sources of pathogens require identification and quantification of risk to patients . After understanding where pathogens reside in the healthcare environment , we can better target and refine mitigation strategies . Potential reservoirs in the healthcare environment that have not yet been fully evaluated may include reusable , mobile , or shared medical equipment and shared spaces . Healthcare water sources that develop biofilms ( e . g ., sinks , premise plumbing , ice machines , and / or heating / cooling , and perfusion machines ) are particularly important for future investigation , as water biofilm sources have been responsible for facility and global outbreaks . Further , we do not know the role of wastewater surveillance in detecting immediate risks of HAI for patients and when to trigger mitigation strategies .
As Kwon , et al . ( 2024 ) note , “ Environmental cleaning is a complex , multi-step , mostly manual process with many opportunities for human error . Research is needed to identify practical methods to improve quality and consistency of environmental cleaning . Although there has been an increase in utilization of touch-free disinfectant technologies in the past decade , these have not substituted the need for effective manual cleaning . To fill these knowledge gaps , we need investigation into the clinical significance of surface contamination prior to terminal room cleaning and how to prevent patient contamination of surfaces , including the role of continuous disinfectant technologies . Research is also needed to determine the specific benefits of enhanced cleaning and disinfection in immunocompromised patient populations . All patients deserve to be cared for in safe , clean , healthcare facilities . Inequity in healthcare access and resources likely impacts the safety of healthcare environments ; however , the degree to which inequities affect healthcare environment cleanliness has not been welldefined or addressed .”
Device-associated infections
The SRN survey respondents said there were unanswered research questions related to device-associated infections , and that while key device-associated infections are monitored by nationally reported surveillance programs that are tied to hospital rankings and pay-for-performance , the healthcare epidemiology community has the opportunity for improvement in several critical areas .
The first priority to fight device-related infections is to improve infection surveillance definitions and goals . According to Kwon , et al . ( 2024 ), “ Healthcare epidemiology requires an evidence-based method to determine the lowest achievable frequency of HAIs . A better understanding of the
Recent studies reported an increase in HAIs during the COVID-19 pandemic , likely due in part to diverted attention from routine infection prevention and antimicrobial stewardship efforts during the emergency .”
lowest achievable infection rates would guide efficient use of infection prevention resources toward truly preventable events . Furthermore , identification of infection prevention interventions that improve patient clinical outcomes , beyond infection rates , would highlight interventions that carry greatest benefit for patients .”
The second priority is to develop novel device technologies or methods to minimize the incidence of infection . As Kwon , et al . ( 2024 ) explain , “ Infection prevention programs need to know the benefits and risks of novel device technologies and approaches to device maintenance , including devices ’ features for colonization or biofilm-resistance and mechanical or biological ways to reduce bacterial burden . Studies of devices and technologies should be powered to include patient-focused outcomes to define when invasive devices ( e . g ., mechanical ventilation ) should be preferred to less invasive devices ( e . g ., non-invasive positive pressure ventilation ), and vice versa , as outcomes focused only on microbial contamination can overestimate infection rates . Studies should include appropriate patient selection to maximize benefit over risk and should include a standard-of- care comparator . Evaluation of novel device technologies and maintenance , especially those that include antimicrobials or disinfectants , should report unintended effects , such as acquired antibiotic-resistance , device degradation , or device dysfunction ( e . g ., catheter occlusion or impaired ventilation ). Technologies that employ non-invasive strategies ( e . g ., non-invasive ventilation , external catheters ) should continue to be a focus of investigation .”
The third priority is to determine how best to prevent device-associated infections in outpatient and high-risk populations . As Kwon , et al . ( 2024 ) advise , “ Several patient populations are at unique risk for developing device-associated infections . Patients who have prolonged device utilization , mostly in the outpatient or long-term care setting , may not benefit from traditional inpatient strategies for infection prevention . Research is needed to further define the epidemiology of device-associated infections and tailor prevention strategies in these groups , including outpatient dialysis and patients on home or clinic-based infusion therapy . Additionally , patients receiving treatment for cancer , particularly hematologic malignancy , frequently develop infection due to severe immunocompromise and associated skin and mucosal barrier injury . Cohort studies can better define the incidence of infection in high-risk outpatient populations , and interventional trials can identify effective infection prevention strategies .”
The authors add that infection prevention practices should be studied for devices that lack effective strategies and are responsible for significant morbidity and antibiotic exposure , such as long-term ventricular assist devices . As they note , “ Opportunities for research include not only defining opportunities to predict and prevent device-associated infections , but also to reduce infections occurring from MDROs .”
Infection prevention during public health emergencies
Another area of concern , according to the SRN survey respondents , is infection prevention during public health emergencies . The three research domains identified represent priority areas with unanswered research questions in infection prevention in public health emergencies :
➊ Identify how hospitals can combat HAIs due to MDROs during public health emergencies .
➋ Determine how constrained staffing or other resources affect the implementation and sustainability of existing and new HAI prevention strategies .
➌ Understand the impact of public health emergencies on the epidemiology of HAIs .
As Kwon , et al . ( 2024 ) observe , “ Recent studies reported an increase in HAIs during the COVID-19 pandemic , likely due in part to diverted attention from routine infection prevention and antimicrobial stewardship efforts during the emergency . Infectious disease events related to emerging pathogen outbreaks , bioterrorism , or mass casualties often occur unexpectedly and cause significant morbidity , mortality , and economic disruption . These events require preparedness at global , national , regional , and facility levels . Healthcare systems are challenged with limited guidance on prioritization of personal protective equipment ( PPE ), isolation rooms , considerations for discharging potentially infectious patients to postacute facilities , practices related to care of immunocompromised patients and other vulnerable populations , and more .”
Populations and Settings Requiring Research
In addition to research topics , the SRN survey respondents also identified several
16 • www . healthcarehygienemagazine . com • december 2024