Looking to the Future of Infection Prevention and Control

Hilary M. Babcock, MD, MPH, FSHEA

This is the third installment in a blog series about awareness of antibacterial resistance that will lead to World Antibiotic Awareness Week, November 12-18, 2018. Check back for more blog posts throughout the coming weeks!

In recent news reports, antibiotic-resistant bacteria and resulting serious infections have been linked to hamburger meat, sink traps, and even puppies. The question of whether a patient in the hospital or a person in the community will encounter these dangerous pathogens appears to be moving instead towards how to identify, prevent, and contain once an infection is contracted.

The foundation of infection prevention and control is rooted in evidence-based guidelines for constant surveillance of emerging infectious diseases outbreaks and strategies for interrupting transmission of organisms across a wide range of healthcare settings. On the other side of the equation, antibiotic stewardship and safe prescribing practices play an important role in reducing the risk for organisms becoming multidrug-resistant. 

For healthcare epidemiologists and infection prevention and control teams, strong evidence, derived from rigorous research, guides the strategies for prevention and containment. And just like the drug-resistant bacteria that we seek to evade, we must continuously evolve our approaches and adapt to changing conditions.

Support for the continued advancement of this critical research is desperately needed to increase our understanding of how to prevent the spread of microbes that cause healthcare-associated infections; and simultaneously, research must define the most effective implementation strategies to move this knowledge into practice across healthcare settings. Since most research has been conducted in hospitals, there is also a pressing need to understand how to apply best practices in urgent care settings, outpatient clinics and nursing homes. A practice that works in one setting is not certain to translate well to another. These challenges compel us to undertake vigorous investigator-initiated research, funded through the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality as well as other sources, to help tailor new approaches for all care environments.

One model that is providing vital information is the Prevention Epicenters Program managed through the CDC. The Prevention Epicenters are academic and public health partnerships all over the country that conduct innovative research in preventing both the development and the subsequent transmission of antibiotic resistant organisms. With this research, the centers help develop and scale up effective strategies to prevent healthcare-associated infections and stop the spread of antibiotic-resistant bacteria. Bolstering these regional collaborations would provide richer opportunities to evaluate new and existing tools, strategies, and evidence-based interventions in additional patient populations, healthcare settings and regions. It would also enable important public health research and the assessment of surveillance strategies for various health care settings, as well as potential community-based programs.

This need is the same for stewardship. Stewardship is a key pillar of efforts to reduce the emergence of antimicrobial resistance.  Stewardship initiatives have been credited with greatly reducing the use of antibiotics, improving patient outcomes, and decreasing costs. But there are still many unanswered questions.  We have witnessed improved outcomes in some settings, but do not have the data to systematically document their effect on patient care more broadly. We must be able to demonstrate the full value of these stewardship initiatives to the health care system as a whole, as well as the benefits of customizing programs for specific patient populations. The strongest way to do that is to build a body of evidence through expanded research capacity.

Coordinated multi-faceted efforts to advance critical research in stewardship and infection prevention and control require funding that can help ensure the health and safety of patients by staving off the spread of antibiotic-resistant bacteria, saving healthcare dollars, and most importantly, saving lives.

 

Hilary Babcock is president-elect of the Society for Healthcare Epidemiology of America (SHEA).

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The capabilities are enormous, a little bit of research can pay off quite a bit in the long run.
Paul D’ Addario, retinitis pigmentosa patient