Infection prevention researcher paves the way

The Streifel File

CV

• Recently retired senior hospital environmental health specialist, University of Minnesota, Department of Environmental Health and Safety, Minneapolis.
• Senior dialysis technician, University of Minnesota Hospitals, Minneapolis.
• Kidney dialysis technician, University of Minnesota Hospitals.

Accomplishments

• 2022 APIC-SHEA Award for Lifetime Contribution to the Field of Infection Prevention and Epidemiology, June 2022.
• University of Minnesota hospitals and clinic infection control committee.
• Continuous appointment (tenured) academic professional, University of Minnesota.
• American Industrial Hygiene Association, biosafety and environmental microbiology committee.
• Midwest Center for Occupational Health and Safety, industrial hygiene specialty advisory board.
• ANSI/ASHRAE/ASHE Standard 170, Ventilation for Health Care Facilities, maintenance committee.
• Task force committee for the revision of Facility Guidelines Institute’s Guidelines for Design and Construction documents.

Education

• Master’s degree in public health, University of Minnesota.
• Bachelor’s degree in biology, University of Minnesota.

Andrew Streifel, MPH, recently received the 2022 Association for Professionals in Infection Control and Epidemiology (APIC)-Society for Healthcare Epidemiology of America (SHEA) Award for Lifetime Contribution to the Field of Infection Prevention and Epidemiology. This month, he discusses changes in the field and the importance of research.

When and how did you begin your career in health care?

I transferred from South Dakota State University to the University of Minnesota where I studied biology. In 1972, I started a one-year internship at a kidney dialysis unit that supported a progressive transplant program. After that, I was hired on as a technician before becoming a supervisor and worked there until 1978.

It was a very eye-opening and stimulating position for me because right around the time I started there, we started seeing problems with patients and the hemolyzing of blood, which we found was caused by the chlorine in the water supply. There was a cluster of hepatitis among our patients and employees, and that interconnection spurred my interest. I always liked microbiology and, in school, I had studied a lot of things related to this type of issue. I studied immunology, medical microbiology, hospital administration, ecology and a number of things that gave me the skills to detect microbial reservoirs in hospitals.

This position showed me how to assist in problem-solving to get the chloramines out of the water used to treat the patient so they didn’t continue to hemolyze the patients’ blood. It gave me a hands-on opportunity to deal with microbiology problem-solving in a dialysis unit. It also was one of the most meaningful experiences I had in the hospital because I worked directly with the people [who] were taking care of patients.

How did your work in the hospital help you transition into research and teaching?

I earned a master’s degree in public health specializing in institutional environmental health. My first job was working as a hospital environmentalist, and that required investigating many infection issues linked to the patient care environment. I also began looking into ventilation for our isolation rooms. However, when I tried to find literature on these topics, the only ventilation research I could find had to do with fire management and smoke control. It opened up an opportunity for me to research pressure management and publish on a variety of topics dealing with air pressure and infection prevention in design.

The work I was doing brought the attention of some other people in the university’s school of engineering and public health. We would have discussions about plumbing and water bacteria. Indoor air quality became an issue with the resurgence of tuberculosis in the early 1990s. I was conducting ventilation studies in the hospital because ASHRAE had issued a request for proposals to look at the impact of construction on health in the indoor environment. It was a very broad topic, but it turned out that I had a pile of papers under my desk that really signified that indoor air quality and fungal diseases were airborne-transmitted and were a problem. We published that paper for ASHRAE, and that paper drove us to create a training program for the University of Minnesota’s extension course program on construction management and infection prevention.

That led to a number of lectures, and around that time, the American Society for Health Care Engineering (ASHE) was just starting a health facilities management certification. The training had an infection control component. They asked me to come and join the faculty, and I served as a member along [with] many others over the years. A representative from the carpenters union attended one of our lectures and we were able to create a program with them, too.

I also participated in numerous committees such as the ANSI/ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities, revision committee; and the American Institute of Architects’ design and construction [committee], which ultimately became the foundation for the Facility Guidelines Institute (FGI) under Doug Erickson. Another best practice document I was involved in was helping to develop ASHE’s new Infection Control Risk Assessment (ICRA 2.0).

What are some of the evolutions you’ve seen in infection prevention and control?

One of the things I feel most gratified about is that over the years I’ve given talks at various courses or conferences, and after a while, I started hearing myself from other lecturers in the conference rooms, and I wasn’t the one talking. It made me feel good that the word was getting out about these matters that I and others were researching. As these issues got more traction and more people were discussing them, I was happily being put out of a job because the reality is that there were enough people saying it to make infection control during construction important. I even attended an infection prevention conference recently, and it was amazing how many of the vendors are talking about water quality, air quality, construction management and health care environmental consulting.

The fight against COVID-19 also has pushed awareness of infection control ventilation and, specifically, airborne infection isolation. COVID-19 has really spurred detailed discussions on ventilation and other sanitation issues. And the discussions are reaching others outside of the facilities departments. It’s been a matter of training administrators, risk managers, safety people, industrial hygienists, infection control practitioners and physicians in the concepts of air pressure and isolation room ventilation.

How does the field continue to develop this awareness of infection prevention?

We have to keep looking into [the] literature and discovering research that addresses ventilation requirements. Professional magazines also are credible resources even if they are not peer reviewed. I published in several professional magazines because they handle concepts, and to understand concepts ultimately saves you money without sacrificing safety. For example, there was a time when air filters were being manufactured with a charge attached to them, and that small charge would attract things to them so that you could get a more efficient filter without having to use as much power. It was great for energy savings but the filters filled with tiny particles, rendering them unusable. It’s important to remember that many things are tested in the laboratory but not in the real world, so you have to do your research.

How does it feel to receive the APIC-SHEA Award for Lifetime Contribution?

It feels wonderful. I am so grateful to have had the experiences I’ve had. I had opportunities to go to the biggest and best hospitals in this country and to a certain extent the world. I got to work with hospitals in Hong Kong and in Singapore as well as Qatar where they were building a huge hospital.

It was a fascinating time, because here we may take two or two-and-a-half years to build a hospital. But there, they will build for 10 to 15 years and the project just keeps expanding. That has been one of the biggest highlights for me — having the opportunity to get up in front of people all over the world and teach about infection prevention.