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Pulcini C, Morel CM, Tacconelli E, et al., 2017, Human resources estimates and funding for antibiotic stewardship teams are urgently needed, Clinical Microbiology and Infection, Vol: 23, Pages: 785-787, ISSN: 1469-0691
Antibiotic stewardship (AS) teams are essential actors for combating antibiotic-resistant bacteria in healthcare and community settings, and are routinely mentioned in national and international guidelines, recommendations and action plans. Usually, AS teams in resource-rich settings are multidisciplinary, made up of different experts, commonly including infectious diseases (ID) specialists, clinical microbiologists and pharmacists, adequately trained in antibiotic prescribing and stewardship [1].
Rawson T, Castro Sanchez E, Charani E, et al., 2017, Involving citizens in priority setting for public health research: implementation in infection research, Health Expectations, Vol: 21, Pages: 222-229, ISSN: 1369-7625
BackgroundPublic sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.MethodA scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool.Results188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of “non-experts” as decision makers were expressed.ConclusionVoting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats.
Birgand GJC, Troughton R, Moore L, et al., 2017, Blogging in infectious diseases and clinical microbiology: Assessment of the 'blogosphere' content, Infection Control and Hospital Epidemiology, Vol: 38, Pages: 832-839, ISSN: 1559-6834
Objective.To analyzeinfluential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers.Setting. World Wide WebDesign. We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.Methods.A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they: 1) focused on infectious diseases (ID), antimicrobial stewardship (AMS), infection control (IC), or medical microbiology (MM); 2) were intended for health professionals, 3) were written in English and updated regularly. We mapped blogs/bloggers characteristics and used an innovative tool to assess their architecture and content. Motivations and perceptions of bloggers and readers were assessed. Results.A total of 88 blogs were identified. 28 (32%) focused on ID, 46 (52%) on MM and 14 (16%) in IC or AMS. Bloggers were mainly male, MD and/or PhD, 32 (36%) posted at least weekly, and 51 (58%) for a research purpose. The aims were considered clear for 23 (26%) blogs, the field covered was broad for 25 (28%), presentation was good for 22 (25%), 51 were easy to read (58%) and 46 included expert interpretation (52%). Among the top 10 blogs (2 equally-ranked), 3 focused on ID, 6 on MM and 2 on IC. Bloggers questioned were motivated by sharing independent expertise/opinion. Readers appreciated the concise messages given on scientific and practical updates.Conclusions.This study describes high level blogs in ID/IC/MM suggesting how bloggers should build/orientate blogs for readers, and highlighting current gaps in topics such as AMS.
Naylor NR, Zhu N, Hulscher M, et al., 2017, Is antimicrobial stewardship cost-effective? A narrative review of the evidence, Clinical Microbiology and Infection, Vol: 23, Pages: 806-811, ISSN: 1198-743X
AIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results.
Castro Sanchez EM, Gilchrist M, McEwen J, et al., 2017, Antimicrobial stewardship: widening the collaborative approach, Journal of Antimicrobial Stewardship
Anti microbial stewardship programs (ASPs) would benefit from the participation of nurses to strengthen the increasingly complex mix of clinical, educational, research, organizational and political interventions included within ASPs.
Charani E, Ahmad R, Tarrant C, et al., 2017, Opportunities for system level improvement in antibiotic use across the surgical pathway, International Journal of Infectious Diseases, Vol: 60, Pages: 29-34, ISSN: 1201-9712
Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
Micallef C, Chaudhry NT, Holmes AH, et al., 2017, Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 1880-1885, ISSN: 1460-2091
Background: Electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use.Objectives: To summarize the literature on secondary use of data (SuD) from EP and EHP systems to support quality and safety of antimicrobial use, to describe any barriers to secondary use and to make recommendations for future work in this field.Methods: We conducted a systematic search within four databases; we included original research studies that were (1) based on SuD from hospital EP or EHP systems and (2) reported outcomes relating to quality and/or safety of antimicrobial use and/or qualitative findings relating to SuD in this context.Results: Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data (n = 9 studies), dose administration data (n = 4) and user log data from an electronic dashboard (n = 1). Barriers included data access, data accuracy and completeness, and complexity when using data from multiple systems or hospital sites.Conclusions: The literature suggests that SuD from EP and EHP systems is potentially useful to support or evaluate antimicrobial stewardship activities; greater system functionality would help to realize these benefits.
