We are thrilled to announce that the Infectious Diseases Fellowship Program at UNMC has successfully filled all positions for the 2026-2027 academic year! Please join us in welcoming our three outstanding fellows who will begin their training in July 2026.
Evangeline Green, D.O. Medical School:University of New England College of Osteopathic Medicine Residency:University of Nebraska Medical CenterBrianna Desa, D.O. Medical School: Kansas City University of College of Osteopathic Medicine Residency: Wayne State University/Detroit Medical CenterHind Kazkaz, MBBS Medical School: Alfaisal University College of Medicine Residency: Creighton University
These talented physicians bring diverse experiences and a shared passion for infectious diseases. We look forward to their contributions to patient care, research, and education during their fellowship.
Stay tuned for more updates as we welcome them to our team!
The first week of December is a time for us to recognize National Hand Hygiene Week. Reflecting on hand hygiene reminds us of the deceptively simple yet profoundly powerful message: clean hands save lives. In healthcare, we face increasingly complex challenges—multidrug-resistant organisms, more invasive procedures, increasing patients with impaired immune systems, all within a fast-paced clinical environment. In the midst of all this complexity, hand hygiene remains a reliable, effective, and accessible tool to prevent healthcare-associated infections (HAIs).
Every infection prevented represents a patient protected, a family spared distress, and a system strengthened. As clinicians and staff, each of us plays a critical role in this effort. Our consistent commitment to hand hygiene is one of the most important contributions we make to patient safety—every single day.
A Quick Refresher: The WHO Five Moments for Hand Hygiene
Hand hygiene is simple, but there are standards to when, and how, to perform it. The WHO Five Moments for Hand Hygiene are the global standard because they work. They anchor hand hygiene to the highest-risk points of pathogen transmission and should be engrained in the minds of all healthcare workers.
The 5 moment for hand hygiene include: before touching a patient, before clean/aseptic procedures, after exposure to body fluid or risk of exposure, after touching a patient and after touching patient surroundings.
These five moments apply across all care settings—from inpatient units to ambulatory clinics, procedural areas, and laboratories. As leaders in Infectious Diseases and Infection Prevention, we must be the example others follow as hand hygiene protects us all, patients and healthcare workers alike.
Why It Still Matters
Hand hygiene is one of the few interventions shown to reduce HAIs across conditions: CLABSI, CAUTI, SSI, C. difficile, and respiratory viral infections. Compliance also serves as a visible expression of our professional standards and shared culture of safety.
Yet even with decades of data, hand hygiene remains an area where slips in consistency often occur and may result in significant consequences. National Hand Hygiene Week is an invitation to reset, recommit, and re-energize our efforts—together.
Every year on December 1, the world pauses to reflect, remember, and recommit to ending one of the most significant public health challenges of our time: HIV/AIDS. World AIDS Day, first observed in 1988, is more than a date on the calendar, it’s a global movement to raise awareness, fight stigma, and honor the millions of lives affected by HIV. The iconic red ribbon, adopted in 1991, remains a universal symbol of solidarity and hope.
The official theme for World AIDS Day 2025 is: “Overcoming disruption, transforming the AIDS response.” This theme reflects the urgent need to address setbacks caused by funding cuts, geopolitical instability, and widening inequalities. Despite decades of progress, the global HIV response faces its most significant challenges in years. Health systems are under strain, prevention programs have stalled, and community-led services, especially those supporting women and key populations, are closing due to lack of resources.
Despite decades of progress, HIV continues to disproportionately affect marginalized communities in the U.S. and globally. Black Americans represent 12% of the population but account for 39% of new HIV diagnoses, while Hispanic/Latino individuals make up 19% of the population yet represent 24% of new diagnoses. Among men who have sex with men, lifetime risk is 1 in 3 for Black MSM compared to 1 in 15 for White MSM, underscoring persistent diagnostic gaps. Prevention disparities are equally stark: although PrEP is highly effective, 94% of prescriptions go to White individuals, while only 13% of Black and 24% of Hispanic individuals who could benefit receive it. Even with breakthrough options like long-acting injectables (cabotegravir for PrEP, cabotegravir/rilpivirine and lenacapavir for treatment), uptake remains limited, only 13% of PrEP users in one large health system were on injectable PrEP, and Medicaid coverage often requires prior authorization, creating delays. High costs (e.g., lenacapavir >$40,000 annually) and geographic barriers, particularly in the South where HIV burden is highest, further restrict access. Programs like the Ryan White HIV/AIDS Program, which provides comprehensive care and medication for uninsured and underinsured individuals, remain critical in bridging these gaps. Continued advocacy for equitable access, policy reform, and community engagement is essential to ensure that scientific advances translate into real-world impact for those most affected.
