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Armando Nahum: [00:00:00] When I asked the infection preventionist at the hospital, Joshuas that, how did you get this infection? He looked down and said, I just don’t know. And that broke me, but it also opened my eyes. No one person can fight every germ, but the system can if we choose to. 

Nicole Kupchik: This is the sepsis spectrum, a podcast about antimicrobial resistance, sepsis, and how to expect the unexpected in your practice.

Not every boy who dreams of the skies gets to visit them, but by 27, Josh Nahum was a skydiving instructor chasing clouds and saving up to become a child psychologist. On Labor Day weekend 2006, a sudden shift in air density caused Josh’s parachute to collapse mid jump. He hit the ground at 60 miles per hour, breaking his femur and fracturing his skull.

Tragic, but thankfully survivable. [00:01:00] After nearly six weeks in the ICU, Josh was improving and transferred to a local rehab facility. Fast forward six days, and he developed nausea in 103 degree fever. Test revealed enterobacter aerogen. A hospital acquired gram-negative bacteria in Josh’s cerebral spinal fluid.

That night Josh coded. An emergency brain procedure saved his life, but resulted in spinal damage that left him a ventilator dependent quadriplegic. On October 22nd, Josh died not from his injuries but from sepsis. Today we speak with his father, Armando Nahum and hear about one family’s necessary mission.

Born from an unnecessary loss.

Hi everyone, and welcome to the sepsis spectrum or as we like to call this season Microbial Mysteries. I’m Nicole Kupchik, critical care nurse and clinical nurse specialist [00:02:00] and your guide through the complicated and sometimes frustrating world of sepsis and antimicrobial resistance. On today’s episode, we’re gonna understand how quality improvement or QI plays a key role in catching sepsis, healthcare associated infections and antimicrobial resistance early, and keeping patients safer.

First up is Armando Nahum. You may recognize his name from the story I shared at the beginning of this episode. Armando is a nationally recognized patient safety advocate whose mission began after losing his. Son to a hospital acquired infection. He co-founded the SafeCare campaign and has advised major institutions like the CDC and CMS on infection prevention and patient partnership, infection prevention, and system-wide change.

Including his appointment to the Presidential Advisory Council for combating antibiotic resistant [00:03:00] bacteria. After the break, Dr. Hudson Garrett will join us. He is one of the most credentialed voices in healthcare, safety, quality, and infection prevention. As president and CEO of the Hudson Garrett Group, and with advisory roles to the F-D-A-C-D-C and A ORN, he’s helped lead the charge in reducing harm and fighting antimicrobial resistance.

Gather. They offer both clinical insight and lived urgency, an essential pairing in the fight to make patient care safer. Let’s welcome to the pod Armando Nahum.

I am privileged to be joined now by Armando Nahum, who you heard the story of his son Joshua, and his unfortunate untimely death back in 2006. So now I’m gonna, we’re gonna talk about what Armando Nahum has done since his son’s [00:04:00] death. So welcome to the show, Armando. 

Armando Nahum: Hello, and thank you for having me here today.

Appreciate 

Nicole Kupchik: it. Yeah. Oh, thanks so much for joining us. Uh, can you just give us a quick recap of what happened back in 2006? 

Armando Nahum: Sure. I’d be glad to. Uh, what I’m about to share, it’s not really just my story. It’s, um, a story that touches so many families across the country, and it’s a story about infections, not the kind we expect and recover from, but the ones we never see coming.

Those that happen in the places that we turn in for healing the hospitals. So within just 10 months time, three generations of my family, my father, my wife, and my son, each suffers serious, even deadly bacterial infections, different hospitals, different procedures, different states, but all preventable. If I may, um, I’d like to take you back to where all this began.[00:05:00] 

So first was my dad, Quint. It was just before Thanksgiving 2005. He had a mild heart attack and was admitted to a hospital in Rochester, New York. And while recovering, he developed a bacterial pneumonia, an infection he got while in the hospital. Thankfully, his doctor caught it early, treated him with the right antibiotics, and he fully recovered.

But that was our warning shot, and it wouldn’t be the last. So I like to fast forward now to the year 2000. My wife, Victoria decided to do something for herself, um, meaning mommy makeover, as they call it. She opted for saline breast implants, and at first everything seemed fine. She felt good and she was confident, but slowly things began to change.

