An introduction to practical healthcare epidemiology.

Abstract

The Society for Healthcare Epidemiology of America (SHEA) is completing preparation of A Practical Handbook for Hospital Epidemiology. The Handbook is intended to be a pragmatic guide that will assist both neophyte and experienced epidemiologists in establishing and operating a successful hospital (or other healthcare) epidemiology program. The Handbook will be published in book form later in 1995. In the meantime, we will inaugurate a new section of the journal entitled "Practical Healthcare Epidemiology," which will begin by presenting one chapter from the Handbook each month. This issue of Infection Control and Hospital Epidemiology features the first of more than 30 installments, Bryan Simmons' and Stephen Kritchevsky's chapter "Epidemiologic Approaches to Quality Assessment." Next month, in a chapter entitled 'The Hospital Epidemiologist: Practical Ideas," Richard Wenzel will present his overall philosophy of, and approach to, hospital epidemiology. I feel that this is an especially propitious time to launch this new venture because, as stated by Faith Popcorn, futurologist and advisor to Fortune 500 corporations, 'These are bizarre times."1 If the times are bizarre for Fortune 500 companies, they are even more bizarre for healthcare providers who must respond to the demands of a myriad of discontented customers—patients, corporations, third-party payers, and the federal government, to name only a few. As we all can attest, the golden era of unlimited budgets for healthcare is over. The economic and social forces that drive other businesses no longer will spare hospitals. Because they must reduce costs drastically while increasing quality and accessibility, hospitals are being forced to shift the center of healthcare delivery from the inpatient to the outpatient setting and to shift the focus of healthcare economics from generating revenue through fee for service to amassing capitated lives. These cataclysmic shifts in healthcare delivery and economics will affect profoundly those practicing infection control. As hospital epidemiologists and infection control practitioners, we either can resist these forces or we can anticipate trends and implement change. If we choose the former, we will be supplanted by those who respond quickly to the pressures but whose vision for health protection is blinkered. In contrast, if we choose the latter, we will help our hospitals survive, and we will assure new and expanded roles for those trained in infection control. We would do well to heed Tom Peters's warning that businesses and individuals will survive in our evermore-competitive economy only if they embrace and thrive on change.2 Clearly, the future of hospital epidemiology and infection control depends not only on our epidemiologic skills but also on how well we apply those skills within the changing environment. This changing environment discomfits and challenges even experts in hospital epidemiology and infection control; it can be daunting for those who are just entering the field. Although several excellent textbooks of infection control and quality assessment3-6 are available as scientific references for hospital epidemiologists and infection control practitioners, these textbooks have