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David K. Henderson, MD, of the Office of the Director of the Clinical Center at the National Institutes of Health, and Tara N. Palmore, MD, of the Laboratory of Clinical Infectious Diseases at the National Institute of Allergy and Infectious Diseases, say that healthcare epidemiology must address significant gaps in understanding of the epidemiology and pathogenesis of healthcare associated infections (HAIs), as well as the efficacy in implementing interventions to prevent these HAIs.
As Henderson and Palmore (2010) note, From our perspective, SHEA needs to focus on the substantial gaps in our current science base in the areas of pathogenesis, epidemiology, interventions, and study design One of the major problems facing the discipline is the complexity of these inquiries. Most of the questions have a multiplicity of variables, many of which are easily confounded. Healthcare epidemiology needs to find a way to conduct large, prospective, carefully controlled, multicenter trials to answer these questions. Too much of our literature is composed of studies that have a quasiexperimental design. Too little is known about the differences between endemic and epidemic infections in healthcare settings. To address these complex questions, the discipline needs a series of clusterrandomized trials involving diverse institutions with diverse patient populations. Historically, these studies might have been impossible to conduct; however, in the next decade, technological advances, such as electronic medical records, electronic personal health records, computerized data collection, datamining software, and rapid diagnostics and microbial fingerprinting may make such studies approachable.
This article and others from the Fifth Decennial on Healthcare-Associated Infections meeting held in March are available from SHEA/Infection Control and Hospital Epidemiology.
Reference: Henderson DK and Palmore TN. Critical Gaps in Knowledge of the Epidemiology and Pathophysiology of HealthcareAssociated Infections. Supplement article to Infect Control Hosp Epidem. November 2010.