Question

evidence based practices aimed at reducing infectious diseases

Answer 1

Evidence based medicine requires the integration of research and clinical expertise in addition to patients values. Regarding infection control practice, clinically relevant research evidence is addressed to benefit not only patients but also communities by limiting the spread of infections, improving health care practices and preserving the health of communities.

Infection control policies are based on scientific research. In order to produce sound research, investigation should be patient centered and aimed to evaluate the accuracy of diagnostic tests, the effectiveness and safety of therapies and of preventive practices. Valid, relevant and impact are the basic components of scientific sound research.

These consequences of ignoring concepts related to infection control and the use of evidence based medicine are the production of flawed research. Flawed research is characterized as lack of clear formulated question in terms of population, intervention, comparison group. Errors in study design and conduct analysis leading to bias assessment of the truth and sample size not properly assessed in advance leading to a testing error.

Preventive or therapeutic measures in infection control should be based on randomized controlled trials. Randomized controlled trials are expensive and not always feasible. Some infection control recommendations are based on ecologic studies comparing exposed and unexposed populations before and after studies. The appropriate study design is a case control study. Cohort studies are the study design addressing questions on prognosis assessment.

Current controversies regarding infection control and the use of evidence based medicine are related and put in practice preventive or therapeutic measures which are not proven yet. That may occur in ongoing epidemics caused by unknown microorganisms requiring a fast action measures. Hypothetical disasters like bioterrorism require plans based on grounds with no prior information to access in the literature. Economical or personnel constraints can limit the applicability of well known infection control practices.

Evidence should guide all the approaches to infection control, but we need to admit that in many areas we have no evidence. Infection prevention and control programs have shown, both clinically effective and cost effective, providing cost savings in terms of fewer health care associated infections, reduced length of hospital stay, less antibiotic resistance and decreased costs of treatment for infections. The responsibility for the infection prevention and control program in the health care lies primarily with the senior administration of the organization. Implementation of the program rests not only with the team, but also with nursing managers, Environmental Services, Occupational Health and Safety, directors of medical services, central reprocessing and other departments and individuals in the facility impacted by the effective delivery of the program.