Charani E, Tarrant C, Moorthy K, et al., 2017, Understanding antibiotic decision making in surgery-a qualitative analysis., Clinical Microbiology and Infection, Vol: 23, Pages: 752-760, ISSN: 1469-0691
OBJECTIVE: To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. METHODS: A qualitative study including ethnographic observation and face-to-face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a 3-month period: (a) 30 ward rounds (WRs) (100 h) were observed, (b) face-to-face follow-up interviews took place with 13 key informants, (c) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed. Applying these methods provided rich data for characterizing the antibiotic decision making in surgery and enabled cross-validation and triangulation of the findings. Data from the interview transcripts and the observational notes were coded and analysed iteratively until saturation was reached. RESULTS: The surgical team is in a state of constant flux with individuals having to adjust to the context in which they work. The demands placed on the team to be in the operating room, and to address the surgical needs of the patient mean that the responsibility for antibiotic decision making is uncoordinated and diffuse. Antibiotic decision making is considered by surgeons as a secondary task, commonly delegated to junior members of their team and occurs in the context of disjointed communication. CONCLUSION: There is lack of clarity around medical decision making for treating infections in surgical patients. The result is sub-optimal and uncoordinated antimicrobial management. Developing the role of a perioperative clinician may help to improve patient-level outcomes and optimize decision making.
Rawson T, moore L, Hernandez B, et al., 2017, A systematic review of clinical decision support systems for antimicrobial management: Are we failing to investigate these interventions appropriately?, Clinical Microbiology and Infection, Vol: 23, Pages: 524-532, ISSN: 1469-0691
ObjectivesClinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimise antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems. MethodPRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management, and Global Health databases were searched from 1st January 1980 to 31st October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation.ResultsFifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have rules based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor.ConclusionGreater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence.
Holmes AH, Carruthers J, Majeed A, 2017, A suspected viral rash in pregnancy, The BMJ, Vol: 356, ISSN: 2044-6055
Charani E, Gharbi M, Moore LSP, et al., 2017, The effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals – an interrupted time series study, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 1825-1831, ISSN: 1460-2091
Objectives To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators using data (2008-2014) from a biannual point prevalence study (PPS) in medicine and surgery wards. There were six data points pre and six data points post-implementation. Results There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in medicine (6.48%, CI -1.25—14.20) and surgery (6.63%, CI 0.15—13.10) in the implementation period, with a significant sudden change in level in surgery (p<0.05). There was an increase, though not significant, in medicine (15.20%, CI 17.81—48.22) and surgery (35.97%, -3.72—75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (-16.25%, CI -42.52—10.01) and surgery (-14.62%, CI -42.88—13.63).Conclusion Introducing the ‘app’ to an existing ASP had a significant impact on the compliance to policy in surgery, and a positive but not significant effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may have been due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions.
Holmes AH, Boyd SE, Moore LSP, et al., 2017, Obtaining antibiotics online from within the UK: a cross-sectional study, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Sastry S, Masroor N, Bearman G, et al., 2017, The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low- and middle-income countries, INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol: 57, Pages: 138-143, ISSN: 1201-9712
Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to limited resources and underdeveloped infrastructure. While evidence-based infection prevention and control (IPC) principles and practices are universal, studies are needed to evaluate simplified approaches that can be better adapted to LMIC needs, in order to guide IPC in practice. A group of experts from around the world attended a workshop held at the 17th International Congress on Infectious Diseases in Hyderabad, India in March 2016, to discuss the existing IPC practices in LMICs, and how best these can be improved within the local context.
Holmes AH, Pittet D, Castro Sanchez E, 2017, Hand Hygiene: key principles for the manager, Hand Hygiene: A Handbook for Medical Professionals, Editors: Didier, Boyce, Allegranzi, Publisher: Wiley-Blackwell, ISBN: 978-1-118-84686-5
Rawson T, Moore L, Tivey A, et al., 2017, Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences, Antimicrobial Resistance and Infection Control, Vol: 6, ISSN: 2047-2994
BackgroundTo improve the quality of antimicrobial stewardship (AMS) interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. MethodsLeading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR) abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. ResultsConferences ran for 110 days with >57,000 delegates. 311/12,313(2.5%) AMS-AMR abstracts (oral and poster) were identified. 118/311(40%) were presented at the UK’s infectious diseases/microbiology conference. 56/311(18%) AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40%) conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%)]. In total 71 unique behaviour change functions were identified. Policy categories; “guidelines” (16/71) and “service provision” (11/71) were the most frequently reported. Intervention functions; “education” (6/71), “persuasion” (7/71), and “enablement” (9/71) were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on “guidelines” and “enablement”. ConclusionDespite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must b
Zingg W, Hopkins S, Gayet-Ageron A, et al., 2017, Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey, LANCET INFECTIOUS DISEASES, Vol: 17, Pages: 381-389, ISSN: 1473-3099
Storr J, Twyman A, Zingg W, et al., 2017, Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations, ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL, Vol: 6, ISSN: 2047-2994
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Iwami M, Ahmad R, Castro Sanchez E, et al., 2017, Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multi-level qualitative analysis., BMJ Open, Vol: 7, ISSN: 2044-6055
Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design: A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level: a) documentary review of 14 hospitals to determine the capacity to report on performance; b) qualitative interviews with three senior managers from five hospitals and direct observation of hospital wards to identify gaps in use of these indicators to improve IPC management and practice.Setting: Two acute English National Health Service (NHS) trusts and one NHS foundation trust (14 hospitals).Participants: Three senior managers from five hospitals for qualitative interviews.Primary and secondary outcome measures: As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. Secondary outcome measure includes the assessment of gaps across national and local levels by comparing the RAG rating results.ResultsNational regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.ConclusionsFor effective patient safety and infection prevention in English hospitals, ro
Castro Sanchez EM, Holmes A, Pittet D, 2017, Chapter 28: Institutional safety climate., Hand Hygiene: A Handbook for Medical Professionals, Editors: Wiley-Blackwell
Rawson T, Charani E, Moore L, et al., 2016, Vancomycin therapy in secondary care; investigating factors that impact therapeutic target attainment, Journal of Infection, Vol: 74, Pages: 320-324, ISSN: 1532-2742
Rawson T, Charani E, Moore L, et al., 2016, Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study, BMC Medicine, Vol: 14, ISSN: 1741-7015
BackgroundThe inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.MethodsNewly qualified to Consultant level physicians participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached. ResultsTwenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision making of individual physicians were; (i) perceptions of providing “optimal” care for the patient with infection by providing rapid and often intravenous therapy; (ii) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; (iii) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort. ConclusionInterventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy requires addressing urgently with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
Rawson T, Moore L, Hernandez B, et al., 2016, Patient engagement with infection management in secondary care: a qualitative investigation of current experiences, BMJ Open, Vol: 6, ISSN: 2044-6055
Objective To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices.Design A qualitative investigation using in-depth focus groups.Participants Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens.Results Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is communicated in a unilateral manner with individuals ‘told’ that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals’ future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up.Conclusions Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use.
Otter JA, Burgess P, Davies F, et al., 2016, Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective., Clinical Microbiology and Infection, ISSN: 1469-0691
OBJECTIVE: To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE). METHODS: We performed an observational economic evaluation of an outbreak of CPE (NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and 'opportunity cost' (staff time, bed closures, and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10 month duration of the outbreak. RESULTS: The outbreak cost €1.1m over 10 months (range €0.9-1.4m), comprising €312,000 of actual expenditure, and €822,000 (range €631,000-€1.1m) in opportunity cost. An additional €153,000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54,000 on anti-infectives for 18 patients treated, €94,000 on laboratory costs for screening, €73,000 on contact precautions for 1831 contact precautions patient days, €42,000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43,000 on 2592 hours of ward-based monitors, and €6,000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244,000related to 840 lost bed days (range 0-2196 bed days, €0-€435,000), €349,000 in missed revenue from 72 elective surgical procedures, and €228,000 in staff time (range €205,000-€251,000). Reduced capacity to perform elective surgical procedures related to bed closures (€349,000) represented the greatest cost. CONCLUSIONS: The cost estimates that we present suggest that CPE outbreaks are highly costly.
Castro Sanchez EM, Kyratsis Y, Iwami M, et al., 2016, Serious electronic games as behavioural change interventions in healthcare- associated infections and infection prevention and control: scoping review of the literature and future directions., Antimicrobial Resistance and Infection Control, Vol: 5, ISSN: 2047-2994
Background: The uptake of improvement initiatives in infection prevention and control (IPC) has often provenchallenging. Innovative interventions such as ‘serious games’ have been proposed in other areas to educate andhelp clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of seriousgames in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games inIPC to support healthcare workers’ behaviour change and best practice learning; and b) to identify gaps across theformulation and evaluation of serious games in IPC.Methods: A scoping study was conducted using the methodological framework developed by Arksey andO’Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus,Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analyticframework of intervention formulation and evaluation.Results: Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and fourfinally selected. Studies focused on intervention inception and development rather than implementation. Expertinvolvement in game design was reported in 2/4 studies. Potential game users were not included in needsassessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported.Conclusions: The growing interest in serious games for health has not been coupled with adequate evaluation ofprocesses, outcomes and contexts involved. Explanations about the mechanisms by which game components mayfacilitate behaviour change are lacking, further hindering adoption.
Holmes A, 2016, Women of the World: The Rise of the Female Diplomat, INTERNATIONAL HISTORY REVIEW, Vol: 38, Pages: 1083-1084, ISSN: 0707-5332
Micallef C, Kildonavaciute K, Castro Sanchez EM, et al., 2016, Patient and public understanding and knowledge of antimicrobial resistance and stewardship: should public campaigns change focus?, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 311-314, ISSN: 1460-2091
BackgroundThe rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies.MethodsA panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room.ResultsOne hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%).ConclusionsWe describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic.
