A guest post by Dr Alexander Sundermann (bio below) in preparation for tomorrow’s Journal Club on genomic surveillance (register here for that)…

When was the last time you investigated a potential outbreak in your facility? How was it identified—or was it even confirmed as a true outbreak? For years, outbreak detection methods have remained relatively unchanged, relying heavily on observing infection patterns or confirming outbreaks reactively using whole genome sequencing (WGS). But what if we shifted this approach to perform WGS proactively on all infections? This idea is the foundation of our new pre-print study, which evaluates whether WGS surveillance can enable earlier outbreak detection and halt transmission before it spreads.

Key Findings from Our Study

We previously conducted a retrospective analysis where we applied WGS surveillance over two years without informing infection prevention (IP) teams in real-time. The results were striking: 99 outbreaks involving 297 patients went completely undetected, while the IP teams suspected several outbreaks that were later disproven. Modelling suggested our hospital could have saved nearly $700,000 in treatment costs had we used real-time WGS surveillance.

Building on that work, our new prospective study involved weekly WGS surveillance of multiple bacterial pathogens over two years. We collaborated with IP teams to implement interventions and assess their effectiveness. Key results include:

• 172 outbreaks with 476 patients detected
• 61.3% (292/476) had identified transmission routes and interventions
• 95.6% of outbreaks showed no further transmission after intervention
• $695,706 in net cost savings from averted infections

What Did We Really Prevent?

A central focus of our analysis was identifying downstream infections from the same transmission route we intervened upon. This approach avoids misleading conclusions based solely on outbreak counts. For example, what if an outbreak occurred on Unit A? IP would intervene on Unit A. But often we saw a patient move to Unit B and spread it there. Is that a failure of interventions? No, because no intervention has been performed on Unit B!

To evaluate effectiveness, we compared outbreak sizes with interventions to those observed in our retrospective data without interventions. This comparison provided a framework to assess how much transmission could be prevented.

The Future of Genomic Surveillance in Infection Prevention

Our findings, along with growing evidence from other studies, support the potential of genomic surveillance to become standard practice for IP programs. However, adoption has been slow. Barriers include costs, infrastructure, and demonstrating a clear return on investment. While we showed cost savings in our study, it is often payors—not hospitals—that benefit financially, complicating funding decisions.

My colleagues and I recently summarized and tried to address these barriers in a commentary. In short, these barriers will require:

• Demonstrating patient safety benefits to encourage hospital investment.
• Advocating for policy changes to incentivize adoption through payor reimbursements.
• Leveraging existing evidence to standardize methodologies and best practices.

Join the Discussion This Wednesday 1/8

I’m very excited to discuss these findings further during this Wednesday’s Journal Club with IPC Partners (register here)! I welcome your questions, insights, and ideas for how to advance genomic surveillance as a tool for proactive infection prevention!

Bio

Dr Alexander Sundermann is an Assistant Professor at the University of Pittsburgh, School of Public Health, Department of Epidemiology. His research focuses on the application of pathogen whole genome sequencing surveillance for the detection and investigation of healthcare outbreaks. Additionally, he researches the use of machine learning algorithms on electronic health records to aid in these investigations. Dr Sundermann and the Center for Genomic Epidemiology have initiated a real-time whole genome sequencing surveillance program that sequences multiple patient infections each week to monitor for outbreaks and guide interventions to prevent spread. Dr Sundermann is board certified in infection control and a fellow of the Association for Professionals in Infection Control.