By Kelly M. Pyrek
A new research consortium through which to address persistent knowledge gaps could be precisely what the healthcare epidemiology and infection prevention community has been waiting for in light of urgent scientific and clinical questions requiring more definitive answers. A report from the Research Committee of the Society of Healthcare Epidemiology of America (SHEA) reveals the results of a recent survey of SHEA members on their perceptions of gaps in the healthcare epidemiology knowledge base and members’ priorities for SHEA research goals. The survey also assessed whether members would be willing to participate in consortium to address identified gaps in knowledge, and evaluated the need for training for the next generation of investigators in the field of healthcare epidemiology. (The survey return rate was 46 percent, with 593 out of 1,289 members responding.)
The newly formed SHEA Research Collaborative is expected to help address critical issues that SHEA members identified in the survey, such as setting the scientific agenda for healthcare epidemiology; developing collaborative infrastructure to conduct research; and developing funding mechanisms for research.
More than 88 percent of respondents said they believed that developing a robust infrastructure for training in research should be a primary role for the SHEA Research Committee, and that almost 92 percent of respondents characterized as important or somewhat important the concept of creating a collaborative infrastructure among SHEA members and partners to conduct research in healthcare epidemiology. SHEA members responding to the survey suggested a number of professional organizations as potential partners for the research consortium, including the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the Centers for Disease Control and Prevention, the Institute for Healthcare Improvement (IHI) and the National Institutes of Health (NIH).
This SHEA member dialogue was continuing around the time of the Fifth Decennial International Conference on Healthcare-Acquired Infections held in March, during which a plenary session addressed the need for an adequately resourced, rigorous research agenda for the coming decade. Panelist David Henderson, MD, deputy director for clinical care and associate director for hospital epidemiology and quality improvement of the National Institutes of Health Clinical Center, noted that there is a problem with the science base that supports infection prevention and control. He explained that it is inadequate to provide definitive support for the HAI-reduction recommendations that are made. "Implementation science has reduced risk but it is not the complete answer," Henderson said at the Decennial meeting. "The existing guidelines have a one-size-fits-all approach that won’t work in diverse healthcare settings." For example, Henderson pointed to the concept of bundles; while they appear to be effective, Henderson said some aspects of the interventions are better known than others and this knowledge gap is of concern.
"We need a stronger science base," emphasizes Henderson, who is also chair of the SHEA Research Committee. "It is much easier if you have ultimate scientific confidence in the principles you are implementing. We talk a lot about bundles of practices – we know with varying degrees of certainty that aspects of bundles work and in some settings it’s entirely possible that some aspects of the bundle might actually be detrimental. That’s why we need the kind of studies that can help sort out those risk factors. If a practitioner calls me and says, ‘Here’s the nature of what’s happening at my hospital and the patient population we have,’ it would be nice to be able to say with certainty, ‘This is an approach you might take that will be successful.’ But we just don’t have a science base that operates at that level currently."
At the heart of translational research is translating an idea from research into practice, going from the concept to the proof of the principle and then moving principle into practice in the real-world setting of healthcare. Henderson pointed to the current knowledge gaps, which included pathogenesis and the mechanisms of acquisition; epidemiology (including the role of the environment, optimal sites for culturing, settings in which screening is beneficial); the efficacy of prevention interventions such as hand hygiene, isolation, bundles, decolonization); study design; and technology (such as rapid diagnostics).
Reflecting on his comments at Decennial, Henderson says the concept of implementation science continues to be important in the fight against healthcare-acquired infections (HAIs) and adds, "Hopefully it will help us do the things we already know how to do well." Henderson explains further, "If one looks at the checkered history of hospital epidemiology all the way back to Semmelweis, there are many practices that are recommended but we don’t accomplish them. If studies can help us implement the principles we know to be effective, then that will move us down the path toward increasing patient safety. But that’s just part of the story. If implementation science depends on knowing what we actually think we know -- and there are many instances where I suspect that’s not true or at least not true in specific settings – there are factors that may influence a patient’s outcome that vary from one facility to another. So there is urgency for research in healthcare epidemiology across the spectrum, to try to help us understand epidemiology and pathogenesis; as we move from early translational science and work out principles in more detail, then implementation science will be even more powerful over time."
