Genomic Surveillance: A New Lens for Understanding Healthcare Transmission

As infection preventionists, we rely on surveillance, observation, and data to detect and respond to healthcare-associated infections (HAIs). But despite best efforts, many outbreaks go undetected—either because they’re too subtle to notice in real time or because traditional tools don’t capture how infections are connected.

That’s where pathogen genomic surveillance is changing the landscape.

By sequencing the genomes of bacteria isolated from patients, we can determine how closely related those isolates are. This allows us to identify previously unrecognized transmission events, understand the scope of an outbreak, and tailor interventions more precisely. In short, genomics turns what was once hidden into actionable insight.

Over the last few years, real-time sequencing has been piloted and implemented at multiple healthcare facilities. These efforts have consistently revealed that transmission is more common than previously thought—and that genomics can detect outbreaks earlier and more accurately than standard methods alone.

Still, the adoption of genomic surveillance has been uneven. While many IPC teams are enthusiastic, others express hesitation—particularly around legal implications. A common concern is that detecting more outbreaks might increase liability. However, evidence and experience suggest that the real legal risk lies not in detection, but in failing to act on preventable harm.

Genomics doesn’t introduce new infections; it helps us see them. And when healthcare institutions identify and respond to transmission proactively, they strengthen—not weaken—their position.

For a deeper dive into the current state of genomic surveillance in infection prevention, including implementation challenges, legal considerations, and its future role in routine practice, see our recent perspective: https://journals.asm.org/doi/10.1128/aac.01479-24

Genomic surveillance offers a powerful new lens on hospital transmission. The more we understand it—and apply it—the better equipped we are to protect patients.