title: Structuring our response to hospital outbreaks under conditions of uncertainty.
abstract: BACKGROUND
  Sometimes decisions have to be made even when we do not have all of the information that we would like to have. It is not uncommon for infection control professionals to be faced with an outbreak of colonization or infection while there is uncertainty about the impact of the outbreak on patient outcomes. How do we decide a proportional response when we do not know the seriousness of the outbreak?
  
  
  OBJECTIVE
  The precautionary approach has become established in the European Union (EU) as a way of structuring responses to potentially serious threats (such as novel pandemic influenza viruses) when there are substantial uncertainties about the true impact of the threat. The potential of this approach to help with structuring responses to outbreaks involving substantial uncertainties is considered in this article.
  
  
  METHODS
  The EU approach requires that actions should be proportional, non-discriminatory, consistent, take account of costs and benefits, be subject to review, and that the responsibility for producing the scientific evidence to fill critical information gaps is assigned. The example of management of outbreaks with multidrug-resistant Acinetobacter baumannii is used here to illustrate how the precautionary approach might be used in infection prevention and control.
  
  
  CONCLUSIONS
  The precautionary approach has potential to provide a structured response to outbreaks of hospital infection when there is uncertainty about the impact of the outbreak on outcomes. Most importantly there is a requirement that we specify which risks we are prioritizing for control, the information that is uncertain but critical to informing decisions, and the responsibilities for gathering that information.
authors.affiliation: Department of Infection, Royal London Hospital, Barts and the London NHS Trust, London, UK. Electronic address: Michael.Millar@bartshealth.nhs.uk.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Millar
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D004196:Disease Outbreaks; D005062:European Union; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D035501:Uncertainty
keywords: Outbreaks; Precautionary; Uncertainty