My seminal research contribution is to utilize innovative clinical and molecular epidemiologic methods to define institutional, healthcare worker and patient-specific risk factors leading to infections and colonization with multi-drug resistant organisms in older adults and to design interventions that reduce these adverse events. I have conducted numerous patient-oriented primary data collection studies that have significantly advanced the field of infection prevention in post-acute and community settings. With the changing ecology of antibiotic-resistant organisms, I have advocated that the infection control approach should move from a single pathogen-based to a risk-factor based strategy.

To this end, I have carefully defined clinical and molecular epidemiology of multi-drug resistant organisms in high risk groups such as those with indwelling devices, functional disability and wounds. I have shown that these patients are not only colonized with multi-drug resistant organisms but carry them at multiple body sites, increasing the risk of transmission leading to an NIH funded multicomponent intervention that reduced resistant organisms and infections. Using advanced molecular techniques, we have also shown the transmission mechanisms of the spread of resistant organisms in near and distant environment within an institutional setting. Lessons learnt from this study has now been disseminated successfully to 500 facilities across the nation enhancing safety and quality of life of aging populations.

My ongoing research will define the role functional disability in transmission of resistant pathogens. Furthermore, with funding from the CDC, we will characterize the scope, practice and ethics of patient engagement in research and clinical practice. Additionally, we will test effective models of engagement between community partners and academic institutions in quality improvement and safety in the evolving landscape of healthcare delivery.