Dr Jennie Wilson, Associate Professor, University of West London
The evidence based medicine movement emerged in the 1980s when the randomised controlled trial became acknowledged as the gold standard for comparing the efficacy of treatments and critical summaries of evidence from such trials were needed to inform clinical practice. Whilst the Cochrane collaboration was only founded 22 years ago, guidelines underpinned by the systematic review of evidence are now widely accepted and used to inform practice across many fields of healthcare. However, although evidence from multiple, high quality RCTs may be available to generate recommendations in some areas, many interventions used to prevent or control HCAI are not feasible to implement as RCTs and pragmatic designs based on multi-modal approaches form a large part of the available evidence base. Thus, guidance to inform prevention of HCAI tends to be based on evidence derived from much less robust study designs. Recommendations must therefore be drawn from imperfect data, balance the desire to ‘do something’ with the tendency to do too much, be transparent about the strength of evidence and avoid cognitive bias. Improving guidance depends on academics and practitioners designing, executing and publishing more robust studies to inform the infection prevention and control evidence base and providing clinicians with practical tools to implement evidence.