Nurse Hits the Road to Combat Infectious Disease

Carrie Tudor fitting respirators in South Africa.

Her passport is stamped with exotic locations: Myanmar, Tibet, South Africa, Vietnam, and Cambodia, as well as Baltimore, MD. But, when Carrie Tudor, PhD, MPH, RN, looks at it, she sees global battlefields in the fight against infectious disease. Her weapons: immunizations, programs to curb tuberculosis and HIV transmission, and a drive to carry on a rich tradition of public health nursing research.

Tudor, a recent Johns Hopkins University School of Nursing doctoral program graduate, likes to think of her role in nursing research as a bridge spanning population-based, public health and individual healthcare around the world. The travel metaphor is an apt one. While her journey hasnt followed a simple or direct path, the destination has remained clear. Tudor wants to make a difference in the health of large groups of people, particularly in the poorest, least advantaged corners of the world. She first set outwith a public health degree and a bit of wanderlustfor a global health stint with the World Health Organization, primarily in Myanmar.

Working to organize immunization campaigns against polio, measles and tetanus, and to introduce a hepatitis B vaccine into a nations immunization program was satisfying. It seemed to be a good path. But 10 years later, at age 38, Tudor revised the itinerary, and with her final destination always in mind, returned to the U.S. to enter the bachelor-of-nursing program at the Johns Hopkins University School of Nursing. It wasand remainsa door-opening credential she finds essential when working with physicians, nurses, and other health professionals to control disease through prevention, education, and early intervention.

As a full-time nursing student, Tudor admits that she missed the challenge of working big in public health research. Studying and improving the health of entire nations as a whole was where her heart and interest remained. That eureka moment, along with the support of nurse research mentors with shared interests, helped spur her to stay in Baltimore for a doctoral degree. Her dissertation research topic was a natural extension of her earlier work with the World Health Organization and her keen interest in infection control and disease prevention, whether through programs of immunizations, patient and health worker education, or improved clinical care.

Eventually Tudors doctoral research did get her on the road again, exploring ways to control the spread of drug-resistant tuberculosis (TB) and HIV/AIDS in South Africa where rates are among highest worldwide. All too often, these two diseases co-occur leading to increased disability and far greater mortality, even among healthcare workers who are not immune from infection themselves. Since TB and HIV infection control and prevention are of significant importance to South African health experts, her research was supported, in part, by the South African Medical Research Council and by K-RITH (KwaZulu-Natal Research Institute for TB and HIV). That support was a stamp of approval that breached any local initial concerns about the goal of the study. Her analysis of five years of data on more than 1,400 healthcare workers medical records, helped demonstrate the serious need for better training to prevent infectious disease transmission.

Other ongoing research undertaken in collaboration with Tudors Johns Hopkins mentor Jason Farley, PhD, MPH, CRNP, and others continues to result in new directions, policies, and programs to boost infection control in facilities, among patients, and across health care providers in South African TB hospitals. At the same time, Tudor is still working to find ways to alter risk factors for TB transmission among healthcare workers, like poorly fitting respirators and insufficient staff screening. Her goal is to rewrite TB health policy to better protect healthcare workers and the people they treat. After all, Tudor, says, treating illnesses shouldnt make you sick. What weve found through our research in South Africa has great potential for adaptation to reduce the transmission of TB and other infectious diseases among healthcare workers in other emerging nations.

Today, with her doctorate and passport in hand, Tudor has launched a second career, this time as a nurse researcher. Shell return to South Africa, as a National Institutes of Health Fogarty Global Health Postdoctoral Fellow supported through a University of North CarolinaChapel Hill consortium with Johns Hopkins, Tulane and Morehouse universities. Over the next 10-12 months, shell broaden her work to prevent TB disease and its transmission among health care workers infected with HIVonce again working big in public health.