Implementation of Daily Chlorhexidine Bathing Programs in the ICU
Jackson Musuuza, MBBS, PhD, is one of the first implementation scientists to receive a degree from the graduate program in Clinical Investigation administered by UW ICTR. He earned the PhD in Clinical Investigation in summer 2016 with primary adviser , MD, PhD, and a dissertation titled Daily Bathing with Chlorhexidine Gluconate for the Prevention of Healthcare-Associated Infections: Assessment of Impact, Potential for Development of Resistance and Sustainability in the Intensive Care Unit. Members of his dissertation committee included Pascale Carayon, PhD, Tonya Roberts, PhD, RN, KyungMann Kim, PhD, and Ajay Sethi, PhD, MHS. Safdar notes,
There remains a significant gap between generation of evidence and its application. Implementation science is a relatively new discipline that aims to accelerate with high fidelity translation of evidence into practice. Jackson’s work shows the importance of careful rigorous implementation and evaluation of implementation to increase the likelihood of sustainability of infection prevention practices.
Musuuza’s dissertation demonstrated that daily bathing with chlorhexidine reduces the incidence of colonization by multidrug-resistant organisms, responsible for many healthcare-acquired infections, some with significant morbidity and mortality. There was no evidence of resistance or reduced bacterial susceptibility to chlorhexidine following long periods of chlorhexidine bathing. His findings uncovered a number of barriers and facilitators that affect chlorhexidine bathing and which are important in planning widespread implementation of the daily bathing intervention. Musuuza comments,
After many interviews with the nursing staff and nurse managers on intensive care units, I found that initial buy-in by frontline staff was crucial to ensuring success of this intervention. You definitely need leadership buy-in to start with, but getting leaders on board without convincing the front-line staff is not an effective approach.
Musuuza is continuing this work in his new position as a Research Health Scientist at the William S. Middleton Memorial Veteran’s Administration (VA) Hospital. He is working on a project implementing chlorhexidine bathing in five VA medical centers nationally. His long-term goal is a career in infection prevention through assessment, implementation, and evaluation of infection control interventions in the health care settings and the environment.
Musuuza had a one-year traineeship in the UW ICTR TL1 pre-doctoral program (2014-2015). His academic career in Clinical Investigation started with a PhD minor while he pursued a PhD in Population Health Sciences. However, after receiving a master’s degree from Population Health Sciences, he transferred to the PhD program in Clinical Investigation at a time when implementation science was emerging as a clinical and translational science specialty, demonstrating the flexibility of entry into the Clinical Investigation program.
Angiogenesis Regulatory Pathways Offer Clues for Treatment of Age-Related Macular Degeneration
Mitra Farnoodian earned her PhD in Clinical Investigation in summer 2016 with Nader Sheibani, PhD, as her primary mentor. Her dissertation, Endogenous Inhibitors of Angiogenesis, TSP1 and PEDF, as Potential Targets for Treatment of Exudative AMD, investigated mechanisms behind age-related macular degeneration (AMD) and development of potential therapies. Barbara Blodi, MD, Peiman Hematti, MD, Michael Ip, MD, and Donna Peters, PhD, were the other members of her mentoring committee.
Although AMD is a major cause of visual impairment in the elderly population worldwide, its underlying etiology remains largely unknown. The increased production of specific growth factors such as VEGF has been identified as an essential factor in the development and progression of AMD and associated choroidal neovascularization. However, safely blocking candidate growth factors has been difficult from the standpoint of short term treatment complications and also the potential for long-term systemic complications. Thus, safe and effective new treatments are needed.
Farnoodian’s doctoral research identified altered mechanisms associated with abnormal expression of endogenous angiogenesis inhibitors. She proposed that alterations in the expression of these proteins and subsequent cellular dysfunction in the eye is involved in AMD. She also investigated the utility of mimetic peptides as safe new therapeutics that effectively delay pathological progression of AMD through blocking ocular neovascularization by mimicking natural endogenous inhibitors of angiogenesis. Sheibani notes,
The significance of Mitra’s studies stems from her delineation of a major role for choroidal endothelial and retinal pigment epithelial cell function in AMD and the novel regulatory pathways by which TSP1 and PEDF angiogenesis inhibitors contribute to ocular vascular homeostasis and AMD pathogenesis. Her findings have a direct clinical significance to our search for new therapies to restore cellular function in the eye and prevent AMD progression.
A native of Iran, Farnoodian came to UW-Madison in 2011 and earned an MS in Bacteriology before applying to the PhD program in Clinical Investigation. Her parents watched her defense on Skype.
Farnoodian’s career goal is to participate in development and implementation of clinical trials to improve outcomes for retinal degenerative diseases. She comments,
I envision a career which incorporates both components of scientific learning and its clinical application and which will allow me to be involved in different stages of the process of clinical and translational research. My mentors in the Clinical Investigation program made an enormous difference in my own progress and ultimately I would like to pay that forward by mentoring the next generation of young scientists.