Rural communities face unique challenges in HIV prevention and treatment. Limited healthcare infrastructure and long travel distances often delay diagnosis and access to antiretroviral therapy. Workforce shortages mean fewer providers trained in HIV care, and awareness of prevention tools like PrEP remains low, one study found that only 1 in 3 rural clinicians were familiar with PrEP. Economic barriers and lack of Medicaid expansion in many states further restrict access to newer options such as long-acting injectables, which can simplify treatment but remain costly and require prior authorization. Stigma and privacy concerns in close-knit communities compound these issues, discouraging individuals from seeking care. Solutions like telehealth, mobile clinics, and Ryan White-funded transportation and support services are helping, but sustained advocacy and investment are essential to ensure rural populations benefit from the same advances driving progress in urban areas.
The UNMC Specialty Care Clinic plays a critical role in reducing HIV-related health disparities across Nebraska. As a Ryan White Program site, the clinic ensures that uninsured and underinsured individuals receive comprehensive HIV care, including access to antiretroviral therapy, PrEP, and long-acting injectable options. Beyond medical treatment, the clinic addresses social determinants of health through patient navigation services, transportation assistance, and insurance support, helping patients overcome barriers that often lead to delayed diagnosis or treatment interruptions. Its multidisciplinary model integrates primary care, behavioral health, and gender-affirming services, creating a safe and inclusive environment for populations disproportionately affected by HIV. Through community outreach, workforce training, and participation in clinical trials for innovative therapies, the UNMC Specialty Care Clinic is not only delivering cutting-edge care but also advocating for equity, ensuring that scientific advances reach those who need them most.
Looking ahead, even though ending AIDS as a public health threat by 2030 seems like an insurmountable task, our path to this goal can only be realized if we act boldly. That means investing in prevention, scaling up innovative treatments like long-acting injectables, and protecting human rights for all. This World AIDS Day, let’s unite behind equity, resilience, and community leadership to ensure no one is left behind.
This time of year is a time for reflection, gratitude, and appreciation of the blessings we have, and we are grateful for the opportunity to share our thanks from all of us at UNMC ID.
We want to thank our interim Department Chair Dr. Mark Rupp and Division Chief Dr. David Warren for their ongoing support and encouragement for all of the ID division member activities, including this work on Digital Innovation & Social Media Strategy
We want to thank our faculty, fellows, residents, students and advanced practitioners for their tireless work countless hours taking care of our patients in the hospital and in our clinics
We want to thank our ID pharmacists who have been instrumental in getting key initiatives off the ground, helping us with navigating tough clinical cases, developing our institutional guidelines, and troubleshooting through crises like antibiotic shortages, and continuing our status as an Antimicrobial Stewardship Center for Excellence
We want to thank our Microbiology lab colleagues for their constant partnership and support through routine ID needs, lab updates and renovations, and dealing with crises like blood culture bottle shortages
We want to thank our Public Health partners for their collaboration on efforts to reduce antibiotic resistance across the state and maintain excellence in biopreparedness
We want to thank our ID nurses and clinical staff who have been the glue that keeps our clinics working
We want to thank our clinical colleagues in the hospitals and outpatient settings who trust us daily to consult on their patients and provide extraordinary care
We want to thank our division/clinic administrators and administrative assistants for keeping the nonclinical work on track, and generally keeping us afloat
We want to thank our trainees for allowing us the privilege of teaching them this, and every year
We want to thank our statisticians and research assistants for working so closely with us on research that has brought us again to be the 2nd most productive division in the department of Internal Medicine at UNMC
We want to thank our patients in the hospitals and clinics for the privilege to treat them and in most cases, journey with them to complete resolution of their illnesses.
We want to thank our families and friends who have supported all of us in our health careers
We want to thank all of our blog subscribers, those who forward our blog on to others, support and share our content.
THANK YOU, THANK YOU, THANK YOU, and keep following us for more amazing work in the future!
Antibiotics are one of the most powerful tools in modern medicine, but their effectiveness is under threat. Antimicrobial resistance (AMR) is rising globally, and without urgent action, common infections and routine procedures could become life-threatening. Clinicians are uniquely positioned to lead the fight against AMR, not only through prescribing decisions but also through advocacy, education, and system-level change.
Beyond Prescribing: Expanding Your Impact
Stewardship is more than choosing the right antibiotic. It involves shaping a culture of responsible use across healthcare and the community. Here’s how clinicians can make a lasting impact:
Mentor and Educate
Teach trainees and colleagues about stewardship principles.
Incorporate AMR topics into grand rounds and continuing education sessions.
Advocate for Policy and Resources
Support institutional investment in stewardship programs.
Engage in local and national advocacy for AMR research funding and access to diagnostics.
Participate in Stewardship Committees
Collaborate with pharmacists, infection preventionists, and microbiologists.
