JAC Advance Access originally published online on March 26, 2007
Journal of Antimicrobial Chemotherapy 2007 59(5):823-824; doi:10.1093/jac/dkm068
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Editorial |
Interventions in healthcare-associated infection: researchers urged to CONSORT with ORION
1 Journal of Antimicrobial Chemotherapy, 11 The Wharf, 16 Bridge Street, Birmingham B1 2JS, UK 2 Lancet Infectious Diseases, 32 Jamestown Road, London NW1 7BY, UK
* Corresponding author. Tel: +44-208-327-6043; Fax: +44-208-205-9185; E-mail: alan.johnson{at}hpa.org.uk
Abstract
The ORION (Outbreak Reports and Intervention studies Of Nosocomial infection) statement has been prepared by a group of investigators with the expressed purpose of increasing the quality of research and reporting in the area of nosocomial infection. It is hoped that publication of the ORION statement will aid investigators in the design, performance and reporting of studies in this area, and will encourage journals and research councils to incorporate it into their submission and reviewing processes.
Keywords: nosocomial infections , HCAI , reporting
The problem of healthcare-associated infections (HCAI) has a high profile in both public health and political terms, with much attention being focused particularly on attempts to reduce the occurrence of infections due to methicillin-resistant Staphylococcus aureus and Clostridium difficile. The implementation of control measures to contain or reduce the spread of such infections places a substantial burden on hospitals, and there is a requirement to know that interventions are effective in order to optimize the use of hospital resources. Although much work has been done in this area, much of this research has been of a quasi-experimental nature, often characterized by methodological weaknesses and inadequate reporting. Consequently, there remains a need for high-quality prospective studies that will enhance the formulation of evidence-based guidelines for the control of HCAI.
The move towards evidence-based medicine in general received a boost in the 1990s with publication of the CONSORT (Consolidated Standards of Reporting Trials) statement, which outlined ways to improve the quality of reporting (and by the same token, the design) of randomized trials.1 The CONSORT statement sought to increase transparency of reporting the methodology, analysis and conduct of randomized trials and in this way allow the reader greater insight into the strengths, weaknesses and potential sources of bias. Following on from this precedent, a group of researchers with experience of undertaking systematic reviews of infection control studies have prepared a CONSORT equivalent called the ORION (Outbreak Reports and Intervention studies Of Nosocomial infection) statement, with the expressed purpose of increasing the quality of research in the area of infection control. The initial statement was put out for public consultation and, following submission of the revised version for publication, was further subjected to independent academic review. The resultant ORION statement, which is published in this issue of the Journal2 and also in The Lancet Infectious Diseases,3 emphasizes the use of appropriate statistical techniques for analysis and the importance of transparency in reporting aims, methods and findings. As an aid to researchers, editors, reviewers and grant assessment panels the statement contains both a checklist and a summary table for key factors that investigators should consider when designing and reporting intervention studies for the control of nosocomial infections.
The current issue of the Journal also contains an exemplar paper which describes application of the ORION statement to a study reporting that feedback of antibiotic use to doctors resulted in increased adherence to a hospital antibiotic policy advocating use of narrow-spectrum antibiotics, with a resulting significant decrease in infections due to C. difficile.4 This finding makes an important contribution to the evidence base, although the authors state that there is still a need for further work such as multicentre interrupted time-series studies or cluster randomized trials of their approach. It is to be hoped that publication of the ORION statement will aid investigators in the design, performance and reporting of such studies and will encourage journals and research councils to incorporate it into their submission and reviewing processes.
None to declare.
This article also appears in The Lancet Infectious Diseases 2007; 7: 244–5.
References
1
Begg CB, Cho MK, Eastwood S, et al. (1996) Improving the quality of reporting of randomized trials. The CONSORT statement. JAMA 276:637–9.
2 Stone SP, Cooper BS, Kibbler CC, et al. (2007) The ORION statement: guidelines for transparent reporting of Outbreak Reports and Intervention studies Of Nosocomial infection. J Antimicrob Chemother doi:10.1093/jac/dkm055.
3 Stone SP, Cooper BS, Kibbler CC, et al. (2007) The ORION statement: guidelines for transparent reporting of Outbreak Reports and Intervention studies Of Nosocomial infection. Lancet Infect Dis 7: pp. 282–8.[CrossRef][Medline]
4 Fowler S, Webber A, Cooper BS, et al. (2007) Successful use of feedback to improve antibiotic prescribing reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother doi:10.1093/jac/dkm014.
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