The recently ended Boar’s Head listeria outbreak, which has caused 57 infections and nine deaths, is just one of the many foodborne illness incidents that the Centers for Disease Control and Prevention detects each year using its PulseNet system. Many people might not realize the extensive effort behind PulseNet, which systematically collects data on foodborne illnesses from patients across the U.S., performs genomic fingerprinting, and traces outbreaks back to their sources. This network of surveillance has been alerting the public to foodborne outbreaks and recalls for years.
PulseNet detects outbreaks — it doesn’t prevent them. Yet, the public can take some comfort in knowing that PulseNet is in place to catch these failures when they occur and contain foodborne illness outbreaks before they spiral out of control. Recently, it may feel like the number of foodborne outbreaks has been increasing, but this is partly because PulseNet has adopted more advanced tools, enabling better detection of these outbreaks.
But what about outbreaks in our health care system? In 2023, the country faced a deadly outbreak of an extremely drug-resistant bacteria linked to contaminated eye drops sold nationwide. There have been at least 81 cases and four deaths as a result. The outbreak was uncovered after investigators in different states recognized a new and dangerous pattern of drug resistance never before seen in the United States. Genomic sequencing helped trace the cause to a common product: eye drops. The factory in India where the eye drops were manufactured revealed unsanitary conditions, echoing the inspection failures found at the Boar’s Head facility in Virginia.
Yet these two outbreaks were detected very differently. While foodborne outbreaks are routinely identified through mandatory genomic surveillance, health care-related bacterial infections do not face the same reporting and oversight requirements. Before the eye drops, this discrepancy appeared in past incidents involving contaminated bone grafts and cardiac surgery devices.
Hospital outbreaks often go undetected not because of negligence but because they’re incredibly difficult to identify amid the constant stream of infections. Consider the multiple outbreaks tied to contaminated endoscopes. Patients across the country were developing sepsis — and sometimes dying — because the devices used in these procedures couldn’t be properly cleaned. The manufacturer was aware of these issues but failed to sound the alarm. The U.S. Senate even conducted an investigation to understand how such a failure could occur and how to prevent future outbreaks. A genomic surveillance system — akin to PulseNet but tailored for hospitals — could stop these catastrophic events before they take hold.
Some of the groundwork has already been laid for such a system. Public health in the United States has made strides in building a robust genomic surveillance infrastructure, particularly during the Covid-19 pandemic through initiatives like the CDC’s Pathogen Genomics Centers of Excellence. Additionally, the Antimicrobial Resistant Laboratory Network includes multiple laboratories nationwide that use sequencing to track AR infections.
While these initiatives have advanced our genomic capabilities, they are not designed for routine genomic surveillance of all health care-associated infections and may not have the current capacity to handle such an extensive workload and investigation. However, their established expertise and infrastructure could be leveraged as a foundational network for broader health care surveillance.
A potential model for implementation involves individual health care facilities or health care systems conducting their own genomic surveillance, using either internal or external resources, to perform outbreak investigations. These facilities would then share their genomic data with public health agencies and CDC partners. This collaborative approach would facilitate the detection and management of cross-facility outbreaks, such as the one involving contaminated eye drops.
While building such a system requires investment, the benefits to patient safety and the potential for cost savings are significant. Hospitals could avoid the high costs associated with managing outbreaks by preventing them through early detection and incentivized by medical payors, similar to as we do with health care-associated infection reporting. While there are many barriers to establishing such a system, my colleagues and I have outlined these challenges and proposed solutions in a recent commentary, emphasizing the transformative potential of genomic surveillance to enhance patient safety and reduce infections.
To be clear, developing such a system would not be easy. Detecting outbreaks in hospitals, where infections are more diverse and complex than in the food system, would require significant investment in both infrastructure and informatics.
Unlike foodborne pathogens, which can be tracked through the food supply chain, infections in hospitals arise from a wide variety of pathogens that can spread through medical devices, procedures, and even the hospital environment itself. Implementing a surveillance system would require standardized data reporting from thousands of health care facilities across the country, significant investment in genomic sequencing capabilities, and cooperation across public health agencies and hospitals. Regulatory mandates and cultural shifts toward proactive transparency would be necessary to make such a system work.
However, research from my colleagues and me, along with emerging data from other studies, shows that such a system could greatly benefit individual hospitals and public health overall. In fact, hospitals could potentially save money through genomic surveillance by preventing and containing costly outbreaks. For example, our hospital’s own genomic surveillance program successfully linked cases to the national eye drop outbreak, demonstrating the real-world potential of such systems in reducing the impact of health care-associated infections.
Building a PulseNet-like system for health care would not only enhance patient safety but also foster greater public trust in the health care system. In an age where transparency and accountability are paramount, hospitals and medical manufacturers would be held to a higher standard, where lapses in safety are swiftly caught and corrected. Implementing such a system would reflect a commitment to innovation, responsibility, and, most importantly, the well-being of every patient who enters a hospital.
Such a system is especially critical as we enter an era where antimicrobial resistance poses one of the greatest public health threats of our time. The World Health Organization has identified antimicrobial resistance as one of the top 10 global public health threats, and without effective systems in place to detect and control the spread of resistant infections, we risk losing one of the cornerstones of modern medicine. A PulseNet for health care could serve as an early warning system, allowing hospitals to detect patterns of resistance and respond before these infections become untreatable.
As we face ever-increasing risks from drug-resistant bacterial infections, a national health care outbreak surveillance system would provide a long-overdue safeguard for our health. The question is no longer whether we can build such a system, but whether we are willing to prioritize public health and take the necessary steps to protect patients.
Alexander Sundermann is an assistant professor of epidemiology at the University of Pittsburgh, School of Public Health. He studies how to detect and mitigate health care outbreaks using genomic surveillance and infection prevention innovations.