Hana Hakim, MD, MS

Strict adherence to hospital-based infection prevention programs lowers the rate of hospital-acquired infections. Core prevention measures have been in place at hospitals for decades and have been successful in preventing avoidable infections. However, effectively preventing infections in our uniquely immunocompromised patient population requires an understanding of how treatments themselves can cause vulnerabilities that lead to infection. 

My role as the medical director of the Infection Prevention and Control Program at St. Jude is to maintain and improve safety for our patients. We identify areas of vulnerability that may surface in daily clinical care, initiate studies to better understand how to prevent infection and enact protocols to improve quality of care.

One of our most impactful contributions has been regarding central line-associated bloodstream infections (CLABSI). Central lines are long-term catheters allowing care teams to deliver medicine into large veins in the body. Maintaining central line sterility is critical as CLABSI events increase morbidity and mortality rates. However, cancer-related treatments, such as some chemotherapies, radiation and transplantation, damage mucosal barriers allowing for the translocation of microbes into the bloodstream. In fact, up to 65% of blood infections are initiated through the gut in oncology and transplant patients. Our team helped describe this infection phenomenon in immunocompromised patients, increased awareness and advanced our understanding of treatment-related risk factors. Along these lines, we also implemented targeted preventative measures to lower risk. We implemented an oral care bundle for our patients, helping them maintain good oral hygiene and decrease mucosal-barrier injury CLABSI events.

I also assumed the leadership responsibility of a performance improvement project that improves patient safety and prevents sepsis-attributable mortality in our inpatient population. Our team developed guidelines, implemented screenings and educated care teams — both at St. Jude and in the broader pediatric oncology field — and effectively improved patient outcomes. 

Improving the field

Our team constantly identifies and employs cutting-edge science to enhance St. Jude’s Infection Prevention and Control program. In collaboration with the Department of Pathology, we utilized whole genome sequencing of bacteria isolated from patients to detect genetic relatedness (which would imply cross-transmission or common source exposure). And whole-genome sequencing was also used to deduce the molecular epidemiology, clinical features and outcomes of immunocompromised patients with Clostridioides difficile infections. 

C. difficile is a Gram-positive bacillus that can cause infectious colitis and diarrhea, which can be especially dangerous in immunocompromised individuals. Children with cancer have 15 times the risk of a C. difficile infection compared to those without cancer, and the infection can be harder to treat. Incorporating whole genome sequencing was instrumental in identifying patients at risk for recurrence and identifying more targeted approaches for infection prevention and control.