Patients as stakeholders: Developing a patient-centered healthcare epidemiology research agenda

To the Editor—Due to its many benefits, stakeholder engagement in health research has been increasingly prioritized in recent years.1–9 Engagement throughout the research cycle, from idea development through dissemination of results, helps to ensure that research questions and outcomes are meaningful and relevant to stakeholders,3,4 and it may also improve research quality and appropriateness.4–6,9 Given the threat of healthcare-associated infections (HAIs) to patient safety,10 stakeholder engagement is critical in healthcare epidemiology. Research agenda discussions centered on a subset of strategies identified by the Society for Healthcare Epidemiology of America (SHEA)10: (1) evaluation of environment and equipment sources for infection; (2) compliance with and impact of contact precautions; (3) patient presurgical preparation; and (4) antibiotic stewardship, particularly the role of pharmacists. Table 1 Patient-Perceived Implementation Barriers to HAI Prevention Strategies Prevention Strategies Individual-Level Barriers Provider- and Institutional-Level Barriers Environment, equipment as infection source; compliance with and/or impact of gowning and/or gloving (contact precautions) protocols ∙ Fear that care will be negatively impacted by addressing variation in compliance with contact precautions ∙ Difficulty maintaining hand hygiene while hospitalized ∙ Patient gowns not changed while hospitalized ∙ Stigma of isolation and contact precautions ∙ Inconsistent messaging between providers ∙ Inconsistent protocol compliance ∙ Lack of ownership in implementing practices ∙ Not involving patients and/or caregivers in conversations ∙ Inconsistent and/or unclear policies and procedures ∙ Unclear division of responsibilities ∙ Lack of training and resources for environmental services ∙ Lack of leadership support ∙ Lack of wearer-friendly gowns, gloves, and/or masks ∙ Challenges in reprocessing and/or cleaning surgical equipment Presurgical preparation (CHG bathing, Staphylococcus aureus testing, lifestyle changes) ∙ Lack of education about preparation for surgery and the risks of not preparing ∙ Variation in procedural information ∙ Variation in products and use∙ Not preparing for surgery ∙ Inconsistent messaging between providers ∙ Inconsistent provider involvement ∙ Lack of access and/or encouragement to learn best practices ∙ Variation in evidence for and priority of practices ∙ Variation in practices and policies ∙ No standardized CHG dilution methods ∙ Lac