Meet Infection Control Today's Editorial Board Member: Alexander Sundermann, DrPH, CIC, FAPIC.

Introducing the Infection Control Today's (ICT's) Editorial Board members—a diverse group of professionals dedicated to advancing infection prevention and control practices. This series highlights each member's unique expertise and contributions to the field.

From groundbreaking research to innovative strategies, these experts are at the forefront of enhancing health care safety. Join us as we learn their insights, experiences, and visions for the future, providing valuable knowledge and inspiration to elevate infection control protocols.

In this installment, 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.

Meet Alexander Sundermann, DrPH, CIC, FAPIC.

My name is Alex Sundermann. Currently, I'm an assistant professor of epidemiology here at the University of Pittsburgh School of Public Health, and my journey in infection control started many years ago at this school. My background is [that] I received my bachelor's degree in microbiology in 2013 from the University of Rochester. At that time, we were taking some classes on emerging pathogens and how infections spread, and, you know, the new pathogens that are arising, and that interested me, and I wasn't quite sure where I wanted to go in my career next. Of course, you do more education until you find out what you want to do. So, I came back here to my home in Pittsburgh, [Pennsylvania], and I started a master’s in public health and infectious diseases and microbiology.

At that time, I connected with some people across the street at UPMC who worked in infection control. The idea of infection control in a hospital was new to me. I didn't realize that people existed in the hospital whose sole purpose was to track infections. As they spread in the hospital, I looked at trends and tried to make interventions, which, in the end, was exactly what I wanted to do.

So, I [participated in a] volunteer program with them through my MPH [master of public health] degree. As soon as I graduated, they offered me a full-time position, and at the time, I was the only MPH person in the entire department full of nurses. So it was an interesting experience for me, where I got to learn, as we IPs say, trial by fire, of learning quickly and fast about how the hospital works, the ins and outs for someone who's never really been inside of a hospital, but it was a great multidisciplinary team, where we had people from the lab, we had nurses, and then I brought my new public health background.

I vividly remember one of the [times] looking into outbreaks. The idea of an outbreak was interesting to me. Outbreaks are unfortunate events, but to me, they also present a learning opportunity, as we like to say, because typically, we are taught what goes well, what's right, and what is the correct thing to do. But when there was an outbreak, something clearly went wrong. There was a big lapse in something, and that provided an interesting learning opportunity.

So, when I started, we had this large mucormycosis outbreak. These infections eventually affected our team and infection control, and I got to be heavily involved in tracing back to contaminated linens. The idea of investigating these outbreaks, trying to pinpoint a source, and doing all this environmental investigation just fascinated me and got me into more in-depth infection control.

After that, the outbreak was resolved again, which we traced back to what we thought were clean linens. It made me want to continue my education and focus on outbreak investigation. So, while working as a full-time infection preventionist (IP), I returned to school here at the University of Pittsburgh part-time to get my doctorate in public health and epidemiology. I worked with a fabulous mentor, who I still work with today at the University of Pittsburgh, Dr. Lee Harrison [MD], where I worked on his grant to look at genomic surveillance and try to detect and investigate outbreaks. This approach is a bit different than what's currently done in hospitals, where typically, we think we have an outbreak, we investigate, we make interventions, and if we have the availability of genomics to confirm that outbreak, we can do it. But some hospitals don't. And oftentimes, we saw that there wasn't an outbreak.

Still, the approach that we started to investigate was to proactively do genomics on every infection to detect these outbreaks early, stop them from growing, and see the true breadth of outbreaks in hospitals. So, through many years of working as an IP and eventually working at Pitt (University of Pittsburgh), we could look at the extensiveness of outbreaks at our one hospital. And then, in a pivot, we started doing real-time Genomics at our hospital every week. Then my role as now an assistant professor here at the University of Pittsburgh is to take the data we generate through our research lab and translate it directly, each week, to our infection control team at our hospital to make these interventions to stop these outbreaks. So that's how I got to where I am today.

So, I still see myself originally as an IP, even though I work in academia right now. I just love this role because I can direct or directly translate research into applied practice every week and also look at how useful what we're doing in research. [Different] perspective, but in the hospital as well, and our hope together is to try to make this a standard practice in the future for all hospitals. And that's what I'm looking forward to doing as we move forward in the next few years.

So, what do we see trending in infection prevention and control? That was a huge spoiler alert of what I just talked about.

We and some or a few others are not many people who do genomic surveillance routinely. There have been many studies that you know they'll sequence everything from isolates that they saved to infections that they've saved in the past. Those studies produce similar results, where if you sequence everything, you'll find tons of outbreaks that went undetected, and we, and maybe a couple of others, are the only few that prospectively make this approach. And what we have found, and what everyone else has found too, is that prospectively, when you do this, you can find outbreaks early and make these interventions. So, what I think will be happening in the next five years is that as these publications come through, hospitals will recognize that our current infection prevention methods miss many, many, many, many outbreaks going undetected. We are misdirected at what we think are outbreaks but aren't really outbreaks. So our hope is that we can show that not only can we find these outbreaks that go undetected, that we can stop them, we can prevent infections, but also that we can save money, which is what we have shown, which is what other people have shown, even by sequencing a bunch of infections, if you prevent just a handful of them, they are very expensive to treat. So, we can show that you save money in the long run by investing in this approach. And part of you know what. When we do that, we uncover interesting outbreaks, like again, there. You never want outbreaks to happen, but they always provide an opportunity to learn so ourselves here at UPMC; when we do this genomics approach, it points us in the direction of outbreaks. And we found outbreaks associated with like non sterile contrast preparation, associated with endoscopes, associated with wound care and other aspects of the hospital that if we were not doing genomic surveillance, we would have never caught so I think as more hospitals start to do genomic surveillance, it's going to start to reveal more interesting outbreaks that we never thought to look at before, and those are going to be very exciting and trending, I think, to see what are those outbreaks and what were these lapses that used to be standard practice, but because of genomic surveillance, we're now able to catch so I'm super excited to see what happens there and then for infection control today and the next couple of years, I really hope to talk about some of these interesting outbreaks as an outbreak researcher myself, for the hospital setting, anytime there's a new publication or something in the news about a new outbreak, it, I will read it in full, because, again, they are learning opportunities. We want to prevent tragic events, but if we can publish them and write about them, we can share with other hospitals what went wrong in that hospital, so those other hospitals don't make the same mistake. So, I'm hoping that in the next couple of years, I can start writing about some of these outbreaks that we see in the news and publications so that people at your hospital, hopefully, can read it, you know, do your investigation and make your prevention efforts so that it doesn't happen in your facility.

(This has been edited for clarity.)