Holmes A, Castro-Sánchez E, Ahmad R, 2016, Guidelines in infection prevention: Current challenges and limitations, British Journal of Health Care Management, Vol: 22, Pages: 440-443, ISSN: 1358-0574
Rawson T, Moore L, Gill D, et al., 2016, Promoting medical student engagement with antimicrobial stewardship through involvement in undergraduate research, Journal of Infection, Vol: 74, Pages: 200-202, ISSN: 1532-2742
The National Health Service recognises the importance of research, teaching, and training tothe future success of the organisation and medical students are expected to qualify with thenecessary clinical, professional, and academic skills to support this. There is a wide variationin the level of cross-specialty engagement with Antimicrobial Stewardship (AMS) &Antimicrobial resistance (AMR) research at UK and international state-of-the-artconferences, with a heterogeneous level of importance also attributed amongst undergraduateand postgraduate training pathways across clinical medicine. It therefore seems apparent thatthe AMS-AMR agenda needs to be promoted from within specialties, rather than being‘pushed’ on them as an external agenda, to promote broad ownership and capacity within allclinical specialties that use antimicrobials. This must start early during undergraduate medicaltraining. We investigated whether the use of an online platform designed to facilitate medicalstudent research projects could be utilised to promote undergraduate engagement with AMSAMRat Imperial College School of Medicine between July 2015 and 2016. During thisperiod 12 applicants were appointed to 11 of the 13 advertised projects. So far, studentsundertaking these projects have achieved: 1 peer-reviewed publication, 3 national oralpresentations, 1 national prize, 1 international poster presentation, 3 national posterpresentations, and 2 further manuscripts are currently under peer-review. Furthermore,despite the students’ broad career interests there has been a high retention rate with studentsrequesting involvement in further AMS-AMR related activities. Further longitudinalassessment of this tool for promoting undergraduate engagement with AMS-AMR research isnow being explored.
Vella V, Aylin PP, Moore L, et al., 2016, Bed utilisation and increased risk of Clostridium difficile infections in acute hospitals in England in 2013/2014., BMJ Quality & Safety, ISSN: 2044-5423
BACKGROUND: The study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for Clostridium difficile infections (CDI) in acute hospitals in England. METHOD: A retrospective analysis was carried out on reported data from the English National Health Service (NHS) for the financial year 2013/2014. Reported rates of CDI were used as a proxy for hospital infection rates in acute NHS hospital trusts. Multivariate linear regression was used to assess the relationship between bed utilisation values and CDI controlling for confounding factors. Hospitals were finally plotted in a Pabon Lasso graph according to their average bed occupancy rate (BOR) and bed turnover rate (BTR) per year to visualise the relationship between bed utilisation and CDI. RESULTS: Among English hospital NHS trusts, increasing BTR and decreasing BOR were associated with a decrease in CDI. However, this effect was not large, and patient mix had a larger impact on CDI rates than bed utilisation. CONCLUSIONS: While policymakers and managers wishing to target healthcare providers with high CDI rates should look at bed utilisation measures, focusing on these alone is unlikely to have the desired impact. Instead, strategies to combat CDI must take a wider perspective on contributory factors at the institutional level.
Castro Sanchez EM, Moore LSP, Husson, et al., 2016, What are the factors driving antimicrobial resistance? Perspectives from a public event in London, England, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334
BackgroundAntimicrobial resistance is driven by multiple factors. Resolving the threat to human and animal health presented by drug-resistant infections remains a societal challenge that demands close collaboration between scientists and citizens. We compared current public views about key contributing factors to antimicrobial resistance with those expressed by experts.MethodsOverarching factors contributing to antimicrobial resistance were identified following a review of literature. The factors were then described in plain language and attached to ballot boxes at a public engagement event organised by a university. Responses to each factor were counted at the end of the event.ResultsFour hundred five responses were received from 3750 visitors (11 % response rate). Nearly half of responses (192/405, 47 · 4 %) considered the misuse/overuse of antibiotics in humans as the main determinant of antimicrobial resistance. The misuse of antibiotics in animal health obtained 16 · 3 % (66/405) responses. However, the lack of quick tests to diagnose infections received 10/405 votes (2 · 47 %), and the lack of effective vaccines received one vote (0 · 25 %).ConclusionsThe majority of responses ascribed the emergence of drug-resistant infections to the misuse of antibiotics in human and animals. Suboptimal dosing, availability of diagnostics and environmental contamination were considered less influential on the development of antimicrobial resistance. The growing recognition of broader multifaceted drivers of drug resistance by experts is not yet echoed in the public mind.
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