FEATURE — Fall 2004

Victoria J. Fraser, the J. William Campbell Professor of Medicine

Champion of Infection Control

From controlling hospital-based contagions to treating women and children infected with HIV/AIDS, Professor Victoria Fraser works hard to fight infectious diseases.

by Diane Duke Williams

In a place where vaccines were delivered on donkeys and medical care was given in an old banana plantation, Victoria J. Fraser found her calling.

As a medical resident in Haiti's Artibonite Valley in the mid-1980s, Fraser saw children with salmonella, tuberculosis, and malaria—some had all three. It was common to arrive at 5 a.m. and have a line of 50 people waiting for help. "I couldn't believe the huge impact that preventable, treatable diseases were still having, and in many parts of the world," Fraser says.

After returning to the United States, Fraser had a hard time adjusting to the waste and extreme affluence. She gave away many possessions and couldn't go out to eat or shop without feeling guilty.

Fraser and her husband, Steven B. Miller, then took some time off to backpack through Africa and Southeast Asia before becoming fellows at the School of Medicine in 1988. Her experiences in other countries helped her decide to specialize in infectious disease.

"Infectious disease has a significant impact on global health," says Fraser, now the J. William Campbell Professor of Medicine and clinical chief of the Division of Infectious Diseases. "It's one of the fields within medicine where we truly have been able to make dramatic inroads in terms of survival, both decreasing childhood mortality and improving long-term survival with relatively inexpensive public health measures."

Although Fraser had decided to do research in molecular virology, Gerald Medoff, M.D. '62, then head of the Division of Infectious Diseases, convinced her otherwise. He suggested that she focus on health-care epidemiology, which includes the study of hospital-based infections such as surgical site infections, bloodstream infections, and ventilator-associated pneumonia. She had never heard of this specialty.

"Her intellect and people and leadership skills were apparent when she interviewed here," says Medoff, now professor of medicine and of microbiology and immunology. "I thought that her skills were more suited to a career in clinical research and patient care."

Today, Fraser is known as a fearless champion of infection control, a phenomenal teacher, and a tireless researcher and physician. She has studied everything from needle-stick injuries among health-care workers to surgical site infections to medical errors. She also has established a center for women with HIV and treated countless patients with infectious diseases.

David K. Warren, assistant professor of medicine, who first met Fraser when he was a resident in internal medicine and who worked with her during an infectious diseases fellowship, says she has more energy than anyone else he knows. "She's able to juggle many roles with skill," Warren says. "She is an excellent mentor and is always working to identify opportunities for others. She also is great at motivating the people who work with her to realize their potential, and she has created a research team that is very successful."

In the late 1980s, infection control statistics were kept on index cards that were stored in shoeboxes. Fraser worked with Thomas C. Bailey, M.D. '84, H.S. '87, associate professor of medicine, and Michael Kahn to establish an electronic surveillance system for hospital-acquired infections. Huge amounts of information were electronically synthesized.

The system merged microbiology results with pharmacy and clinical information, including the patient's recent surgical procedures, day of admission, and day of culture. Infection types were classified as community-acquired infections or hospital-acquired infections, which could be sorted by floor, surgeon, or organism. This new system allowed complex analysis of trends, rates of infections, and antibiotic-resistant organisms over time in different hospital units.

Nationally, when someone enters a hospital, he or she has a 1 in 20 chance of getting a hospital-acquired infection. Victoria Fraser is the medical director of a consortium of infection control specialists at BJC HealthCare working hard to decrease nosocomial infections.

William C. Dunagan, M.D. '83, H.S. '89, associate professor of medicine and vice president of quality at BJC HealthCare, says Fraser is very courageous and has a penchant for tackling difficult issues that others avoid. "She's shown over and over again her ability to make real and important progress in finding solutions that will work, advancing not only clinical science but also directly improving the quality of care," Dunagan says. "Her leadership has been instrumental in making BJC HealthCare a national leader in infection control, and I can't think of a more productive or harder working person."