She developed strange symptoms, deep fatigue, aching joints, rashes, and numbness in her arms and legs. Even her tongue would stick to her roof of her mouth from dryness. We went to every doctor you can think of, [00:06:00] dermatologists, neurologists, rheumatologist you named Theologist. We saw them. Eventually a rheumatologist told us she had developed an autoimmune disease, very likely triggered by the implants.

Even removing them would not undo the damage, and when she finally did have them removed. They discover biofilm of staph epi growing all over them. So breast implant illness, or BII is actually real. It mimics autoimmune disease and in some cases becomes one. Victoria’s symptoms continue to this day. She lives with them, manages them, and she’s not alone.

And then there’s Josh. Our son Josh was 27. Living his best life in Colorado, he was a skydiver, full of life, full of adventure. But on Labor day of 2006, everything changed. He had a bad landing, um, shattered his femur and fractured his [00:07:00] skull. He was rushed to the ICU six weeks. He fought not just to recover from the accident, but to survive two separate M cases, uh, than that he picked up in the hospital.

He started to get better. They transferred him to rehab and we began to hope. But then suddenly he spiked. The fever became violently ill and fell into a coma. Doctors ru rushed to his spinal tap. His cerebral spinal fluid was full of deadly gram-negative bacteria, and they performed an emergency brain surgery to relieve his swelling.

Josh survived that, but now without devastating consequences. Josh became a ventilator dependent quadriplegic. He couldn’t move, he couldn’t breathe on his own, and yet through it all, he was still Josh, still conscious, still fully aware as as he laid in the ICU for those final days. [00:08:00] Over 70 of his friends gathered in the hospital lobby.

They stayed there two full days just waiting to say goodbye, and they shared. Stories, funny, sweet, raw memories of Josh. I remember standing there at the foot of his bed just outside his field of vision, listening as his friends say their goodbyes. Watching these young people full of strength and life suddenly break down into tears as they whispered their last words to the friend they loved.

When it was finally my turn, I turned. I didn’t know really. I didn’t know what to say. What do you say to a child when the world is about to lose? So I leaned in close and whispered what I had said to him ever since he was born. I love you so much. Josh passed away shortly after that. He was 27 and every day, since my world has never been the same [00:09:00] hospital acquired an infection.

Also called healthcare association. Infection or nosocomial infection are not rare. They’re not random and they’re not unavoidable. When I asked the infection preventionist at the hospital, Joshuas that, how did he get this infection? He looked down and said, I just don’t know. And that broke me, but also opened my eyes.

No one person can fight every germ, but the system can if we choose to. So I started asking question, reading papers, meeting with experts. And I realized something powerful. Patients, families have a vital perspective that’s been missing from this conversation. In 2018, MedStar Health, one of the largest healthcare system in the Mid-Atlantic, they, um, approached me and they were launching a system-wide initiative to address sepsis, and they asked me to lead [00:10:00] that effort.

I was hourly surprised. I was just a grieving father, not a clinician. I remember thinking, got the wrong guy. I don’t know anything about sepsis, but I showed up anyway. And what I brought, what any patient can bring was a different kind of insight. I learned that 80% of sepsis starts outside the hospital and that in the er people were waiting three to four hours before even being evaluated as a lay person.

That did not make any sense. So I asked, what if we screened for sepsis at the door? What if we integrate it into the electronic medical record? They said it may not be perfect. It might lead to some false positive, but if we saved even one life, wouldn’t it be worth? It was worth it, right? In the end, we reduced sepsis mortality rate by 25%.

We passed legislation, won awards papers, but more importantly, [00:11:00] we save lives. And so I share all of this enough for sympathy. For action because every caregiver, every administrator, every policymaker, you have the power to make care safer through your choices, your attention, your voice, if you made it this far into this episode.

Thank you so much. I, I hope Josh’s story, my family story, stays with you, not just as a, you know, cautionary tale, but as a call to action. Because when we get this right, when we truly commit to preventing infection. We don’t just save patients, we save mothers, we save fathers sons. More importantly, we save families.

Thank you. 

Nicole Kupchik: Wow. That’s pretty powerful. You know, uh, just looking back at his hospitalization or like your father’s experience or even your wife’s experience, is there just anything that was glaring to you that possibly could have been done different? [00:12:00] 

Armando Nahum: Yes, quite a bit. I mean, this is an interesting question because now we’re talking, um, time, right?

I mean, how we used to give care back in the 18 hundreds. Now how we do care today in 2025. So in 2000 and and and six, when Josh was hospitalized. The one thing that, and, and of course I knew nothing about healthcare, but in, in looking back, I remember there was a coffee pot. In the hallway, in the ICU, that’s a no-no, that’s the first, that’s a, everybody touches that coffee pot.

