SHEA Releases 10-Year Research Agenda Focusing on HAIs

By Matt Phillion

Healthcare-associated infections (HAI) continue to harry the healthcare industry, affecting 3% of hospitalized patients to the cost of $8 billion to $12 billion in the U.S. each year.

To help combat this ongoing challenge, the Society of Healthcare Epidemiology of America (SHEA) has released a comprehensive 10-year research agenda aimed at reducing HAIs and improving outcomes for patients.

SHEA highlights three key areas for research in its 10-year agenda:

• Implementation science, focusing on how to effectively apply infection prevention strategies in real-world healthcare settings.
• Modes of transmission, investigating how infections spread in hospitals and care facilities, targeting improved prevention measures.
• Diagnostic stewardship, enhancing diagnostic practices to ensure timely, accurate detection of infections, reducing unnecessary treatments.

“One of the major functions of our society is to set direction into the future in terms of research, education, and changes in clinical modalities in care,” says Lona Mody, MD, M.Sc, professor of epidemiology at the University of Michigan School of Public Health and one of the authors of the SHEA research agenda. “A piece of that is providing a research agenda offering direction for the future and looking at what challenges we have to tackle.”

These three areas were chosen not just through discussion with researchers but also with professionals on the ground who face these challenges daily.

“They had an important say in developing this research agenda,” says Mody. “We’re really proud of this document and how it came about, and are hoping it helps everyone, from senior researchers mentoring junior researchers or teams in the field tackling modern issues.”

The timing of the agenda is particularly relevant, she notes.

“It’s an especially important time- during the pandemic everything was turned around, and we had to develop policies and procedures quite rapidly, without much research at the time,” Mody says. “This is a time for us to reset and think about where we’re headed.”

Three focus areas

There is a lot of ground to cover in the area of HAIs, as organizations look at large-scale changes or smaller quality improvement projects on a more local level.

To help narrow down the focus areas, the team drew feedback from the SHEA network of research facilities.

“The network provides a good range of responses. We looked at the healthcare populations and settings initially identified by the SHEA research committee and then surveyed the 95 facilities with a set of questions and priorities” for them to weigh in on, Mody says.

The respondents were asked to select five out of 14 topics and to rank them from least to most impactful. The research team then took that data to focus down on the three priority areas where there was an immediate, urgent need for more work to be done for larger scale improvement.

In fact, the need for more rapid improvements made one topic area, implementation science, rise to the top.

“There’s already evidence-based research out there, but we know it can take up to 17 years in healthcare for research to be integrated. This is why we want to look at implementation science,” says Mody. “We want to find ways to enhance healthcare delivery by identifying behaviors and system-level factors that organizations can influence and become faster, and more evidence-based. We want to study how to get evidence into the implementation phase.”

The industry overall seems to be ready for a change, Mody notes.

“In healthcare, because of the amount of progress we’ve seen in the past century, we’re reluctant to make sudden changes the way a business would,” she says. “We want to be thoughtful about it, but there has to be a happy medium to enable healthcare to be quick in the way that businesses can be disruptive and innovative and yet not put lives in jeopardy.”

Transmission research, on the other hand, is an ever-present need.

“We need to understand the transmission of infections that that are prone to spread from one patient to another,” says Mody. “We’ve made important gains, and we’ve learned a lot for the pandemic: areas we should focus on, such as viral transmission in healthcare settings, the role of environmental contamination, persistent organisms, the role of hand hygiene and environmental cleaning. We know what need to develop efficient, less labor-intensive cleaning protocols to make advances happen.”

But the conversation doesn’t stop here, she notes.

“We need to understand how transmission happens in populations that are underrepresented, nursing homes, jail populations, other enclosed populations where research is not often done,” says Mody.

This is why the agenda has focused on this topic—to nudge investigators towards untapped areas and populations to study.

“We always knew under-researched populations that in a variety of healthcare settings are challenging, but the extent was not known and the pandemic highlighted that,” she says. “And it’s not just populations in enclosed settings, but also vulnerable populations. We need to study how viruses interact with certain hosts.”

We know more now and have seen inexpensive interventions rolled out to offer practical implementation guidance to improve and build on existing practices. The research agenda highlights priority areas in these domains and urges researchers to put their know-how and training toward developing even more innovation.

A deeper dive into diagnostic stewardship

Diagnostic stewardship is a key issue to focus on as the industry looks to make sure the right tests and treatments are being used for the right patients.

“The world is quickly evolving in this space, and there’s now, more than ever, an urgent need to develop diagnostic stewardship in the virtual world,” says Mody. “The way judgment calls are made when seeing a patient in person versus remotely is different.”

Diagnostic stewardship is gaining even more value and importance with the increasing reliance on virtual care models.

“I don’t think people have had a chance to study it much yet. It’s important to ultimately have the principle that we use lab testing to improve patient care,” says Mody. “We want to improve outcomes and de-implement strategies that do not help with patient care. Those are the areas we hope to learn from people developing their research around this area.”

All three focus areas have the capacity to offer a powerful impact on healthcare in this space, Mody notes.

“I hope those involved take a look at this guidance and that it helps set a stage for innovation in healthcare epidemiology,” says Mody. “I hope they look to the questions we’ve posed. If there are answers to them, they can have a huge impact to enhance infection prevention programs, develop more champions, train the future workforce, and help get new generation interested in this area. It’s time to tackle multiple issues and engage with our populations to go beyond what we have right now and think more globally.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.