Hospital Epidemiology Beyond Infection Control

The significant role of a working knowledge of the epidemiology of infectious diseases in nosocomial infection control has been recognized in the titles "nurse epidemiologist" and "hospital epidemiologist" for the coordinators and supervisors of these programs. As a scientific discipline, epidemiology has broadened from its origins in infectious diseases to the study of the occurrences and determinants of other types of health events. Therefore, it appears appropriate to consider hospital epidemiology in a broader context. Nosocomial infections as a group may be considered biological risks and constitute but one of the facets of total risks faced by patients and health care workers. Programs in patient safety, employee occupational health and safety, and "liability management" recognize some of the other risks sufficient to require formal efforts at control. A study of the literature of "risk control programs" suggests a common methodology in each involving the classic application of descriptive epidemiology (criteria formation and data acquisition), analytical epidemiology (data evaluation and association for causation), and experimental epidemiology (implementation and evaluation of intervention programs). Even the broadened study of risk, however, considers only the negative features of health care. How to maximize benefits within favorable costs, recognizing patient preferences, is central to the positive programs of patient care evaluation and utilization review mandated in our institutions. A format for these "quality of care" programs has been presented in idealized form by a National Academy of Medicine Committee and directly parallels the methodology for a successful infection (risk) control program.