So you go into a room to a patient who’s in ICU and you come out to get a cup of coffee and you just contaminated that coffee pot. You know, uh, hand hygiene was not as compliant as it is today. We, we don’t, we didn’t have that, that. That knowledge that we have today, because today we even have technology that even talks to you if you don’t wash your hands or sanitize your hands when you walk into a [00:13:00] room.

So, so the care that was given back then there’s, I mean, I could turn around and say this and this and this and that. There’s a whole slew of things that they could have done differently. But the more importantly was hygiene. My wife, his mom had to give him a bath because the hospital was not diligent enough.

Josh fingernails were black. You know, just poor, poor hygiene. So, you know, if you don’t keep the place clean or you don’t keep the, uh, the, the patient, uh, clean and protect the patient. By you washing your hand, sanitizing your hand, something bad is going to happen. It’s inevitable. It’s not, if it’s when.

Nicole Kupchik: Yeah. Well, you know, even right now the CDC, another thing that we’re looking at is the stethoscope that goes from patient to patient. In fact, the C, DC is calling it the third hand because we’re finding the same pathogens on your hands or on our stethoscopes. 

Armando Nahum: Yeah. It’s really ironic because, um, my wife and I, uh, were asked [00:14:00] to speak at one of the hospitals, uh, but HCA here has hospitals in London, England.

And so they asked us to speak over there and we found out that doctors over there no longer can wear a tie because the tie would just swing over. Sense and be contaminated. Yeah. It’s, it’s, it’s really crazy. Um, so things that completely makes 

Nicole Kupchik: sense though. Yeah. Right. 

Armando Nahum: Yeah. I mean they just, you know, you lean over and that, that tie just picks up everything, so.

Yeah. Um, but yeah, that a, a lot of, a lot has changed, but we have a, a long way to go. 

Nicole Kupchik: I completely agree with you. Um, so one of the things I wanted to talk about was the organization you started after Josh’s death. Can you talk a little bit about that? 

Armando Nahum: Well, I dunno which one you’re referring because we started three different organizations.

Tell, and so the tell the first one, well the first one that we started is, is called Safe Care Campaign because living in Atlanta, uh, my wife and I reached out after Josh died to the CDC, and we thought that’s a great [00:15:00] place to start. As a layperson, I thought, that’s a federal agency. That’s the first place we should go, and they’re right here in Atlanta.

45 minute meeting ended up being three hours. They were extremely generous with their time. And the entire epidemiology department met with us. And when I asked the question, you are a federal agency, you can’t do anything about this. And they actually looked at me and they said, no, we can’t. Uh, we just put out guidelines.

And I said, well, who can they? And they point, they all pointed in my face and they said, you can go out there and tell the story. And so they encouraged us. To start something, what, whether you call it a movement, a website or something. So we started a safe care campaign, which was really based on infection prevention.

And then of course they asked me to be under Council of Infection Prevention. So I sit under council, um, and participate in a lot of the discussions on infection prevention, but that, that only worked for a little while. So hospitals [00:16:00] got a, uh, uh, they, they, they started calling us and, oh, we, we, we’ve heard about your story, your family story.

We’d like you to speak at our hospital. We’d like you to be a keynote speaker at APEC Infection Prevention, uh, conference. It was great. But one year I was flying back from Washington, DC and I started thinking, you know what, how long does that message resonate? Three months, six months. And then what? Going back to do whatever you were doing before.

Right? And if somebody takes charge, if you have a, a, a nurse manager or somebody that takes charge of, let’s say a hand hygiene compliance program, she goes on vacation, then what happens? And sure enough, I found out that that number goes way down. So I started thinking, you know what, what’s missing is the patient’s voice.

We need a partnership here. We need to get the patient involved in this. And at that time. CMS was, was launching Pat, uh, the partnership for patients under the CMS Affordable Care Act. Right? And so [00:17:00] we down in our home and develop tools. To help hospital engage with patients and family, therefore patient and family advisory councils.

And, uh, we added the QNS to make it for quality and safety. Because my thought was that, although, yes, I do think the patient experience is important, but let’s not just stick to that because patient experience should be the umbrella that encompasses quality and safety. If you go out in the street and you ask any person on the street what’s important when you go in the hospital, it’s not the color of the walls, it’s not the kind of food that they provide you with.

