SHEA 2026: Alexander Sundermann, DrPH, Explains How Whole Genome Sequencing Reveals Hidden HAI Transmission and Ethical Challenges in Patient Notification

At the 2026 SHEA Spring Conference in Chicago, Illinois, held from April 12 to 15, emerging data on whole genome sequencing (WGS) is challenging long-held assumptions about health care-associated infections (HAIs) while raising new ethical and operational questions for infection prevention programs.

Alexander Sundermann, DrPH, AL-CIP, FAPIC, assistant professor of public health with expertise in outbreaks, genomics, and public health at the University of Pittsburgh, School of Public Health, Department of Epidemiology, Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology in Pennsylvania, presented research demonstrating how genomic surveillance is reshaping understanding of transmission dynamics within hospitals. His work highlights a critical gap in traditional surveillance methods, suggesting that a significant proportion of infections may go undetected using current approaches.

In an interview with Infection Control Today^®’s (ICT’s^®), Sundermann, explained his presentation, “Metrics vs the Genome: How Molecular Epidemiology Can Inform HAI Metrics,” and the poster, “Pathogen Genomic Surveillance in Healthcare: Emerging Ethical Dilemmas in Outbreak Detection and Patient Notification,” he presented with Waleed Javaid, MD, MBA, MS; and Lisa S. Parker, PhD. 

“The way that we detect outbreaks and transmission has not changed in so long,” said Sundermann, who is also a member of ICT’s editorial advisory board. “But if we do sequencing surveillance prospectively, we can find all of these outbreaks and transmission events that go completely under the radar.”

Historically, HAIs were largely attributed to exogenous transmission, such as contaminated instruments or poor hygiene practices. However, modern infection prevention efforts, including improved sterilization and environmental cleaning, have shifted that landscape. Today, many infections originate from endogenous sources, or the patient’s own microbiota. Yet exogenous transmission still plays a meaningful role—and one that may be underestimated.

“On average, about 25% of health care-associated infections are from transmission events,” Sundermann explained. “And that’s something genomic sequencing can actually help us identify and intervene on.”

This distinction is critical for infection preventionists. Interventions differ significantly depending on whether an infection is endogenous or transmitted between patients or from the environment. Without genomic data, those distinctions can remain unclear, limiting the effectiveness of prevention strategies.

Perhaps more striking is the gap between what is measured and what is actually occurring. Sundermann’s research suggests that current surveillance systems may significantly underestimate the true burden of HAIs.

“About 55% of transmitted infections do not meet NHSN criteria and do not get reported,” he said. “So we know we’re missing a substantial portion of the true burden.”

By supplementing traditional surveillance with genomic sequencing, hospitals can identify previously undetected transmission events, allowing for earlier intervention. This proactive approach has the potential to reduce infections, improve patient outcomes, and lower costs.

“We can make infection prevention interventions—enhanced cleaning, education, audits—and actually stop those outbreaks,” Sundermann noted.

However, implementing genomic surveillance is not without challenges. Cost remains a major barrier, particularly as reimbursement pathways are not yet well established.

“As with anything in health care, it comes down to money,” Sundermann said. “We can show that it saves money overall, but the savings don’t always go back to the hospital.”

Beyond financial considerations, the successful integration of genomic data depends heavily on infection prevention teams. Without proper training and clear protocols, the value of sequencing data may not be fully realized.

“This technology is not going to work unless infection preventionists are on board and know what to do with the data,” he emphasized.

In addition to operational challenges, Sundermann’s work also explores emerging ethical dilemmas, particularly around patient notification. As genomic surveillance identifies more outbreaks with greater precision, hospitals may face difficult decisions about when and how to inform patients.

“We’re going to find more outbreaks than we traditionally have,” he said. “And that raises the question: Are we notifying patients appropriately, and what is our obligation to do so?”

These questions extend beyond individual institutions to broader issues of transparency and equity. As genomic surveillance becomes more widely adopted, disparities may emerge between hospitals that have access to advanced diagnostics and those that do not.

“If you had a choice between a hospital that uses genomic surveillance and one that doesn’t, which would you choose?” Sundermann asked.

As Sundermann’s and his colleagues’ presentations at SHEA 2026 made clear, whole genome sequencing is poised to become a powerful tool in infection prevention. Yet its success will depend not only on technological advancement, but also on thoughtful implementation, ethical consideration, and the ability of infection preventionists to translate complex data into meaningful action.