Help develop protocols for antibiotic time-outs, IV-to-oral switches, and formulary restrictions.
Leverage Data
Use prescribing dashboards to monitor trends.
Share feedback with peers to improve practice patterns.
Patient Education: A Critical Piece
We can change the narrative and belief that antibiotics are a cure-all treatment for any ailment.
Sample Script:
“Antibiotics are powerful medicines, but they only work for bacterial infections. Taking them when they’re not needed can make future infections harder to treat. Let’s focus on what will help you feel better.”
Provide clear instructions for symptom relief and when to return for care.
Share resources like CDC Antibiotic Use and Symptom Relief Guide.
Check out some scholarly activity from our UNMC ID team on strategies for leading the way in antimicrobial stewardship:
Antimicrobial resistance (AMR) is a global health crisis, but its impact is not evenly distributed. Vulnerable populations, especially those with limited access to healthcare, marginalized communities, and patients in resource-limited settings, face disproportionate risks. These disparities stem from systemic barriers, including unequal access to diagnostics, inconsistent prescribing practices, and language or literacy challenges.
Research shows that racial and socioeconomic differences influence antibiotic prescribing patterns, often driven by implicit bias or structural inequities. For example, some groups may receive antibiotics unnecessarily, while others experience delays in appropriate therapy. Both scenarios increase AMR risk and worsen health outcomes.
Clinician Action Steps
Audit Prescribing Patterns for Equity Regularly review antibiotic use data by race, ethnicity, and socioeconomic status. Identify trends and address gaps through education and policy changes.
Improve Access to Diagnostics Advocate for point-of-care testing in safety-net clinics and rural settings. Accurate diagnosis reduces unnecessary antibiotic use and ensures timely treatment for bacterial infections.
Use Culturally and Linguistically Appropriate Materials Provide patient education in multiple languages and formats. The CDC Health Literacy Resources offer tools for creating clear, accessible instructions.
Engage Community Health Workers Community-based outreach can bridge gaps in understanding and adherence, especially in populations with limited health literacy.
Why This Matters for Clinicians
Embedding equity into stewardship is not just ethical, it’s essential for effectiveness. When patients lack access to care or clear instructions, antibiotics are misused, resistance spreads, and outcomes worsen. By addressing these gaps, clinicians help ensure stewardship benefits all patients, not just those with resources.
Key Takeaways:
AMR disproportionately affects underserved populations.
Equity-focused stewardship improves outcomes and reduces resistance.
Clinicians can lead by auditing prescribing patterns, improving access, and tailoring education.
The Hidden Role of the Environment in Antimicrobial Resistance
When we think about antimicrobial resistance (AMR), we often picture hospitals and clinics. But the environment—our water systems, soil, and even hospital wastewater—plays a critical role in spreading resistant organisms. Antibiotics and resistant bacteria can enter the environment through pharmaceutical manufacturing, agricultural runoff, and improper disposal of medications. These residues create reservoirs where resistance genes thrive and spread. Recent studies have detected multidrug-resistant organisms in hospital effluent and community wastewater, highlighting the need for environmental stewardship alongside clinical interventions (WHO Environmental AMR Report).
Why This Matters for Clinicians
Resistant organisms in wastewater can re-enter healthcare settings through water systems or community exposure.
Environmental contamination accelerates global AMR spread, impacting infection control efforts.
Clinicians can influence institutional policies on waste management and antibiotic disposal.
Practical Steps for Clinicians
Promote Proper Disposal of Antibiotics
Encourage patients to use pharmacy take-back programs.
Advocate for hospital protocols that prevent flushing antibiotics into wastewater.
Collaborate with Infection Prevention Teams
Ensure environmental cleaning protocols are robust.
Support monitoring of hospital wastewater for resistant organisms.
Educate Patients and Staff
Share why environmental stewardship matters for public health.
Provide clear instructions for safe medication disposal.
Patient Education Tip
“Never flush antibiotics down the toilet or throw them in the trash. Bring unused medications to a pharmacy take-back program to keep our water and soil safe.”
Provide patients with local take-back program information or direct them to FDA Safe Disposal Guidelines.
Key Takeaways
AMR is not just a clinical issue—it’s an environmental one.
Resistant organisms in wastewater and soil can perpetuate the cycle of resistance.
Clinicians can lead by promoting proper disposal, supporting infection prevention, and educating patients.
Antimicrobial resistance (AMR) is not confined to hospitals or clinics—it spans human health, animal health, and the environment. Resistant bacteria can move between people, animals, and ecosystems, making AMR a One Health issue. For clinicians, this means stewardship efforts must extend beyond prescribing practices to include partnerships across sectors. The One Health approach, endorsed by the CDC and WHO, emphasizes collaboration among physicians, veterinarians, pharmacists, environmental scientists, and public health professionals. This integrated strategy is essential to slow the spread of resistance globally.
