The Problem with Evidence: The Thorny Relationship of Infection Control and Evidence Based Practice

FJ Bowden1,2

1 Canberra Hospital, Garran, ACT, 2605.
2 Australian National University Medical School, Acton, ACT, 2601


The emergence of the discipline of evidence based medicine/practice (EBM/EBP) over the past two decades has aimed to establish a scientific basis for all aspects of health care. EBM ‘purists’ often find themselves at odds with real-world practitioners because of the inherent difficulties in conducting high quality research in a complex clinical workplace.

While the randomised controlled trial (RCT) is the gold standard for demonstrating the efficacy of an intervention, the reality is that few are performed in infection control because of the expense, prolonged lead time and sample size limitations. In the Cochrane database of systematic reviews in infectious diseases only 22/821 (2.6%) relate to infection control.

Many institutional policies are based on evidence derived from observational and retrospective studies and newcomers to the area are often perplexed by the inconsistencies in infection control recommendations.  On the other hand, some policies have been implemented on the basis of results from systematic reviews of RCTs that lack the power to demonstrate differences in rare but critical outcomes.

This paper will give a brief overview of the current evidence base in infection control and use examples to highlight its strengths and weaknesses.