It’s to go home safe and sound after a procedure and no readmission. That is the number one thing that people want. So building these, these p FACS became so successful. They became a model and that’s how I got connected with MedStar. ’cause we built all of their p facs and then. Uh, BHA, which today’s [00:18:00] Vizient, they engaged us to do the same thing.

And, and then after that I thought, okay, you know what? That’s my voice in Armando’s Work and Infection Prevention building p FACS and all that. But what if we get 10 of us known patient advocates, nationally known patient advocates, and we get together and together we’ll have a stronger voice. Sure enough.

We develop patients or patient safety US, or PFPS us, which is a chapter under the World Health Organization. You gotta be careful today, say World Health Organization. But, uh, but um, but yeah, we, we move mountains because we get in the conference with CMS and they’ll say things like, oh guys, we’d like you to say X, Y, Z, because you can say it, but we can’t.

So we have now. Uh, passed, um, the structural measures, we’ve published [00:19:00] aton of papers. We, it, it’s just gave us a, a, a platform where now we can go up to the hill and actually talk to congressmen and senators about the problems that this country’s facing in healthcare. 

Nicole Kupchik: Yeah. So let’s say like, what would you like to see happen in the next five years to 10 years?

Armando Nahum: Well, first of all, the number one thing is to make sure that patient safety is not politicized. Patient safety has to be front and center. I don’t care what administration we have, I, I, you know, it doesn’t really matter. You know, patient safety is, and, and we, we are totally nonpartisan. It doesn’t matter. I don’t care who you believe in, what party you in, it’s sooner or later we all go into a hospital, you know?

Um, and so patient safety to me has to be front and center. And then I would like to see things like, um, transparency and reporting. There has to be a place. [00:20:00] Has to be a bank where patients can report an adverse event. And right now people say, yeah, there is. You can report it to Joint commission. Really show me what it does.

After that, it goes nowhere. We’ve done it, it goes nowhere. Um. So there, there has to be transparency and there has to be accountability for all of that. You cannot, you know, we keep talking about driving healthcare to Z zero harm, but how do you, how do you get to zero harm? So you have to have patient and family engagement, you have to have transparency, and you have to have.

Accountability and oversight. If you, if you don’t have those things, um, you know, you’re just not going to reach that. And, and I love it when people say, um, they tell me, I walk in the hospital and they say, oh, we started a head hygiene program and it’s, uh, our goal is, uh, you know, 80%. I go really 80%. So the other 20% will die.

Yeah, it should be a hundred percent right. Your goal should always be a hundred [00:21:00] percent right? Absolutely. Are you gonna reach percent percent? Yeah. Are you going to reach a hundred? Most likely not. It’s extremely difficult, even though it’s such a simple thing to do, but it’s extremely difficult and not because you wanna cause harm, but because in the middle of the day, especially running like crazy in an ICU environment, you forget that single most important component in the delivery of care and hygiene.

It’s really, it’s, it’s very simple that it’s, it’s missed often. So those are the things that I wish in the next five years. I’m hoping to, to have ’em in the next three years, but I’m not so sure. Yeah, 

Nicole Kupchik: yeah. No. Well, you know, I think ev all your points are valid and, you know, one of the hospitals I worked in, I remember it was just such a culture for us that we would give each other feedback like, Hey, I saw you walk outta that room and didn’t see you gel.

You know, I mean, you know, and it was so funny. I remember one time I got yelled at, ’cause I had gelled coming out of one patient’s room, was walking down [00:22:00] the hall and then went into another patient’s room and I got yelled at and I’m like, no, I swear I was just, I was walking down the hall doing it. You know, but that’s what it, it takes it.

So we’ve got to be just truly holding each other accountable. And then, you know, also I think doing root cause analysis when we have patients who have hospital acquired infection and it really, our goals should be zero. 

Armando Nahum: Absolutely. You know, there’s one thing that I tell every CEO that I meet is they’ll say, well, if there’s one thing you would like us to do, what would that be?

I say, I would like you to hold a meeting with every single person, um, that, that you employ. I don’t care if they work in the basement to clean, you know, the, the, that the tools, I don’t care if they, they just clean the rooms. Every single person that gets a paycheck from you should be in their meeting.

They say, and then what I said, and then tell them that they are entitled to speak up. If they see something, say something. You have the power to [00:23:00] tell them that. Because what happens is, and you know as well as I do, a lot of nurses, they are afraid to speak up because you know, oh, you know, repercussion here and there, you know, it shouldn’t be.

