Expert Asks, Can HAI-Related Interventions Be 'Right-Sized?'

A one-size-fits-all approach may not work for infection prevention and control efforts, says Kathryn B. Kirkland, MD, from the Section of Infectious Disease and International Health at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. In a commentary in the August issue of Infection Control and Hospital Epidemiology, Kirkland acknowledges, "Determining which infection control interventions should be implemented in a given situation is a constant challenge for those who work in healthcare epidemiology. The literature overflows with papers detailing successful outcomes associated with numerous interventions applied in a range of settings to a variety of patient populations."

Kirkland says it should be "intuitively obvious" that not every intervention that seems to be successful should be implemented in every facility and that it could be disingenuous to assume that there is one "right size" that is a fit for all healthcare facilities. Kirkland advocates the importance of infection preventionists and healthcare epidemiologists being able to select from best practices as well as other interventions that could be considered to be "good practices, useful in some settings, unnecessary in others." She emphasizes that a better fit could be achieved if these professionals were able to customize their infection prevention and control programs, and that "which good practices to choose likely depends on local context."

Linking outcomes to intended interventions is a slippery slope, Kirkland suggests, noting, "Because infection prevention often involves a complex set of socio-behavioral interventions that are clearly dependent on the context in which they are implemented, studies that provide information about situations in which certain interventions do or do not work make up an important part of the evidence base." Kirkland suggests further that researchers "carefully measure the extent to which the intended interventions were actually impemented," and that they "provide enough detail about the context in which the interventions were implemented to allow others to judge the applicability in their own setting." Kirkland adds that it could be time to modify the existing categories used by guideline writers, such as those at the Centers for Disease Control and Prevention (CDC) to acknowledge "the importance of local context in determining which of the hundreds of infection prevention best practices should be implemented when."

Reference: Kirkland KB. From Best to Good: Can We "Right-Size" Approaches to Reducing Healthcare-Associated Infections? Infect Control Hosp Epidemiol 2010;31:784-785.