The accidental epidemiologist: Icon in the field was drafted into infection control

January 12th, 2015

Among the pioneers of modern infection prevention who took the stage recently in Fort Lauderdale at the 40^th annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) was Dennis Maki, MD, who recalled with some self-deprecating humor that he got into the field somewhat by accident and with initial regret.

“My career was very serendipitous,” Maki said, noting that as a young doctor he was drafted during the Vietnam War. “For reasons it took me decades to find out I got sent to the CDC rather than one of the arms of the uniformed services. They sent me to the EIS [Epidemic Intelligence Service]. I had little or no interest in infectious disease and I was oblivious to infection control.”

Assigned to investigate a serratia outbreak, Maki jokingly recalled that he was advised to spend some time in the research library after asking, “What’s serratia?”

Now the Ovid O. Meyer Professor of Medicine at the University of Wisconsin School of Medicine and Public Health, Maki is an internationally recognized infectious disease expert and author or coauthor of scores of peer reviewed papers.

“The CDC was an extraordinary experience,” he said. “It changed the lives of most of us that were there. I found my career. I was going to be a cardiac surgeon. I was going to go back to Boston, finish my training and do cardiac surgery. But at CDC they assigned me to the hospital infections branch and I was not very happy about it initially.”

Things took a dramatic turn in 1970 when reports began coming in of patients developing gram negative bacteremia infections in an outbreak that would ultimately be linked to contaminated IV solutions and equipment. Thousands of patients were infected and some 15% died as a result, Maki noted.

“I had the opportunity to play a major role in the investigation of that outbreak and it was a heady experience,” he said. “It made me realize patients are vulnerable to bad things at hospitals. I realized how oblivious I had been to that in my training up to that point in time. It really was a career changing experience.”

In the aftermath of the outbreak, Maki wrote one of the first evidence-based guidelines on preventing line-related sepsis.(1)

“I laugh when I say evidence based because we really didn’t have much evidence,” he told some 4,000 APIC attendees. “We put together everything we could extrapolate from the epidemic and we also put together everything else we could find, and it was really the first guideline and it was widely accepted,” he said. “It’s gone through many iterations and it is full of evidence now. Almost everything that we do to prevent line sepsis is based on studies.”

Looking at the evolution of infection prevention through the decades, Maki said in the current era the knowledge gained over the years must finally be translated into “failsafe” systems.

“The decade of the ‘70s focused on surveillance -- defining the problem and being able to put together guidelines,” he said. “The era of ‘80s was big on guidelines and studies to find what measures will reduce risk. The era of the 2000s really has been [an acknowledgement] that it is not enough to know what to do -- we have to know how to make it happen. We have to develop systems that are failsafe if we want to really maximize safety.”

Reference

1. Maki DG, Goldmann DA, Rhame FS. Infection control in intravenous therapy. Ann Intern Med 1973;79:867-87.