They should, if you in the military, you know, if you see something, you say something. It’s just common sense, and that’s how you learn from your mistake. You know, we filed a complaint with the Office of Inspector General when the Vanderbilt case happened, you know, a couple years ago. Why? Because granted, the nurse made a mistake.

She killed a patient. Sure. You know, but. You have to support her. You have to step up to the place she worked for in your hospital. You have to say, we made a mistake. It’s, you know, it, it just, you can’t do the hiding because you’re not learning from your, from any mistakes you make. So. 

Nicole Kupchik: Well, I just wanna thank you for being here today.

I wanna thank you for all the work you’ve done and you know, and just really thank you honoring [00:24:00] Josh’s life and you know, truly making a difference in healthcare. I just really appreciate all the work you’ve done. Thank you so much for having me.

Are you a nurse infection, preventionist, or healthcare professional who wants to stay ahead of the curve? Visit sepsis podcast.org to learn how you can receive free nursing CE credits by listening to or watching the sepsis spectrum. It’s our way of supporting you and together better understanding the ever evolving world of sepsis care and a MR.

And now back to the show.

So now I am joined by Dr. Hudson Garrett, who has done a lot of work in infectious disease and quality improvement. So welcome to the show. Thank you so much for having me. Yeah. So we heard an amazing interview and [00:25:00] just so much work that’s being done, um, in a legislative way to try to make change. So now what I wanna do is kind of drill down and talk about a lot of the work that you’ve done with antimicrobial resistance and antibiotic stewardship and quality improvement in those areas.

So can you tell us a little bit about some of the work you’ve done? 

Dr. Hudson Garrett: Yeah. So I mean, I, I think intentionally, my background in infectious disease touches on a lot of different stakeholders. Um, and when you think about antimicrobial stewardship and resistance, it’s a true community issue. Um, it’s one that frankly, we don’t talk near enough about.

The implications reach far beyond even sepsis. And so when, when you think about a patient who, for example, doesn’t take their full dose of antibiotics, um, they think, well, that’s just a problem limited to me. And, and the reality is it’s, it’s not. And so I’ve really enjoyed sort of bringing the different facets of medicine together, whether it’s infectious disease or.

Quality or patient safety and even concepts like risk management, uh, to the table [00:26:00] so that we can sort of bring those intricacies to the same table and have the dialogue that’s more interprofessional. Uh, healthcare, whether it’s sepsis or heis or surgical site infections, each of those is a complex issue.

And it requires a lot of different disciplines to come together and sort of put egos aside and say, let’s solve the problem. Um, and our patients are desperately seeking that. And that’s really where my fundamental focus is, is on breaking those silos, bringing those stakeholders together, and fundamentally trying to get to the root of the issue.

Nicole Kupchik: So can you give me an example of, um, if you can think of a case or if you can kind of bring a practical approach to how this is done in hospitals? 

Dr. Hudson Garrett: Well, I think there’s a, a gap analysis that has to start to, to your question, you know, what’s the current state versus the desired state. Um, so many healthcare facilities, whether it’s a hospital and, and frankly even places like long-term care, you know, the resources may be scarce.

They may not be near as appropriate as they need to be. [00:27:00] And so I always say, start with where you are today and think about where you wanna go in the future. ’cause, you know, stewardship, resistance, understanding, uh, patient education and, and, and sort of even building confidence with our prescribers is a journey.

And you can’t just start and say, let’s break down all the doors immediately. Um, and so I always say start there. Uh, the second thing I think about is getting stakeholder engagement. Uh, making sure that you have the right people sitting at the table that have the desired outcome in mind that are saying, yes.

That sounds like a great place to go. I’d like to be a part of that initiative. And getting input from patients I think is absolutely critical. I mean, that basic concept of consumer feedback, I mean, at the end of the day, they’re the ones that pay the paychecks, um, and they have to be at the center of the care.

But there’s also that dimension of that, the healthcare teams engagement. And I think sort of the fourth dimension of my mind is, are we actually moving the needle? And that’s where the data, the performance improvement and frankly the quality component comes in [00:28:00] of. You know, are we going in the right direction?

And if the answer is yes, then fantastic. Let’s keep going. The answer is no. Let’s figure out why we’re not moving in that direction and let’s make some tweaks and some adjustments and continue to ideate. 

Nicole Kupchik: So in your experience, what have you found some of those tweaks and adjustments are? ’cause I think this can be a monster of an issue to try to tackle.

So what have you found that’s been more practical that has helped? 

