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Healthcare-associated Infections (HAI)

Washington University

Washington University School of Medicine in St. Louis (WU), Barnes-Jewish Hospital

First Funded: 1997

Overview: The Washington University School of Medicine in St. Louis (WU), Barnes-Jewish Hospital (BJH), and BJC Healthcare, a 13-hospital integrated healthcare delivery system in the Midwest, partnered together to form the WU/ BJC Epicenter for Prevention of Healthcare-associated Infections (HAI). The WU/BJC Epicenter has been funded since the inception of the CDC Epicenter Program in 1997.

The overarching goal of this multicenter research team is to develop improved systems to detect and prevent HAIs and antimicrobial resistance. The Epicenter team developed standardized reporting procedures to more efficiently and effectively collect and report risk-stratified HAI surveillance data using active surveillance, electronic medical record data, and administrative data. This data led to improved interventions to prevent HAIs in the most vulnerable patients, including the elderly; immuno-suppressed; intensive care unit (ICU) patients; patients with invasive devices, such as central venous catheters and mechanical ventilation; and surgical patients. The Epicenter developed and implemented multidisciplinary interventions, which have dramatically reduced the rates of catheter-related bloodstream infections and ventilator-associated pneumonia in ICU patients over the past 10 years. The Epicenter currently uses large administrative databases (i.e., Medicare, Medicaid, National Inpatient Sample) to study risk factors, outcome, and prevention of HAIs in diverse settings and performs translational research to understand the epidemiology and transmission dynamics of antibiotic-resistant infections, the role of the fecal microbiome in the development and spread of antibiotic-resistant bacteria, unique biomarkers and metabolic profiles to diagnose urinary tract infections, new strategies to improve antimicrobial stewardship, and bundled interventions to prevent surgical site infections.

Research Study Areas:

  • The role of the fecal microbiome in the development and transmission of antibiotic resistant bacteria and the impact of fecal microbiome transplants on antibiotic resistance and recurrent infections
  • Detection of novel biomarkers and use of metabolic profiles to predict and diagnose urinary tract infections
  • Determining whether fecal transplants are effective in preventing recurring urinary tract infection caused by multi drug-resistant bacteria
  • Assessing antibiotic prescribing practices among dentists in the U.S. and developing interventions to improve antibiotic utilization and reduce resistance
  • Evaluating the effectiveness of chlorhexidine body washes to reduce MRSA acquisition in ICUs
  • Assessing the efficacy of a multidisciplinary antimicrobial stewardship program
  • Evaluating adherence to surgical antibiotic prophylaxis recommendations using real-time electronically collected data
  • Using Medicare claims data to identify hospitals with high SSI rates following cardiac surgery, orthopedic surgery, breast cancer surgery and hernioraphy
  • Studying the benefits of active surveillance to prevent and control MRSA, the role of colonization pressure in MRSA and Clostridium difficile acquisition, risk factors and outcomes of SSI after breast cancer surgery, spine surgery, cardiac surgery, and total joint replacement surgery, and risk factors for falls and fall-related injuries
  • Studying attributable costs of HAIs and noninfectious adverse events using economic models
  • The epidemiology and transmission dynamics of C. difficle
  • Developing risk prediction models and risk stratification models for surgical site infections in diverse surgical patient populations
  • Evaluating the role of aerosols and environmental contamination in transmission of antibiotic resistance and healthcare-associated infections

Principal Investigator: Victoria Fraser, MD

Co- Investigators: Hilary Babcock MD MPH, Carey Ann Burnham PhD, Gautam Dantas, PhD, Erik Dubberke MD MPH, Michael Durkin MD, Jeff Henderson MD PhD, Kevin Hsueh MD, Jenny Kwon DO, Margaret Olsen PhD, MPH, David Warren MD MPH.

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