When someone enters a hospital in the United States, he or she has a 1 in 20 chance of getting a hospital-acquired infection. Cancer patients on chemotherapy, people with AIDS, and transplant patients on immunosuppressive drugs face an even greater risk. Infection risks vary greatly from hospital to hospital, Fraser says, and depend on the patient population, and the severity of the patients' illnesses and underlying diseases. Treatment processes at the hospital also are a factor.

Fraser has been medical director of a consortium of infection control specialists at BJC HealthCare for eight years. This group has helped decrease ventilator-associated pneumonia by more than 30 percent and catheter-related bloodstream infections by almost 50 percent in its hospitals.

"Part of our program has really focused on interventions," she says. "We don't just count and track infections."

Hospitals across the country now are using these procedures to lower infection rates. Training programs on these procedures also are being sold to other health-care-related industries, including insurance companies.

Fraser has been medical director of a consortium of infection control specialists at BJC HealthCare for eight years. This group has helped decrease ventilator-associated pneumonia by more than 30 percent and catheter-related bloodstream infections by almost 50 percent in its hospitals.

In addition to her research on hospital-acquired infections, Fraser is especially proud of founding a center in 1995 that provides comprehensive care to women with HIV and AIDS.

The Helena Hatch Special Care Center for Children, named after a young local woman who died of AIDS, offers everything from food to childcare to transportation. The staff develops a close, nurturing relationship with patients, taking the time to contact them if they miss appointments.

"When a woman has three kids, a dying husband, no car, and no food at home, it's absurd to just give her a prescription and expect her to do well," Fraser says.

The center currently is funded by the Missouri Foundation for Health as well as a Ryan White Title IV grant and now treats more than 400 area women. Linda M. Mundy, previously assistant professor of medicine at Washington University, played an important role as medical director. And Fraser continues to treat patients at Helena Hatch, as well as at Barnes-Jewish Hospital and the Washington University Infectious Disease practice.

Professor Victoria Fraser (center) shows medical students, Jessica Despotovic (left) and Nefertari Daaga, the proper procedures for inserting needles, to avoid exposure to another's blood and possible infection.

Martie Aboussie, Jr., who went to Fraser for a second opinion about a rare chest tumor last year, says she stands above many other doctors he's encountered. "She's thoughtful, extremely sharp, and really listens to what you have to say," says Aboussie, a 21-year-old student at Saint Louis University.

His father, Martie Aboussie, Sr., adds: "Her skills as a physician and her knowledge of her particular field are extraordinary. I don't think you could say enough good about her. She's a real credit to Washington University."

Larry J. Shapiro, A.B. '68, M.D. '71, executive vice chancellor for medical affairs, dean of the School of Medicine, and the Spencer T. and Ann W. Olin Distinguished Professor, calls Fraser a tremendously talented physician and leader. "We are fortunate to have her as clinical chief of the Division of Infectious Diseases," he says. "She is brilliant, deeply committed, and works countless hours to the benefit of her patients and colleagues."

Fraser knew as a high-school student in Webster Groves, Missouri, that she wanted to become a physician. She had wonderful doctors as a child, and some of her family's friends were physicians. "They seemed like very smart, hardworking, noble people," Fraser says. "I thought it would be great to help people feel better, minimize disease, and develop long-lasting relationships with your patients."

Growing up, her family spent almost every weekend at their family farm near Sullivan, Missouri, with a "gaggle" of cousins, aunts, uncles, and grandparents. They slept in a bunkhouse and barbecued, rode horses and fished.

She also was taught that people should use the gifts and energy they are born with to try to help other people and leave the world a better place.

Fraser and Miller, now associate professor of medicine at the School of Medicine and chief medical officer of Barnes-Jewish Hospital, have 14-year-old twins, Becky and Jake, and a 10-year-old, Hallie. The couple spend a lot of time at their children's basketball games and English riding lessons, and the whole family enjoys fishing and snow skiing. They also occasionally visit the family farm in Sullivan.

"I have been very blessed in my life," Fraser says. "Many people are not as fortunate, and I believe we have an obligation to try to improve the quality of life for everyone."

Diane Duke Williams is a free-lance writer based in St. Louis, Missouri.