Dr. Hudson Garrett: I mean, probably fundamentally is, is leadership engagement. I mean, when you have a good culture and a good leadership engagement and, and an executive leader particularly that’s engaged, a lot of things are possible. Um, not just in the topic that we’re discussing today, but just fundamentally truly transforming care delivery.

Um, and, and not just doing it for today and, and even tomorrow, but the true future building those truly transformative care systems that are highly reliable. Um, I, I think that’s probably number one, but. Two is really fundamentally getting to the root of the issues. You know, if you think about stewardship, you know, why do we have problems with [00:29:00] stewardship?

It’s no different than basic concepts like hand hygiene. It boils down to organizational cultures and process management and accountability, and sometimes having difficult conversations. You know, antibiotics are one of our most important portfolios and medications that we have at our disposal, and we have got to protect them at all costs.

Um, the implications of antibiotic resistance is, is tremendous, and yet sometimes we just sort of become complacent, uh, from that perspective. And so it’s really critical to also remind ourselves that complacency kills. And, and our patients have a high expectation as safe, reliable, and affordable care. Um, and, and if we go back to those core tenets, I think we always end up at the right place.

But losing sight of that sometimes can become easy and it’s a, a good reminder for us to step back and focus on the most intentional efforts. 

Nicole Kupchik: Well, how do you take what you’re talking about, because you’re talking about bringing people together, um, and from, definitely from a leadership perspective, but I always wonder how [00:30:00] often does that information make it to those that are doing the work at the bedside and ’cause I truly, those are the people you’ve gotta engage.

And so what have you found that has worked? Because I find so many times I’m in these big meetings and yet the people doing the work don’t get the information. So what have you found that’s worked? 

Dr. Hudson Garrett: Interactive dashboards, I think are, are certainly helpful. Um, pushing information to them in a format that works.

You know, putting people to your point in a staff meeting or a once a month committee meetings, that’s completely antiquated. Um, providing retrospective information is not helpful. You know, if I tell you with, you know, you have this patient and they were here 15 days ago, you should look at me and say, well, that’s completely useless.

That patient’s long gone, the length of stay is over. The patient is, is, is out of the facility. What do you want me to do with that other than just learn from it? Um, but true real-time information, whether that’s laboratory diagnostic notifications or understanding the antibiotic and, and really looking at susceptibility, [00:31:00] um, and resistance profiles and, and frankly, engaging patients in true, meaningful competency, um, of, of really engaging in their treatment.

Um, you know, we’re great at printing off a lot of patient education. Plants, and we’re terrible at getting good competency with our, our patients and their families to understand their condition. You know, I think new onset diabetes is a great example of, well, here’s your 40 pages of, you know, information on the new diagnosis.

Well, that’s not good. Um, that’s not gonna be effective for them. So here, whether it’s sepsis or something else, we’ve gotta give real time information that allows for strategic, evidence-based and data-driven decisions. To your point, to the frontline clinicians that are making those decisions. When we do that, we not only help the patient, but we also help create better engaged stakeholders because they feel like they’re a part of the solution and they feel like they’re truly in a system that actually is working in the favor of the patient as well as the team that’s delivering the care.

Nicole Kupchik: So can we drill that down a little more? [00:32:00] So what does that look like practically? Like what does that look like? Are there, um, do you have screens set up and like, for example, workstations? Or are reports delivered on the, the patient? Like what it, I just wanna walk through like what does that look like?

Truly make a difference. 

Dr. Hudson Garrett: I mean, today you, you see dashboards, I, I think is, is really where we’re today. In the future though, I think that’s gonna completely transform. And when I say future, I’m not talking about 10, 15 years, I’m thinking three to five years. Especially with these new AI technologies, we’ll be able to truly individualize treatment plans.

Uh, we’re already seeing this with antibiotics where we can make more individualized treatment, you know, based on even the facilities antibiotic. So they really look at the, you know, the microbe that we’re trying to treat with the susceptibility and the resistance profile. Well, that’s a great thing for the patient, and it’s also great for us.

We’re not gonna hit them with multiple antibiotics that are not gonna work. We’re not creating resistance profiles, but we need to take it a step deeper. You know, if I’m looking at a patient that’s in front of me, how do I [00:33:00] arm that clinician with, you know, preferably ai, customized information that’s pulling from the entire sort of plethora of, of databases that we have, the peer-reviewed literature as well as institutional data that says based on, you know, this patient Nicole, sitting right in front of me.

