Insights on Infection Prevention: Dr. Ed Septimus

‍Dr. Ed Septimus, MD, is an esteemed figure in the field of infectious diseases, serving as a Professor at the Texas A&M Health Science Center while also conducting groundbreaking health science research at Harvard Medical School as Senior Lecturer in the Department of Population Medicine. With a career marked by excellence, Dr. Septimus has made significant contributions to the fields of infection prevention, antimicrobial and diagnostic stewardship, and sepsis.

Before taking on his current roles, Dr. Septimus held key positions in the healthcare industry that exemplify his expertise and leadership. He notably served as VP Research and Infectious Diseases at HCA, a position where he played a vital role in ensuring the safety and well-being of patients and healthcare staff in addition to leading key health science research studies. Prior to that, he served as the Medical Director of Infectious Diseases and Occupational Health at the Memorial Hermann Healthcare System.

In this illuminating interview, Dr. Septimus shares insights from his remarkable research career, offering valuable perspectives on navigating the complexities of the healthcare industry. He also delves into the intricacies of building and maintaining strong relationships with hospital leadership and Environmental Services (EVS) teams, shedding light on the collaborative efforts required to uphold high standards of care. Furthermore, he discusses the challenges and strategies involved in sustaining meaningful change over time, a topic of great importance in the ever-evolving landscape of healthcare.

As a distinguished physician, researcher, and educator, Dr. Septimus's experiences and wisdom provide an invaluable resource for anyone seeking to make a lasting impact in the healthcare sector. This interview promises to be an engaging and enlightening exploration of his life's work and the lessons he has gathered along the way.

Interview with Dr. Ed Septimus, MD: A Career of Excellence

Q: You've had a fascinating career leading landmark clinical studies, most recently around sepsis. How did you make them happen?

Dr. Septimus: Some of the big research projects I did at HCA were a true collaboration between private (HCA), public (CDC), and academic (Harvard and UC Irvine) organizations, where we collectively applied for grants with funding from CDC, NIH, and AHRQ. I was fortunate to have a forward-thinking CMO at HCA, who very much supported the concept of doing clinical research. Part of our advantage was that very few organizations have the kind of infrastructure and scale of HCA with over 160 hospitals to be able to recruit a significant sample size and run studies across a 4-5 year life cycle.

Q: Have there been any interesting findings from your research that have stuck with you?

Dr. Septimus: The concept of using positive deviance to effect change. As an example, a hospital in Connecticut was conducting interviews 3 weeks after discharge about how knowledgeable patients were on their medications and diagnoses. Most of the patients had a tremendous medical literacy issue and were nervous or upset, but they did find a group of patients that had a very strong grasp of their medications and how to take them. They traced it back to one single nurse, and when they asked how she discharged patients and why she was so successful, they found that she sat down with the patient and their caregiver and had the patient write out in their words what each medication was for and how to take it. They were then able to model the discharge process after the best practice set by this nurse – she was the positive deviant.

Q: Given the current financial hardships being faced by many hospitals, how do you get hospital leadership to invest in infection prevention?

Dr. Septimus: Generally, my recommendation to infection preventionists is to get financial people involved on the front end and learn their language, and then use that language when you present to the C-suite. For a long time, many of us in infection prevention have always thought about preventing infections through the lens of cost avoidance, but it's not the easiest model to understand. Most hospital costs are fixed, so even if a patient stays longer, the cost of keeping the lights on are still the same. Maybe you might need to increase the need for nursing or maybe there's the cost of an extra drug, but trying to figure out the true cost of an infection is not easy. A different way to think about it is revenue. Some of this depends on case mix, percentage of Medicare vs. PPO, how full the hospital is, but if a patient doesn't get a complication, they go home sooner, the length of stay is decreased, and throughput is increased in the facility which enables the hospital to care for more patients and increase revenue. This is what I always tell clinical transformation groups: very few organizations that cut cost improve quality, but I know a lot of organizations that improved quality and decrease costs. When you fall behind budget and cut costs, the only way to get back on budget in the middle of a budget cycle is to cut people. And typically the first people who get cut are educators and clerks, and I mention this because they might not be the people at the bedside, but they support the nurses. And what happens is that the burden on nurses grows larger, this creates burnout, and increases turnover.  This results in loss of institutional memory so important to sustain quality improvement and safety.

Q: One of the hardest things is to sustain change. How do you think through that?

Dr. Septimus: It comes down to culture and how people feel about their jobs. Change always sounds good, but the actual translation into sustainable change is very difficult. When you move onto the next project, everything before often just reverses to the mean, but I've found the involvement of frontline healthcare workers to be critical. In the positive deviance project  to reduce MRSA, we sat EVS down and explained to them that the environment plays a role in transmission of  very serious infections. And for the first time, EVS felt like they were part of a patient safety team, and they weren't just cleaning because someone needs a room. They ended up owning the process and figuring out which rooms to clean first. Over the years, I've found that the best approach is to give everyone access to the basic science, and then have each group take the science and design themselves what works best. I don't ask them to buy in or tell them to do A, B, and C. What I've found is that if I get too enthusiastic and intervene too early, it shuts off the conversation, and it's better to let consensus develop and be a better listener.

Q: What do you wish more people in the IPC community thought about?

Dr. Septimus: If you don't do things right, just like anything else, you don't get the impact you want. Environmental cleaning is a good example where it's tough. I don't think we pay enough attention to cleaning when patients are still in the room. We're a bit better on discharge, but we've learned with organisms like C. difficile and C. auris that they're very stubborn to get rid of in the environment and the environment clearly plays a role in transmission of organisms like  like VRE, MRSA, and Acinetobacter. It's a lot of hard work, and we need ways to help EVS staff more consistently clean rooms and include them as part of patient safety  

Q: Now for some fun questions! If you could go on vacation anywhere, where would you go?

Dr. Septimus: I like to veg on a nice cruise!  

Q: What's your favorite place to eat near the office, and what's your go-to order?

Dr. Septimus: There's a neighborhood place called Costa Brava, this Spanish continental restaurant, and they have a wonderful red snapper. They also do good lamb chops.

Q: What's your secret office superpower?

Dr. Septimus: Being respectful and creating an environment that people can feel comfortable coming to me with concerns. Be a good listener.  

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