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Leadership: Dawn Terashita & Zachary Rubin, Los Angeles County Department of Public Health on the Future of HAI/AR Response in the Face of COVID-19

Posted: January 14, 2022
Authors: Dawn Terashita, MD, MPH, FACPM & Zachary Rubin, MD

COVID-19 has impacted healthcare-associated infections and antimicrobial-resistant (HAI/AR) threats across all healthcare settings.

COVID-19 has impacted healthcare-associated infections and antimicrobial-resistant (HAI/AR) threats across all healthcare settings. Los Angeles County saw an increase in HAIs, such as central line bloodstream infections (CLABSI) as a result of many facilities changing their CLABSI prevention efforts to accommodate the challenges of caring for COVID-19 patients. Additionally, Los Angeles County saw an increase of multidrug-resistant organisms (MDROs), such as Candida auris, due to personal protective equipment (PPE) practices being altered early in the pandemic due to severe shortages. Despite the difficulties brought on by COVID-19, awareness of infection prevention efforts has improved over the last two years, especially in nursing homes.  

The Covid-19 pandemic has had both negative and positive impacts on infection prevention in healthcare. The negative impacts, such as PPE shortages, staffing shortages, facility crowding, frequent moving of patients throughout the facilities due to COVID-related cohorting, and lack of focus on identifying and containing MDROs, contributed to increased MDRO spread. The positive impacts include new legislative actions, increased funding, and building stronger relationships and partnerships to support infection prevention efforts across the healthcare community. California introduced a new state law requiring all nursing homes to employ a full-time infection preventionist (IP). Funding opportunities from the Centers for Disease Control and Prevention (CDC) at the local and state level have helped to improve infection control and has provided some much-needed resources for nursing homes and other long-term care facilities. Increased funding, stakeholder engagement, and requirements for infection preventionists have helped shaped the backbone for an unprecedented future educational program centered on infection prevention within nursing homes.  

There are many insights that we have gained while leading the Healthcare Outreach Unit at the Los Angeles County Department of Public Health that can help improve HAI/AR response. We believe that stakeholder engagement is a key to success for health departments. Programs rolled-out by public health departments should be developed in conjunction with stakeholders and should address the concerns that these stakeholders bring to the table. As an example, to support nursing homes, we have hired two geriatricians and nurses with experience working in this setting, who understand many of the concerns and constraints present in these facilities, and already have relationships in the field. We have learned that you should not underestimate the importance of giving each nursing home a specific public health nurse to work with and build rapport. We have also strengthened our ties with the leadership in individual nursing homes and with the nursing homes operators, which helps to improve stakeholder buy-in and input. We plan to use the engagement and trust that we have developed over the last two years to elevate infection prevention across all nursing homes through standardized template policies and training, instead of allowing each facility to develop their IP program unilaterally, which is what many facilities have done in the past with mixed success. 

Overall, we believe the future of HAI/AR response success is dependent on the ability to adapt and remain flexible while refocusing activities beyond COVID-19. The Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogen (CORHA) plays a vital role in improving practices and policies at the local, state, and national levels regarding HAI/AR outbreaks across the healthcare continuum. We hope that through sharing our experience we can help promote CORHA’s mission to improve practices and policies for the detection, investigation, control, and prevention of HAI/AR outbreaks, with other local health departments and healthcare facilities. 

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Dawn Terashita

Dawn Terashita



Dawn Terashita, MD, MPH, FACPM serves on the governance committee of CORHA as the National Association of County and City Health Officials (NACCHO) Representative. Dawn is the founder of the Healthcare Outreach Unit (HOU) at the Los Angeles County Department of Public Health (LACDPH) and is currently the Associate Director of the Acute Communicable Disease Control Program.





Zachary Rubin

Zachary Rubin



Zachary Rubin, MD, is the chief of Healthcare Outreach Unit (HOU) at the Los Angeles County Department of Public Healt(LACDPH) and was previously the medical director of Infection Prevention for UCLA Health.