Graphical depiction of isolates that belong to an outbreak (connected dots) versus those that are unrelated (unconnected dots), by species. Credit: doi: 10.1101/2024.09.19.24313985. medRxiv [Preprint]
Researchers in Pittsburg have developed and tested an infectious diseases platform that can prevent the spread of hospital-based infections—and thereby deaths—while saving hundreds of thousands of dollars.
They tested the detection system over a two-year period at UPMC Presbyterian Hospital, where it was proven to stop outbreaks, save lives and cut costs.
“We saved lives while saving money. This isn’t theoretical—this happened in a real hospital with real patients,” said lead author Alexander Sundermann, Dr.P.H., assistant professor of infectious diseases in Pitt’s School of Medicine.
The Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT) is based on genomic surveillance using whole genome sequencing—or prospective WGS surveillance— an emerging and increasingly affordable technology that overcomes current limitations.
Traditional hospital detection methods rely on surveillance and monitoring for an observed increased incidence of infections from a baseline level. Whole genome sequencing is the current standard for genetic relatedness testing. However, this approach lacks timeliness, often misidentifies outbreaks that are not confirmed, and could even miss outbreaks altogether.
Meanwhile, prospective WGS surveillance enables the sequencing of pathogens regardless of the presence of an outbreak. The technique can identify outbreaks as early as two patients, which allows for rapid interventions and halts further transmission.
For example, when EDS-HAT detects that any two or more patients have near-identical strains of an infection, the system flags the results for the hospital’s infection prevention team to find the commonality and stop the transmission.
Without this genomic sequencing, hospital infection preventionists have no way of knowing if two hospitalized patients have the same infection coincidentally or if one of them was infected by the other. Because of this, patients with the same type of infection who don’t have an obvious link—such as staying in the same inpatient unit—may unknowingly spread the infection, leading to an outbreak significantly growing before it can be detected.
University of Pittsburgh scientists working with UPMC infection preventionists tested EDS-HAT from November 2021 through October 2023 at UPMC Presbyterian Hospital. The study results, published in Clinical Infectious Diseases, show during that time EDS-HAT prevented 62 infections and five deaths, compared with if the system had not been running. It netted a savings of nearly $700,000 in infection treatment costs—a 3.2-fold return on investment.
Based on the study results, the research team is now making the case for EDS-HAT adoption in hospitals nationwide, as well as the development of a national early outbreak detection database.
“[EDS-HAT] could easily be scaled,” said Sundermann. “The more hospitals implement this practice, the more everyone benefits, not just by stopping previously undetected outbreaks within the walls of the hospital, but by finding medical device or medication-linked outbreaks sweeping the nation.”
If health care facilities across the U.S. adopt EDS-HAT, a nationwide outbreak system could be developed—similar to PulseNet, the U.S. Centers for Disease Control and Prevention’s network for detecting multistate outbreaks of foodborne illness. Sundermann and colleagues previously found that, had such a system existed, the 2023 outbreak of deadly bacteria linked to contaminated eye drops could have been stopped far earlier.
“It is a no-brainer to implement EDS-HAT at every health care facility nationwide,” said senior author Lee Harrison, M.D., professor of infectious diseases at Pitt’s School of Medicine. “We hope these findings will contribute to ongoing conversations among U.S. health care leadership, payors and policymakers about the benefits of genomic surveillance as standard practice in health care.”
Although genomic sequencing is becoming more and more affordable, prospective WGS surveillance has not been widely adopted in healthcare settings previously due to needed investments in WGS infrastructure and lack of incentives.