HOLLI W. HAYNIE

Solving clinical problems the way a detective solves crimes is akin to the work of Mack Land, MD, internist and hospital epidemiologist at the Regional Medical Center at Memphis (the MED). Being in an acute-care and trauma facility, combating infections is a demanding, non-stop task. Whether it's discovering the source of a mysterious fever or combating the spread of infection through hospital equipment, Land is on the scene to reduce infection and direct safety control measures.

"I like the challenge of diagnosis and trying to see the problem," he explained. "It's like I'm a doctor for the hospital to see what might work better in infection control, learn from that and (apply) best practices from throughout the country and world."

He does this without the advantages of all the high-tech equipment money can buy. Safety is maintained through vigilant infection control from practitioners and nurses.

"A lot of it is good, old-fashioned surveillance," Land said. "Being a public hospital that doesn't have the resources of a private or not-for-profit hospital, we are holding our own."

The MED has a 20 percent uninsured patient base and serves a six-state region within 150-miles of Memphis. That good old-fashioned surveillance comes in many forms, from using bundle systems for central lines and ventilators, to promoting simple hand washing through a county-wide project.

"Despite all our technological advances, basic hand washing still remains the best tool we have to prevent infection from one person to another," explained Land, adding his approval for the foam hand sanitizers throughout the hospital. "Everybody's level of hand washing, professionals as well as visitors, can be better."

Making rounds through the hospital, Land's ultimate joy is found right in the middle of things with patients and colleagues. Another certainty to his daily routine is the presence of residents, because he "loves to teach." He has held a teaching position at UT since he began private practice 25 years ago, and throughout his career has chosen appointments at teaching hospitals. Rounds are exciting, he said, since he's always up for a good challenge. Being with residents allows him advanced perspective on solutions, he said, since they suggest up-to-date reading materials, while he trains them to become medical detectives in their own right. Some of the infections Land routinely works to prevent include pneumonia, sepsis, infections of the bone, osteoarthritis, diabetic infections, and infections around the heart valve.

Patients arrive for one reason, and it is Land's job to make sure patients don't get sick from what is done to them in the hospital.

"You have to look at the safety issues of everything we do to people, and (whether it) will decrease any chance of untoward events occurring," he added. "At the MED, we would like to see hospital acquired infections as a rare event."

Ultimately his brain thrives when he's on the bug hunt. An avid reader, Land, not surprisingly, enjoys detective mysteries.

"The detective mysteries give you some idea how to solve things and point out the problems that a detailed observer would see," he said. "I also like to read medical histories – how epidemics started and how society handled them, how infectious diseases affect the world."

Land has worked around the HIV epidemic since it struck the U.S. in the early 1980s, when it was a death sentence. He still sees HIV patients today, although the landscape of the disease has
dramatically transformed.

"The greatest privilege of my career is to see the HIV epidemic from the beginning to where we are now, and to watch the person infected with HIV, particularly in the early days, the courage in facing that disease," Land recalled. "I'm gratified that it is really a chronic disease, not a rapid failing disease. That's been one of the greatest medical advances that I've seen in my lifetime."

Land was trained at the UT School of Medicine in infectious diseases and has worked in the Baptist and UT systems. As a past president of the Memphis Medical Society, Land understands the importance of being involved in organized medicine. He's participated in various national, state and local organizations such as the state's governor's council, the AMA and Infectious Diseases Society of America. Not only does Land spend his days at the MED, his wife, a NICU nurse, and his daughter, a trauma nurse, both work at the hospital as well.

Happy to have the family on staff, Land explained they have a long history working in hospitals downtown, from his early days at the original Baptist on Madison.

As for the future, Land hopes for a healthcare transformation on a national scale to get to patients sooner and treat illnesses earlier through vaccinations and preventive care.

"We need to change our focus on wellness, working to keep people well, as opposed to treating them after they're sick," he advocated. "Both parties need to do more for public health, to keep people healthy and address our unhealthy lifestyles."