Bacteria and microbes that cause illness and infection are small and virtually invisible, yet they have a dramatic impact on the health and safety of patients, affecting one out of every 25 hospitalized patients in the United States on any given dayi.
Consider the cancer patient who receives lifesaving chemotherapy through a central line—a catheter placed in a large vein to make it easier to administer medications. With the help of medical advances, the patient might survive the cancer, but without effective infection prevention and control practices, they could die from a healthcare-associated infection related to the central line.
Implementation science, which determines how to deliver care and treatment most effectively, is a critical link in our ability to deliver on the promise of clinical research. It provides the evidence required to understand how multiple interventions work for various patients in diverse settings. Despite its importance, it is often overlooked and undervalued when compared with other areas of medical research; but it affects the health and safety of every single patient by providing healthcare professionals evidence-based knowledge to make informed care decisions that protect patients, prevent infectious outbreaks and save lives.
Innovation must continue in two parallel areas to ensure game-changing developments in medicine aren’t derailed by the evolution of antibiotic resistant pathogens in the environment. Research is required to increase our understanding of how to prevent the spread of microbes that cause HAIs; and simultaneously, research must support effective implementation of this knowledge across healthcare settings. Since most research has been conducted in hospitals, there is also a vital need to understand how to apply practices in urgent care settings, outpatient clinics and nursing homes as well as in low- and middle-income countries. A practice that works in one setting is not guaranteed to translate to another.
The urgency of this need cannot be overstated, especially considering that antibiotic resistance, if left unchecked, will surpass cancer as a leading cause of death by 2050.
Federal research investments through the Department of Health and Human Services, and specifically Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) have a direct and real impact on patient safety; yet funding for this research has been unpredictable over the last decade and under constant threat. In reaching our goal of eliminating HAIs and stopping the spread of antibiotic resistance, federal investments supporting research in this area must be robust, predictable and sustainable year over year to ensure a steady pace toward elimination.
Uncertain funding comes with serious consequences, endangering the nation’s healthcare ecosystem, discouraging young investigators from coming into or remaining in the field, limiting the future pool of researchers with the expertise and curiosity to create new breakthroughs and stay ahead of the ever-changing world of microbiology, not to mention curtailing the research projects that improve health outcomes.
A review of international research published this week in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), shows that even in wealthy countries and in hospitals with infection prevention protocols in place, effective, consistent implementation of evidence-based practices can reduce infections by up to 55 percent. This directly translates to lives saved, but also demonstrates that infection prevention requires constant vigilance by professionals who are up to date with the latest research and trends and tuned into the culture of their facilities to ensure effective application of best practices in complex healthcare settings.
Another recent study published in the New England Journal of Medicine and funded by AHRQ is an example of how research provides critical information about how to prevent infections in some of the most vulnerable patients. The study found that reducing the burden of bacteria in all patients, whether causing infection or not, through the use of topical antibacterial agents was the best way to prevent bloodstream infection and the drug-resistant MRSA bacteria compared to treating only select groups of patients. Prior research had shown mixed-results favoring one strategy or another, but with this study, researchers compared the leading approaches in a standardized way to demonstrate the benefits.
Failure to adequately support important research like this will make it harder for healthcare delivery organizations and the people they serve to make informed choices about how to provide the best, safest care. Every dollar that we invest in researching healthcare quality and streamlining its delivery is a sound investment in our fiscal future and helps to eliminate inappropriate, ineffective or harmful practices that create unnecessary spending. We must ensure the AHRQ and CDC have reliable funding to do this critical work in infection prevention. We must continue to advance implementation science or we risk shortchanging medical advances with the threat of HAIs. Patients and their families deserve no less.
