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Complexity of care provided in healthcare settings is increasing tremendously . With increasing complexity and more procedureoriented care , use of antibiotics have gone up and with it there is a rise in resistance to broad spectrum antibiotics – this includes increasing resistance to carbapenems used to combat Gram-negative organisms .” “ This increase in antimicrobial resistance has reached a crisis level around the globe .”
— Lona Mody , MD , MSc
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This updated research agenda is preceded by the SHEA research agenda titled “ The Evolving Landscape of Healthcare- Associated Infections : Recent Advances in Prevention and a Roadmap for Research ,” published in 2014 , and its earlier predecessor in 2010 , “ Charting the Course for the Future of Science in Healthcare Epidemiology : Results of a Survey of the Membership of SHEA .” The 2014 SHEA research agenda explored knowledge gaps and challenges in healthcare epidemiology and progress made toward addressing those issues , and built on the first SHEA research agenda , published in 2010 , which called for a “ national approach to HAIs ” and a prioritized agenda .
One of the authors , Lona Mody , MD , MSc , of the University of Michigan , VA Ann Arbor Healthcare System in Ann Arbor , Mich ., says that several things have changed since this original research agenda was published . She highlights what has evolved : “ Complexity of care provided in healthcare settings is increasing tremendously . With increasing complexity and more procedure-oriented care , use of antibiotics has gone up and with it there is a rise in resistance to broad-spectrum antibiotics – this includes increasing resistance to carbapenems used to combat Gram-negative organisms ,” Mody says . “ This increase in antimicrobial resistance has reached a crisis level around the globe .”
A second change in the research agenda is related to what Mody characterizes as a “ culmination of years of research in healthcare epidemiology which showed that many HAIs are preventable and that effective interventions exist to mitigate the risk of HAIs for patients .” Mody adds , “ Even with this progress , the landscape of healthcare epidemiology is expanding and gaps in knowledge remain . This research agenda addresses the gap .”
Mody says that a third change is that “ Care is now provided in many different settings including acute-care hospitals , nursing homes , community programs such as hospital-at-home , and sameday-surgery – just to name a few . We need to conduct high-quality research in all these settings to fill gaps in evidence .”
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In October , APIC released its research agenda ; if you missed it , Healthcare Hygiene magazine ’ s October cover story may be accessed HERE
Let ’ s explore some of the specifics of the research agenda itself .
More than half of SRN ’ s survey respondents prioritized three topics , with their specific research questions identified as the most urgent according to weighted scores , Kwon , et al . ( 2024 ) report , noting , “ The three research domains identified represent priority areas with unanswered research questions in implementation science in the field of healthcare epidemiology and infection prevention .”
These immediate research areas are :
Implementation science in healthcare epidemiology and infection prevention
Priority area 1 : Identify implementation strategies and techniques that facilitate behavior change in healthcare workspaces to support the uptake and use of evidence-based infection prevention practices .
Priority area 2 : Identify and implement strategies to support sustainability of infection prevention interventions and practices in hospitals and other healthcare settings , including those with resource constraints . This also includes developing approaches for measuring the effects of these interventions over time .
Priority area 3 : Determine the extent to which evidence-based infection prevention practices are being implemented and sustained within and across different healthcare settings , which includes settings with differential access to resources .
As Kwon , et al . ( 2024 ) explain , “ Evidence-based recommendations can take 17 years to become integrated into healthcare practice . Implementation science seeks to overcome this delay by studying methods ‘ to promote the systematic uptake of research findings and other evidence-based practices into routine practice , and , hence , to improve the quality and effectiveness of health services .’ The focus goes beyond solution-oriented practices
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of quality improvement to create a generalizable knowledge base that can be utilized at a broad scale .”
Modes of transmission for multidrug-resistant organisms and novel pathogens
Priority area 1 : Increase the frequency of regular genomic sequencing and integrate results into infection prevention to improve understanding of sources of transmission events .
Priority area 2 : Improve understanding of the role of HCP in transmission to patients directly and indirectly through the environment .
As Kwon , et al . ( 2024 ) explain , “ HAIs pose a significant threat to patient safety and burden to the healthcare system . Understanding transmission , colonization , and infection pathways of pathogens , and especially of MDROs , is critical to pursuing investments in future interventions . Existing gaps in our understanding of how MDROs spread compound the difficulty in developing and interpreting the effectiveness of interventions . With reducing costs of genomic sequencing , we can more accurately define transmission chains and thereby improve attribution around the sources and pathways of transmission .”
Diagnostic stewardship
Priority area 1 : Understand sociobehavioral , contextual , and adaptive factors that affect diagnostic test use .
• Priority area 2 : Review opportunities for diagnostic stewardship across the continuum of testing ( pre-analytic , analytic , and post-analytic stages of testing ).
• Priority area 3 : Expand diagnostic stewardship interventions beyond traditional culture-based tests to include non-culture-based tests like precursor tests , biomarkers , and molecular diagnostic panels .
• Priority area 4 : Leverage the electronic health record ( EHR ) and use clinical decision support for diagnostic stewardship interventions .
• Priority area 5 : Develop future performance metrics that align with diagnostic stewardship interventions and provide meaningful information to healthcare facilities to improve outcomes .
As Kwon , et al . ( 2024 ) Diagnostic stewardship refers to optimizing the use of laboratory testing to improve
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