group Climate Health Now.
Shira Abeles, MD
Dr. Shira Abeles is a board-certified infectious disease specialist who cares for patients with general infectious diseases. Dr. Abeles serves as medical director of sustainability at UC San Diego Health, supporting efforts to adapt practices to best promote health of patient and planet. Dr. Abeles also serves as medical program director of antimicrobial stewardship at UC San Diego Health, and as associate medical program director of infection prevention / clinical epidemiology. As an associate professor at UC San Diego School of Medicine, she is involved in the training and education of medical students, residents, and fellows in the division of infectious diseases and global public health. Her research focuses on evaluating methods for curbing unnecessary antibiotic use in health care settings as well as assessing the clinical impacts of various infection prevention interventions. Dr. Abeles completed an infectious disease fellowship and a residency in internal medicine at UC San Diego School of Medicine. She earned her medical degree from Columbia University College of Physicians and Surgeons. She is board certified in internal medicine and infectious disease. She is a member of numerous professional organizations, including the Infectious Disease Society of America, the Society for Healthcare Epidemiology of America, and the Infectious Disease Association of California.
Culture
Pam: the pizza scene in Long Beach, California! There are several spots and she mentioned Speak Cheezy on the podcast
Shira: the great outdoors, hiking and being by the ocean in San Diego
Preeti: cooking (she shared a recent Thai cooking class where she used the three musketeers of Thai cooking of lemongrass, kaffir lime leaves, and galangal)
Shreya: loves listening and singing class Bollywood songs
Consult Notes
Key Points
This episode is highlights the start of some supplemental articles on the topic of sustainability and climate
- JPIDS and OFID have partnered to bring a collection of articles that raise awareness of different aspects of how our field can help reduce the negative environmental impact we can have when providing care.
- Healthcare sustainability can be broadly defined as measures to decrease greenhouse gas emissions, waste, and other pollutants generated during the healthcare delivery process
- Check out some of the links below for more!
- PIDS statement on sustainability and climate from May 21, 2024
- Introduction to the supplement: Doshi SM, Jaggi P. Healthcare Environmental Sustainability Through an Infectious Diseases Lens. J Pediatric Infect Dis Soc. 2024 Jun 28;13(6):305. doi: 10.1093/jpids/piae035. Erratum in: J Pediatric Infect Dis Soc. 2024 Jul 20;13(7):386. doi: 10.1093/jpids/piae063. PMID: 38758203.
- This episode’s focus article: Doshi S, Vuppula S, Jaggi P. Healthcare Sustainability to Address Climate Change: Call for Action to the Infectious Diseases Community. J Pediatric Infect Dis Soc. 2024 Jun 28;13(6):306-312. doi: 10.1093/jpids/piae029. PMID: 38758197.
This episode was also in honor of World Environment Day, which was June 5 2024!
World Environment Day is led by the United National Environment Programme and has been held annually on June 5th since 1973. This is the largest global platform for environmental public outreach
Sustainabil-ID
- Sustainabil-ID is a collaborative that is dedicated to advancing sustainable practices within the field of healthcare, with a particular focus on processes in the infectious diseases field.
- Their mission statement: Collaborative for infectious diseases physicians, pharmacists, public health personnels and trainees to discuss integrating environmental sustainability into all things infectious diseases.
- This group meets monthly and invites researchers to talk about the intersection of infectious diseases and healthcare sustainability. This was established in 2023, and you can reach through the contact information below to learn more or join
- X/Twitter: @sustain-ID
- Email: sustainabilityiddocs@gmail.com
- There are additional healthcare and scientific professional advocacy groups noted in Table 3 of the episode’s paper
A quick overview of extensively drug-resistant (XDR) typhoid fever
- Typhoid fever is a systemic illness caused by the bacteria Salmonella enterica serotype Typhi. Most US cases of typhoid fever are related to international travel (~85%), but some acquire infection in the US. Infection can be transmitted via contaminated food/water and person-to-person contact. Without appropriate antibiotics, 12-30% of people with typhoid fever will die.
- CDC recommends vaccination for people traveling to places where typhoid fever is common – but vaccines are not 100% effective, so travelers should always practice safe eating and drinking habits to help prevent infection
- In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Sindh province, Pakistan.
- XDR Typhi strains are resistant to antibiotics generally recommended to treat typhoid fever, including ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole
- Isolates from patients linked to the outbreak in Pakistan are susceptible to carbapenems and azithromycin
- Before the outbreak in Pakistan, no case of ceftriaxone-resistant Typhi infection had been identified in the US
- Here is the archived CDC Health Advisory from 2021
- Read more in this OFID Brief Report about XDR typhoid fever in the US: Hughes MJ, Birhane MG, Dorough L, Reynolds JL, Caidi H, Tagg KA, Snyder CM, Yu AT, Altman SM, Boyle MM, Thomas D, Robbins AE, Waechter HA, Cody I, Mintz ED, Gutelius B, Langley G, Francois Watkins LK. Extensively Drug-Resistant Typhoid Fever in the United States. Open Forum Infect Dis. 2021 Nov 16;8(12):ofab572. doi: 10.1093/ofid/ofab572. PMID: 34917695; PMCID: PMC8669042.