This is the best option that’s truly transformative. And, and it’s also gonna decrease cost. It’s gonna improve quality, and it’s gonna make our healthcare system so much more efficient from the patient’s perspective too, and hopefully decrease weight. Um, which I think is really key for better outcomes.

Nicole Kupchik: Yeah, I mean, ’cause the reality is that we just don’t have enough specialists in hospitals to really deal with every patient who’s got an infection or god forbid a hospital acquired infection. Or even an antimicrobial resistant infection to be able to one-on-one make decisions. I, I see AI being huge in this.

Dr. Hudson Garrett: We, and, and I would say the laboratory space is far ahead of us. You know, we see laboratory methods that [00:34:00] are much more sophisticated in advance, which is fantastic. Um, you know, even with the large national reference labs, they are doing some pretty stellar work in terms of real-time notifications, pushing that information to the provider, creating systems that allow us to make better decisions.

And, and I think we need that in the drug space. Um, and also in the medical device space too, you know. We can’t ever forget that sepsis is not just a drug related issue. It’s not just a body system related issue, but devices can also be directly associated with this, like Foley’s as an example. You know, how do we automate some of those clinical workflows where our clinicians that might have placed a Foley seven days ago?

Really thinking about clinical necessity of that line and, and really reviewing those types of things where it becomes second nature and we remove the human component that we know is not perfect out of the equation. And that’s gonna be the sweet spot that we’ve gotta achieve. 

Nicole Kupchik: Yeah. Especially if we can make the information easy.

I can’t tell you how many times I’ve been at the bedside and I’m like, what Foley Day is it anyway? And was this [00:35:00] the original Foley? You know, our longer term patients, that information can be really difficult to dig out of a chart. 

Dr. Hudson Garrett: Absolutely. Absolutely. And you know, the EHR had all the good intentions, right, to, to be created.

And sadly, uh, there’s lots of data that goes into it, but we’re terrible at pulling the data out. And to the earlier point, making it provided in a meaningful way to our clinicians where it says, here’s how you’re performing. Here’s what you could do better. And here’s how do we use that information to make better treatment decisions because our patient is expecting us to use.

Every available data point to make a personalized decision. And that’s what medicine has gotta become is more personalized. 

Nicole Kupchik: Yeah. And then I wanted to ask you about antibiotic stewardship. Uh, what do you find procalcitonin to be a helpful lab to follow? Or is there anything you see that’s coming up on the horizon or what are your thoughts?

Dr. Hudson Garrett: I mean, I, I do, I think it’s, it’s part all of our [00:36:00] portfolio, right? I mean, it, it, it’s, it’s almost like if you think about A CBC versus a, a lactate versus a this versus a that, when you have the total bundle collected, right, you get a much better holistic picture of that patient. Um, you know, one of the best examples I could think of that’s correlated to this is collecting a blood culture.

You know, and we think about, well, we get some commensals back and we, we rush to go to try to treat it, versus taking a step back and saying, well, let’s look at the bigger picture. Is this a patient that’s in the bed that actually looks clinically sick? You know, maybe a little staff, you know, epi is in the blood culture, but if the patient looks clinically well and they’re completely hemo ally stable, why are we treating this?

And that’s where I think we have to have more focus is, you know, how do we combine good sort of, you know, drug portfolios, you know, better understanding of device related issues with this, you know, good use of AI and some of the data as well as some of these other components and frankly, better systems.

Um, you know, a lot of our systems in healthcare are just frankly not designed to talk well to each [00:37:00] other and they don’t give us information that’s a good output. I mean, I was looking at something last night, ironically. There was something that was new in the system at the top and I thought, what is that cool little button?

And it said, AI summary. And it said, would you like us to summarize the last seven days for you? And so I just clicked it ’cause my, my brain was excited and it said, it said, you know, give us, I think it said gimme 10 seconds or something like that. And I thought, well, I’ll give you 30 seconds, and 30 seconds later it summarized all of the information in, in, in that medical platform.

And I thought. Oh my gosh. This just basically took something that would’ve taken me probably an entire day to go through seven days of postings, and it generated it in a way that was completely personalized for me based on my profile. That’s what we need to see more of, so that whether you’re an ER physician or you’re an infectious disease practitioner, or you’re a bedside nurse.

Everything should be customized also to you as the healthcare professional based on your expertise so that you can deliver your expertise to our patient. And I think [00:38:00] that’s gonna make people really want to engage more on hot topics like sepsis, you know, ’cause sepsis is not going anywhere, sadly. It’s, it’s gonna always be a part of healthcare, but frankly, I want to make it sure where it’s extinct.

