Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review
Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the Retraction Watch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing “closed infusion systems” for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers’ dependency on industry ties. Further research is needed on COIs and their management.
KeywordsConflicts of interest Integrity Industry sponsorship Public-private partnerships Infection prevention and control Antimicrobial resistance Retraction
We sincerely thank Dr. Deborah J. Nelson, J.D., Associate Professor of Investigative Journalism, Philip Merrill College of Journalism, University of Maryland (who co-authored the Reuters Investigates article) for assistance in preparation of this manuscript and critical reading of the manuscript prior to submission.
Daniela Pires is supported by the Swiss National Science Foundation (32003B_163262) for hand hygiene research activities and by Fundação para a Ciência e Tecnologia (SFRH/SINT/95317/2013). No additional funding was obtained. Hand hygiene research activities at the Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, are supported by the Swiss National Science Foundation (32003B_163262).
Compliance with ethical standards
Conflicts of interest
Mohamed Abbas and Stephan Harbarth have worked on an investigator-initiated research project mandated by SwissNoso that was funded by Pfizer USA. SH has received funding by the European Commission and the Swiss National Science Foundation for several clinical studies and has consulted for Sandoz, Bayer, and DNA Electronics. Didier Pittet has received funding from the European Commission and Swiss National Science Foundation for several research and clinical studies. Didier Pittet also works with the World Health Organization (WHO) in the context of the WHO initiative Private Organizations for Patient Safety (POPS) Hand Hygiene. The aim of this WHO initiative is to harness industry strengths to align and improve implementation of WHO recommendations for hand hygiene in healthcare in different parts of the world, including in least developed countries. In this instance companies/industry with a focus on hand hygiene and infection control related advancement have the specific aim of improving access to affordable hand hygiene products as well as through education and research. Walter Zingg has received funding by the European Commission, the European Centre for Disease Prevention and Control, and the Swiss Federal Office of Public Health for research and has consulted for Baxter, Schülke & Mayr, and Carefusion. All other authors have no conflicts of interest to declare.
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