- We didn’t focus on this in the episode, but you can check out more on typhoid fever vaccination on the CDC page
Climate change and air pollution are greatly influencing global health and infectious diseases
- The “One Health” approach was mentioned on the episode and aims to optimize the health of humans, animals, and ecosystems by recognizing they are interdependent. Although this is often discussed related to bacterial resistance or zoonoses, this also applies into how environment affects human health
- Greenhouse gas emissions must urgently be decreased to protect human health. Here is a resource called the AR6 Synthesis Report on Climate Change 2023 with more resources
- There are a variety of articles providing more info on how climate change is changing the risk of infectious diseases. Here are a few resources/overviews:
- Atwoli L, Baqui AH, Benfield T, et al. Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health. N Engl J Med. 2021;385(12):1134-1137. doi:10.1056/NEJMe2113200
- Freifeld AG, Todd AI, Khan AS. The climate crisis and healthcare: What do infection prevention and stewardship professionals need to know?. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e136. Published 2023 Aug 2. doi:10.1017/ash.2023.170
- Edelson PJ, Harold R, Ackelsberg J, et al. Climate Change and the Epidemiology of Infectious Diseases in the United States. Clin Infect Dis. 2023;76(5):950-956. doi:10.1093/cid/ciac697
Healthcare contributions to climate change
- The US healthcare system accounts for 8.5% of the total US greenhouse gas emissions (GHGe), 35% of that is from the hospital setting
- Health care associated air pollution and GHGe is estimated to cause the loss of 388,000 disability-adjusted life years in the US alone
- The Department of Health and Human Services launched the Health Sector Climate Pledge in 2022: a voluntary initiative for healthcare systems to commit to reducing GHGe by 50% by 2030 and achieving net zero emissions by 2050
- https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-sector-pledge/index.html
- This pledge was signed by >130 health organizations representing 900 hospitals
- There are also Joint Commission standards for a voluntary certification program for minimizing hospital-associated GHGe: measuring emissions from energy use, purchased energy, anesthetic gas, pressured metered dose inhalers, fleet vehicle gas consumption, solid waste disposal, incineration
So what are some opportunities to decrease GHG emissions in healthcare? How might ID clinicians get involved?
- Measurement of GHGe is a first step in decreasing the climate impact of healthcare facilities. The biggest category of types of healthcare emissions is related to pharmaceuticals, chemical, and medical supplies —> so daily healthcare processes are a high impact target area
- Preeti described the mnemonic “WE ACT”, which was coined by the Providence healthcare system and targets healthcare sustainability in 5 domains. Check out Table 1 in the associated article for this episode, but here is a quick intro:
- W – Waste
- E – Energy and water
- A – Agricultural/food cycle and anesthetic gas
- C – Chemicals and pharmaceuticals
- T – Transportation
- Healthcare professional can enable healthcare sustainability by:
- Emphasize the public health benefits of healthcare sustainability to hospital administrators
- Connect healthcare sustainability to the core mission of hospital or health system
- Consider clinical choices while balancing patient safety and quality (such as reducing anesthetic gas emissions, reduce inappropriate personal protective equipment use, converted IV to PO meds, etc)
- Learn more and advocate
- This is just a quick introduction to these concepts. Check out various examples and resources in this episode’s article!
- You can find a list of proposed healthcare sustainability strategies for ID societies and practitioners in Table 4 of the paper:
- Education
- Funding opportunities
- Encourage sustainability in research
- Formalized committees
- Job creation
- Expand diagnostic stewardship
Preeti discussed the parallels between sustainability and stewardship in the episode
- “Stewardship” involves careful management of resources, but “sustainability” expands upon stewardship to explicitly include the concept of meeting current needs without sacrificing the ability of future generations to meet their own needs
- Healthcare sustainability is an expansion of the types of efforts of antimicrobial stewardship programs and involves examining the entire healthcare system and its consequences in a systematic way.
- Both antimicrobial stewardship and healthcare sustainability have an emphasis on long-term goals of preserving resources
Infection prevention and control & healthcare sustainability
- IP&C strategies are often perceived as a barrier to those of sustainability and reducing healthcare waste due to the generation of vast amounts of solid waste (in particular, use of single-use disposable supplies which are widely used as an IP&C measure)
- Pam discussed that sometimes IP&C is driven to these measures due to lack of available reusable products and inflexible, outdated, and sometimes non-evidence based and overly conservative regulations —> IP&C has the potential to be a great partner for healthcare sustainability
- Our guests discussed identifying ways that the collective power of IP&C as a community can be used to reduce waste
- Some of this will take high-level advocacy with regulatory bodies such as the CDC and FDA
- Some actions can be local, such as MRSA/VRE contact precautions projects. Here is a resource on rethinking contact precautions from LA county Department of Health: http://publichealth.lacounty.gov/acd/RethinkingContactPrecautions/index.htm
Infographics
Goal
Listeners will be able to define healthcare sustainability and its relevance to infectious disease practice
Learning Objectives
After listening to this episode, listeners will be able to:
- To identify common ground between healthcare sustainability and antibiotic/diagnostic stewardship
- To describe current challenges associated with greening healthcare as related to infection prevention and control
- To examine the role of infectious disease clinicians within healthcare sustainability, and how to add sustainability to a career in ID
Disclosures
Our guests as well as Febrile podcast report no relevant financial disclosures
Citation
Doshi, S., Jaggi, P., Lee, P., Abeles, S., Dong, S. “#103: Greening ID with Sustainabil-ID”. Febrile: A Cultured Podcast. https://player.captivate.fm/episode/7b451f5e-a897-48c2-a6e6-4f665ea03edc