Incorporating Horizontal Plasmid Transfer Findings in Bacterial Infection Prevention and Control

Alexander Sundermann, DrPH, CIC, FAPIC, an assistant professor at the University of Pittsburgh's Division of Infectious Diseases, Center for Genomic Epidemiology, is dedicated to advancing the field of outbreak detection and investigation in health care settings through his research and utilization of whole genome sequencing surveillance. He spoke with Infection Control Today^® (ICT^®) on his recognized work presented at the Association for Professionals in Infection Control and Epidemiology (APIC) 2023 Annual Conference and Exhibition, held in Orlando, Florida, June 26 to 28, 2023.

ICT: Please let us know a little bit about what you're presenting at APIC this year.

Alexander Sundermann, DrPH, CIC, FAPIC:Yeah, so I have 2 talks that I'm giving this year. The first one is titled “empirical methods and genomic epidemiology to improve surveillance of plasmids exchange among health care-associated bacteria.” It's a very long title for a simple topic. Essentially, what this talk investigates is plasmid transmission within hospitals. So normally as infection preventionists, traditionally, we look at bacteria transmission, where, you know, we spread a VRE from one patient to another. But using some genomic techniques, new methods that we're looking into as many of these bacteria have resistance genes and resistance factors that exist in the bacteria as plasmids, and those plasmids can be transferred to different bacteria and different bacterial species. Using genomics, we're able to see how these plasmids carrying resistance are moving around in hospitals, from patient to patient. So that first talk is summarizing a lot of those findings of how frequently does occur and what we can do with them.

Secondly, I'm copresenting with [Janet Glowicz, PhD, RN, MPH, CIC, infection preventionist, CDC, Denton, Texas] on a topic called “Keeping health care linens clean.” Health care linens are known to cause health care outbreaks in the past of molds and bacteria. Jenna, glow X is going through the important factors to look through to keep linens clean across the spectrum of their entire lifespan within the hospital. And then what I'm providing in that talk is published research that we did in the past on an outbreak that we had at our hospital from contaminated linens, and then also the state of contamination of linens across the United States through another study that we did as well. I'm excited to be talking to both of those [presentations].

ICT: Can you tell me a little bit more about the practical applications of those studies and how they can be beneficial for IPs?

AS: Whenever we think of plasmids, too, there's [many] opportunities for intervening on transmission events. In this current state, we're doing a lot of this work retrospectively, meaning that we've had all these infections that we built up, and we look to see what happened in the past. But going forward, what we're trying to build up is a real-time surveillance program that can look at how plasmids are being transmitted within the hospital. And we're doing that with bacteria at our hospital right now.

From an application perspective, IPs are going to be the ones in the end, to take this type of information of how plasmids and bacteria are being transmitted in the hospital and be the ones doing the interventions to stop that transmission. So doing enhanced cleaning, or audits on a certain unit where we see an increased transmission or investigating devices that we think may be contaminated and causing these transmissions that happened to have plasmids in them as well. So that'll be a big take-home message about the future application.

We can do it within the linen side. There are many take-home messages right away from this talk. Dr. Janet Glowicz provides a lot of recommendations for what IPS can do, how to partner with the health care linen industry, to make sure that the linens are safer than the end in the patients. Giving my experience investigating this large outbreak we had and looking at the experience of others, [the presentation] will give IPs an understanding of where they need to look in the health care laundry facilities and what they should be looking for. And then a better understanding about the level of the degree of burden that this can carry across hospitals and how severe it can be.

ICT: Were there any results that surprised you?

AS: Whenever we look at keeping health care linens clean, we did a study of multiple hospitals across the United States, large hospitals, transplant centers, etc. And we measured how clean their linens were using a method that we'll talk about in that [presentation]. And most of these hospitals have high levels of contamination of their clean linens that were being brought into the hospital, showing that [many] of these linens that we think are laundered clean can carry pathogens on them. But from the same perspective, when we looked at our facility when we addressed the problem of the contamination at our laundry facility, we were able to sustain essentially zero contamination of our linens. And that's because the industry is not regulated. The IPs [must] go above and beyond what the current regulations are—or lack of—to make sure that their linens are safe.

On the other side, with our plasma transmission talk, we have a few instances that we'll talk about where we have plasmid with resistance genes, where it went from one species to another species in patients [who] were near each other in the same room. These are cool, interesting incidents where we see transmission where we never think of seeing transmission before across different bacterial species. These are all opportunities for IPs to intervene on.

ICT: Do you have any future research related to these topics planned?

AS: What I alluded to before, at our hospital, every week, we do genomic surveillance of [many] of our bacterial pathogens, where we see transmission happening in real-time because, in all hospitals, we think transmission is underrecognized and undermeasured. What we're going to pivot to as well, because we do this for bacteria, is apply our methods and look for plasmid transmission within our hospital as well. We're building up this analysis plan that hopefully other hospitals can look at and use, and then go to their leadership and say, “Look, this is something that we should probably look into as well and adopt that same methodology because these are all opportunities to increase patient safety to make sure that we're stopping transmission.” The same thing with the health care linen side, I’m advocating for IPs to look out at their health care linens to enhance the safety of those linens as well because there is no regulation. The more we let IPs know about this, that there is a possible issue, the more that field can then further advance as a hot topic within our field. That'll be important looking into the future.

ICT: Do you have any other key messages that you would like attendees to take away from your APIC presentations?

AS: [In] my past, I was an IP at our hospital here as well. And then I deviated and went to the research route. I hope this work inspires IPs to do these types of projects because IPs are going to be the ones who know their hospital. They know how it works and how it moves around. And it's because of that experience that I have that I'm able to do this type of work, where I'm doing research, but applying it to the hospital in real-time. I hope IPs can see that as well and get inspired and bring that back to their hospital to do those types of projects too.

ICT: What are you most excited about APIC this year?

AS: I haven't gone in person since pre-COVID-19. I gave a talk virtually during the 2020 [annual APIC conference]. I'm very excited to see everybody I've ever met virtually online since then. It's been over 3 years. There are many people that I know very well [whom] I've never met in person. I'm excited to see all these IPs, network with them, meet with them.