Marin Schweizer, PhD, thinks a lot about how to make effective change stick. For about the last eight years, she has been working on ways to reduce the incidences of hospital-acquired infections (HAI), particularly those that come during and after surgeries. An Associate Professor of Internal Medicine in General Internal Medicine and of Epidemiology, Dr. Schweizer looks at a lot of quantitative data, doing research “to find those really rare events,” identifying what makes the patients who had the rare infection different, and then testing interventions to prevent these infections. In health services research, these usually result in recommendations and eventually even new protocols.

But as a member of the Comprehensive Access & Delivery Research & Evaluation (CADRE) at the Iowa City VA Medical Center, Dr. Schweizer also works with qualitative researchers who help her blend their experiential information gathered through interviews with stakeholders. The resulting recommendations then have not just the weight of data but also input from those who will have to implement the new procedure. Dr. Schweizer and CADRE find greater success this way. “We work with the nurses and physicians to make sure that what we’re doing is solving the problem in the way that they perceive it.”

In the case of S. aureus infections in people getting hip or knee replacement surgery, this multifaceted approach, also known as implementation science, worked. An early identification of those most at risk, an extra step or two with a pre-surgery body wash for those individuals, and Dr. Schweizer, working with Dr. Loreen Herwaldt and others, reduced the infection rates in half. Their results are now protocol at about thirty hospitals in Iowa, in the VA system, and in the Southeastern United States, while the team continues to search for and test refinements.

Dr. Herwaldt gives a lot of credit to Dr. Schweizer’s expertise for this project’s success and the success of multiple other studies they have done together. “Marin is a terrific collaborator, colleague, and friend,” Dr. Herwaldt said. “Marin has contributed significantly to each project and often has been the key to a project’s success. She also enjoys teaching and has been a great mentor to her students. She has helped many of them publish studies that they have done with her.”

The road to Iowa
Dr. Schweizer’s path to the University of Iowa was fairly direct. She says that she always liked science, and got into research the summer after her senior year in Mahtomedi, a suburb of St. Paul, Minnesota. A scholarship from the VFW paid her salary while she did summer work alongside a cardiologist at the Minneapolis Heart Institute in between each academic year at Drake University in Des Moines. “That’s how I caught the research bug.”

After finishing with a degree in biochemistry at Drake, Dr. Schweizer began her postgraduate work at University of Maryland, bloodstream staph infections in hospitalized patients, “very similar really to what I’m still working on now.” That interest has kept her motivated to find solutions: “I would love to put myself out of a job.” It was while she was doing a postdoctoral fellowship at Maryland that her former thesis advisor for her PhD research, Dr. Eli Perencevich, got in touch. He and Dr. Gary Rosenthal, then Director of the Division of General Internal Medicine, invited Dr. Schweizer to Iowa City for an interview.

Part of a nimble team
Once here, it was not long before Dr. Schweizer was off and running on her work inside the VA system. Even now, resources like a Veterans Engagement Panel, aid in the development and adjustments of her health services research programs. “We have a group of about eight veterans who come here once a month and we just sort of pitch research ideas to them, and they poke holes in them,” forcing Dr. Schweizer and her colleagues to find what is feasible. She praises the role they played in the pre-surgery mupirocin administration, in particular.

Now, as she and her colleagues engage with orthopedic trauma surgeons, they hope they can bring this same principle that worked with hip- and knee-replacement patients to prevent infections in patients who might be even harder to identify as at-risk. She is also hoping to receive funding to pilot a program for dialysis patients who, Dr. Schweizer says, “are constantly at risk, coming in three days a week.” She recognizes that engaging with their providers will be just as critical as it has been in the other instances. “But that’s implementation science: ‘it worked in the lab, how can we get it to work with our patients?’”

Thinking globally, living locally

Although Dr. Schweizer has teaching responsibilities in the Carver College of Medicine, she has also adopted a responsibility to educating providers in other nations as well. She regularly travels to low- and middle-income countries, visiting hospitals in places like Thailand next January, and offering recommendations for how they can improve infection control. Besides money, barriers to reducing HAI vary from site to site, but simple access to alcohol-based hand sanitizer, she says, is one of the quickest and easiest things any hospital can do to have a major impact. Her advice helps them see that major investments are not always necessary to produce transformative effects.

Closer to home, Dr. Schweizer and her husband can be found floating on the Mississippi River in their boat down to Galena, Illinois, or then back up to a campsite. They enjoy the outdoors and visited family this summer in Minnesota on their way to a beloved childhood wilderness area as well. The two of them will likely pass some of the winter months in a local bowling alley, where Dr. Schweizer will spend as much focus on taking out a seven-ten split as she might a tenacious operating room bacteria.