How Clinicians Can Engage
Partner with Pharmacists and Infection Preventionists
Work together to implement stewardship protocols in inpatient and outpatient settings.
Share prescribing data and resistance trends to guide formulary decisions.
Collaborate with Veterinarians and Public Health Agencies
Advocate for judicious antibiotic use in agriculture and companion animals.
Participate in local AMR task forces or advisory boards.
Support Community Education
Join outreach programs that teach families about safe food handling and the dangers of unnecessary antibiotics.
Provide culturally appropriate materials for diverse populations.
AMR is a shared problem requiring shared solutions.
Clinicians can lead by building bridges across human, animal, and environmental health.
Collaboration amplifies stewardship impact and protects antibiotics for future generations.
Call to Action: Join the conversation during U.S. Antibiotic Awareness Week using #USAAW25 and #AntibioticsAware. Explore resources and consider how your practice can integrate One Health principles.
Basic prescribing principles such as avoiding antibiotics for viral infections are essential, but they’re not enough to curb antimicrobial resistance (AMR). Hospitals and clinics need advanced stewardship strategies to optimize antibiotic use, improve patient outcomes, and reduce resistance rates. These strategies go beyond education and require system-level interventions supported by data and technology.
Core Advanced Interventions
Antibiotic Time-Outs At 48–72 hours after initiating therapy, pause and reassess:
Is the antibiotic still needed?
Can we narrow the spectrum based on culture results?
Can we switch from IV to oral therapy? This simple intervention reduces unnecessary exposure and improves targeted therapy.
Audit and Feedback Regular review of prescribing patterns with feedback to clinicians is one of the most effective stewardship tools. Peer comparison and constructive feedback encourage adherence to guidelines without punitive measures.
EMR-Based Decision Support Integrate clinical decision support into electronic medical records:
Alerts for duplicate therapy or prolonged duration.
Embedded order sets aligned with institutional guidelines.
Dose calculators for renal adjustment.
Diagnostic Stewardship Encourage appropriate use of microbiology tests and rapid diagnostics to guide therapy decisions. Avoid unnecessary cultures that lead to overtreatment.
Building a Multidisciplinary Team
Effective stewardship requires collaboration:
Pharmacists for dosing and drug selection.
Microbiologists for rapid reporting.
Infection preventionists for surveillance and education.
Clinicians for bedside implementation.
Patient Education Tip
Patients may worry when antibiotics are stopped or changed. Try the following approach:
“We’re adjusting your antibiotic based on your test results. This ensures you get the safest and most effective treatment while reducing side effects.”
Provide clear explanations and written instructions when therapy changes occur.
Key Takeaways
Advanced stewardship strategies—time-outs, audit-feedback, EMR support—are proven to reduce resistance and improve outcomes.
The Overlooked Link Between Animal and Human Health
When we talk about antimicrobial resistance (AMR), most of us think about hospital-acquired infections or outpatient prescribing. But the reality is broader: antibiotic use in animals (both livestock and pets) contributes significantly to resistance patterns that affect human health. Resistant bacteria can spread from animals to humans through direct contact, food consumption, and environmental contamination. According to the FDA, antibiotics are commonly used in agriculture to prevent disease and promote growth in livestock. While these practices have improved productivity, they also create selective pressure for resistant organisms like Salmonella, Campylobacter, and certain E. coli strains, which can cause severe infections in humans.
Why Clinicians Should Care
Foodborne Transmission: Resistant bacteria can enter the food chain and cause infections that are harder to treat.
Community Spread: Resistant organisms from pets or farm animals can spread to humans through close contact.
Global Impact: Agricultural antibiotic use accounts for a significant portion of total antibiotic consumption worldwide.
Understanding this connection helps us to advocate for responsible antibiotic use beyond the hospital walls.
Action Steps for Clinicians
Educate Patients on Food Safety
Wash hands after handling raw meat.
Cook meat to safe internal temperatures.
Avoid raw milk and unpasteurized dairy products.
Support Policy and Advocacy
Encourage adherence to FDA guidelines limiting non-therapeutic antibiotic use in livestock.
Promote awareness of the One Health approach that integrates human, animal, and environmental health.
“Antibiotic resistance doesn’t just happen in hospitals; it can start on farms. Choosing meat raised without antibiotics, cooking meat thoroughly, and practicing good hygiene helps protect you and your family.”
Key Takeaways
Veterinary antibiotic use impacts human health through foodborne and environmental pathways.
Clinicians can play a role by educating patients and supporting responsible agricultural practices.
Stewardship is a shared responsibility across sectors—human, animal, and environmental.
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