And Tonto ain’t feeling so great either

Larson E, Olmsted RN. Research Priorities Project, year 2000: The Lone Ranger rides again. Am J Infect Control 2001; 29:69-72.

"The Lone Ranger is dead," the authors of this editorial wakeup call warn. That means the days of the autonomous infection control practitioner (ICP) — to extend their conceit a bit — have gone the way of the Old West.

"Stop hunkering down and riding the range alone," they urge. "Actively expand your role and practice beyond infection control, beyond a single health care setting, and beyond your discipline; assess and improve the effectiveness and efficacy of your own practice. Move toward evidence-based practice."

This does not necessarily mean working harder but working smarter, they note, advising ICPs to focus on high-priority issues on which they can have an impact. By way of example, they extrapolate the well-known concept of "surveillance by objectives" to the idea of "practice by objectives."

"Institutions and employers are unlikely to continue paying top dollar for a single result (i.e., infection control), particularly when they are not even provided with the evidence of how well the practice works!" they exclaim. ". . . There is scientifically important information to be examined in the cool, bright light of research. [It] has not been done, is not being done adequately now, and it has to be done. What is it going to take for us to hear this wakeup call? Progress is limited by the isolated capabilities of each person; let us get together and get moving."

The authors observe that the application of scientific epidemiologic methods is the common thread that runs through all the recent emphasis on outcomes research, evidence-based practice, medical errors, patient safety, and quality improvement. "If any specialty group is positioned with the skill set of clinical and epidemiologic expertise needed to tackle the expanded fields of evidence-based practice and outcomes assessment, it should be ICPs," they state.

Sound the alarm and round up some help

While the editorial sounds the alarm, an accompanying article rounds up the posse of research items that must be addressed if infection control is to grow as a profession. (Lynch P, Jackson M, Saint S. Research Priorities Project, year 2000: Establishing a direction for infection control and hospital epidemiology. Am J Infect Control 2001; 29:73-78.) As identified by the research foundation of the Association for Professionals in Infection Control and epidemiology, the priorities include:

• research to improve compliance with excellent practices;

• study antibiotic usage and resistance;

• measure the financial impact of complications and value of interventions;

• perform surveillance of infectious and noninfectious complications across the spectrum of care delivery;

• study the effectiveness of interventions to prevent complications at specific sites.

"The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach," the authors of the article conclude.

Lone Rangers need not apply.