Policy Implications of the Society for Healthcare Epidemiology of America's Research Plan for Reducing Healthcare-Associated Infections

From the Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus (K.B.S.), and the Department of Infectious Diseases, The Cleveland Clinic, Cleveland (S.G.), Ohio. Received December 11, 2009; accepted December 13, 2009; electronically published December 29, 2009. Infect Control Hosp Epidemiol 2010; 31:124-126 2009 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2010/3102-0003$15.00. DOI: 10.1086/650583 The country is currently in the midst of a healthcare debate about all aspects of healthcare spending; $2.4 trillion is spent annually on health care, representing 16% of the gross national product. The focus has been on value-based competition (paying for performance and not quantity of care) and on patient safety and the quality of medical care. Two seminal publications from the Institute of Medicine were early catalysts for the creation of this movement to reform healthcare spending: To Err is Human: Building a Safer Health System, published in 2000, and Crossing the Quality Chasm: A New Health System for the 21st Century, published in 2001. Infectious diseases physicians and healthcare epidemiologists were the first to point out that healthcare-associated infections (HAIs) were major contributors to adverse events associated with the delivery of health care. The focus on HAIs is in part because many of these infections are preventable and can be measured using standard and well-validated surveillance systems and definitions. Public health officials, government officials, and consumer advocates have recognized the impact of HAIs, as witnessed by the increased emphasis on legislation for the public reporting of HAIs. Furthermore, many HAIs are increasingly difficult to treat because of their consistent association with multidrug-resistant organisms (MDROs). The Centers for Disease and Prevention and the Healthcare Infection Control Practices Advisory Committee have provided guidance on infection control and prevention. Among national leaders in this arena, SHEA has been an advocate for active surveillance and prevention programs. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, published by SHEA, represents a compilation of evidence-based practices and expert consensus opinion on strategies to address the prevention of HAIs and the transmission of MDROs. Despite this exhaustive review of the current evidence, it has been increasingly clear that there are significant gaps in knowledge that require a broad and multifaceted research agenda to bridge. One timely example is the current debate on respiratory protection for healthcare workers against novel H1N1 influenza A virus in the workplace. The Institute of Medicine Committee, which is charged with studying this issue, reported on a recommendation for supporting the use of fittested N95 respirators and also increasing research on influenza transmission and personal respiratory protection. The article by the Research Committee of SHEA published in this issue of the journal outlines a comprehensive national research agenda on HAIs, addressing 3 major areas of research: pathogenesis, epidemiology, and infection prevention strategies. A fourth area of proposed research is in improving the design of healthcare epidemiology studies. Pathogenesis and host defense mechanisms have been the subject of much funding, provided by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH). Funding for the other areas of the proposed research agenda has been extremely limited, with clinical investigators in healthcare epidemiology and prevention implementation research receiving relatively less funding than colleagues in basic science disciplines. From a policy perspective, enhancing the funding for HAI research is at the core of the SHEA research agenda. The recent emphasis by the NIH on translational research is promising, because it recognizes the need to effectively implement, diffuse, and disseminate medical discoveries into clinical practice. The later phases of translational research (ie, phase 3 translation research and phase 4 translation research) focus on moving evidence-based practices into health