Providing Infection Prevention on the Navajo Nation

In this first installment of a 3-installment series, Infection Control Today^® (ICT^®) speaks with 2 managers at Sage Memorial Hospital, Navajo Health Foundation, Navajo Health Foundation, in Ganado, Arizona, about their infection prevention and control program, including their strengths, challenges, and what innovative ways they provide the very best care to their patients, staff, and community.

Christian Bigwater, BSBA, director of public relations and marketing, and Tiyarra Wauneka, environmental services supervisor, discuss the hospital's size and the issues that differ from larger hospitals in more urban areas.

The facility follows its Navajo Nation’s values: “The mission of Sage Memorial Hospital is to provide quality healthcare for the Dine people with respect, unity, beauty, and harmony in honor of K‘é an, the sacredness of life,” according to the hospital’s website.

ICT: What is the hospital, how large is it, and whom do you serve?

Christian Bigwater, BSBA: We're located in Granado, Arizona, and that's on the Navajo Nation. Primarily, we focus on our immediate community, which includes the chapters of Cornfields Ganado, Kinlichee, Klagetoh, [Lower] Greasewood [Springs], Steamboat, Wide Ruins, and Nazlini.

We do welcome patients and visitors [who] are beyond our service area. We do cater to both Navajo and non-Navajo [for] just little bit about the demographics of the people that we serve. And this is based off the Community Health Needs Assessment. Approximately 95% of patients [who] come in here are of American Indian or Alaskan descent. Although I did mention we do service other people and are welcome to come to the hospital, our primary visitors and patients are mainly Navajo.

ICT: What unique challenges do you have in the infection prevention and control space that maybe a hospital in Boston or Houston may not have?

Tiyarra Waunkea: Some of the challenges that we currently have with our infection control [within the hospital] is that because our hospital is a private hospital, we do have surrounding facilities, healthcare facilities that are funded by IHS [Indian Health Service]. And so being a private sector, we are faced with the challenge of ensuring that we get the proper training that we need to carry out the services that environmental services provide for our facility. Also, we are in a rural location. So often, we don't have access to those resources. If you were in a bigger city, where resources are nearby, so it takes time for us to receive supplies.

I will give the example of going into the pandemic. When we went into the pandemic, a lot of the health care facilities that were in a bigger city or town, I had access firsthand to all the PPE [personal protective equipment] supplies or any kind of disinfection solutions that they needed. But for our hospitals located on the reservation, it was hard to get those supplies for not only our hospital but for our community that we serve.

(Adobe Stock 90930195 by enrico113)

And here on the reservation, that community that we

serve, we have a wide spread of community members. We don't have anything like street signs or streets with houses that are clustered together. We spread across a big section of land, where we're just scattered here and there. So that was our biggest challenge. And it's still our biggest challenge to ensure that we can get to all those communities [and] and team members that we serve and be able to find a reliable resource where we can get the things that we need for infection control, [like] our supplies, and sometimes it does take time for them to get it to us.

For example, if you were down in the Phoenix area, they could get supplies within a day, overnight. But for us, it could take anywhere from a week to 3 months to receive those supplies. So we have to plan ahead at least 3 months in advance to ensure that we constantly have the supplies that we need to take care of our community and our health care facility.

ICT: You have everything all there in the hospital, [and] you have sterile processing environmental services. Do you have an IP [infection preventionist] on staff?

TW: Yes, we have 1 IP [who] is currently with us. And then myself included. So my team and I are the infection control and infection preventionist team that oversees our facility.

(This interview has been edited for clarity.)