Um, I wanna, you know, eliminate it as much as possible because that’s what our patients deserve. 

Nicole Kupchik: Yeah, absolutely. And I can say just from, as a clinical nurse specialist, I’ve had to do m and ms or patient case reviews, things like that. And it literally can take like four plus hours, just do one case to gather the information, to be able to click a button and get a summary.

That would be amazing. 

Dr. Hudson Garrett: Well, and, and our colleagues in infection prevention and control have become heavily burdened. On federal data requirements with the CDC, national Healthcare Safety Network, and that’s become a problem, right? Because infection prevention and control is not performed behind a desk.

It’s not performed with data collection. And it goes back to what you said earlier, [00:39:00] how do we truly transform care? Well, it’s great to have data, it’s great to have benchmarks and don’t disagree with that, but that’s not helping the patient that’s in the bed right now. Whether that’s in the ER where we can intervene and stop sepsis before they have to go to the ICU or whether that’s a patient that’s in the OR that starts to code where we can intervene as a rapid intervention, the more we get ahead of that eight ball with the different systems and technologies and better competency, um, I think that’s where we’re gonna win.

And it also engages our clinicians at a different level of granularity than where we are today. 

Nicole Kupchik: Yeah. Okay. So we’re gonna wrap up our interview. This has gone by really fast. Could talk to you all day. Uh, but let’s say it the year is 2035. What would you like to see from an infectious disease standpoint?

Dr. Hudson Garrett: I think it’s gonna be something where we can individualize the risk profile of our patients. To the point where it’s almost like an a SA [00:40:00] score when you come in for anesthesia and, and anesthesia can sort of eyeball you and look at your anatomy and say, yeah, you’re gonna be a difficult intubation and we’re gonna have this kind of trouble.

We’re gonna need a GlideScope, whatever it is. We need the same thing in terms of sepsis risk or risk for. You know, vessel preservation and, and some of the other core competencies associated with care of these critically ill patients that I think is gonna be actually pretty close. I don’t even think we’re talking about 10 years.

Um, the technology is moving so quickly. Our patients are certainly very interested. AI has so much capacity. And I, and I think the FDA in particular, um, here lately is very interested in registry data. So it’s gonna be quite fascinating to sort of combine all those different data points and say, wow, we can actually start to draw a lot of lines here to.

Really collect this puzzle and actually draw some true conclusions about what’s best practice, what’s not. How do we adapt that? How do we become [00:41:00] more agile and then truly deliver personalized care to our patients, but also allow our clinicians to truly practice medicine, um, and do so in a way that’s not cookie cutter, not algorithm.

Uh, the worst thing I can think we ever did was create the, you know, the, the BLS and A CLS algorithms. Um, because while they’re great, they’re also a double-edged sword where people say, well, it’s not on the algorithm. What do I do? Um, that’s critical thinking. And so if we can utilize new technologies, whether it’s laboratory or a medical device, or drugs or ai, clinicians are gonna benefit from that.

And at the end of the day, so our patients. 

Nicole Kupchik: Yeah. Exciting. Well, I’m excited to see where the future takes us, but I just wanna thank you for sharing your expertise and thank you for joining us on the show today. 

Dr. Hudson Garrett: My pleasure. Thanks.

Nicole Kupchik: Wow. I am completely inspired by Armando [00:42:00] Nahum and his story and really making something good out of something extremely tragic. And I’m so proud of Dr. Garrett Hudson for all the work he’s doing with a MR and advocating and, uh, really getting involved with legislation and really trying to change the way we handle a MR and the way we deal with sepsis.

In the healthcare system. So I just wanna thank you for joining me on today’s episode of the Sepsis Spectrum. If you like the show, we wanna hear about it. Please leave a review wherever you’re enjoying this podcast. It helps a ton. You can also reach me in our awesome team@infoatsepsis.org or visit sepsis podcast.org to share any stories of your own questions, concern, or episode ideas.

To learn more about Sepsis Alliance, visit sepsis.org. The sepsis spectrum is brought to you by Sepsis Alliance. I’m your host, Nicole kic. Our executive producers are Allison Strickland, Hannah sas, Claudia Orth, and Alex [00:43:00] Colvin. Our producers are Aaron Corny, Rob Goldman, Shahnti Brooke, and me Nicole Kch.

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Episode 7 of The Sepsis Spectrum: Microbial Mysteries features Dr. Hudson Garrett and Armando Nahum. Click on their names to learn more about our guests.