Imperial College London

DrGabrielBirgand

Faculty of MedicineDepartment of Infectious Disease

ARC Early Career Research Fellow
 
 
 
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Contact

 

+44 (0)20 3313 2732g.birgand Website CV

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Publication Type
Year
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35 results found

Birgand G, Haudebourg T, Grammatico-Guillon L, Ferrand L, Moret L, Gouin F, Mauduit N, Leux C, Le Manach Y, Lepelletier D, Tavernier E, Lucet J-C, Giraudeau Bet al., 2019, Improvement in staff behavior during surgical procedures to prevent post-operative complications (ARIBO2): study protocol for a cluster randomised trial, Trials, Vol: 20, ISSN: 1745-6215

BackgroundInappropriate staff behaviour during surgical procedures may disrupt the surgical performance and compromise patient safety. We developed an innovative monitoring and feedback system combined with an adaptive approach to optimise staff behaviour intraoperatively and prevent post-operative complications (POC) in orthopaedic surgery.Methods/designThis protocol describes a parallel-group, cluster randomised, controlled trial with orthopaedic centre as the unit of randomisation. The intervention period will last 6 months and will be based on the monitoring of two surrogates of staff behaviour: the frequency of doors opening and the level of noise. Both will be collected from incision to wound closure, using wireless sensors and sonometers, and recorded and analysed on a dedicated platform (Livepulse®). Staff from centres randomised to the intervention arm will be informed in real time on their own data through an interactive dashboard available in each operating room (OR), and a posteriori for hip and knee replacement POC. Aggregated data from all centres will also be displayed for benchmarking. A lean method will be applied in each centre by a local multidisciplinary team to analyse baseline situations, determine the target condition, analyse the root cause(s), and take countermeasures. The education and awareness of participants on the impact of their behaviour on patient safety will assist the quality improvement process. The control centres will be blinded to monitoring data and quality improvement approaches. The primary outcome will be any POC occurring during the 30 days post operation. We will evaluate this outcome using local and national routinely collected data from hospital discharge and disease databases. Thirty orthopaedic centres will be randomised for a total of 9945 hip and knee replacement surgical procedures.DiscussionThe field of human factors and behaviour in the OR seems to offer potential room for improvement. An intervention providi

Journal article

Birgand G, Schouten J, Ruppe E, Less contact isolation is more in the ICU: the con position., Intensive Care Medicine, ISSN: 0342-4642

Journal article

Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, Zahar JR, Sales-Wuillemin E, Tubach F, Lucet JCet al., 2019, Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey, Antimicrobial Resistance and Infection Control, Vol: 8, ISSN: 2047-2994

BackgroundMuch effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs.MethodsA multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception.ResultsBetween June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation.Conc

Journal article

Birgand G, Troughton R, Mariano V, Hettiaratchy S, Hopkins S, Otter JA, Holmes Aet al., How do surgeons feel about the “Getting it Right First Time” national audit? Results from a qualitative assessment., Journal of Hospital Infection, ISSN: 0195-6701

The implementation of thenational“Getting It Right First Time” (GIRFT)was assessed by interviewing six surgeonsinvolvedat various levelsinsurgical site infection (SSI) audit.The positive impacts were to create new professional collaboration, improve stakeholder engagement, and increase the profile of SSIs. One particular knowledgegap highlighted was that some participantshad been unaware until that point of the criteria for diagnosing an SSI. The quality of data collected was felt poor due to methodological flaws. The audit was described as highly time-consuming and unsustainableif leaning on junior surgeons, without protectedtimeanddesignatedresponsibility.

Journal article

Birgand G, Haudebourg T, Grammatico-Guillon L, Moret L, Gouin F, Mauduit N, Leux C, Manach YL, Tavernier E, Giraudeau B, Lepelletier D, Lucet J-Cet al., Intraoperative door openings and surgical site infection: a causal association?, Clinical Infectious Diseases, ISSN: 1058-4838

Journal article

Ahmad R, Zhu NJ, Leather AJM, Holmes A, Ferlie Eet al., 2019, Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review, BMJ Global Health, Vol: 4, ISSN: 2059-7908

Introduction: The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods: A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results: 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion: The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation eff

Journal article

Peiffer-Smadja N, Rawson TM, Ahmad R, Buchard A, Pantelis G, Lescure F-X, Birgand G, Holmes Aet al., Machine learning for clinical decision support in infectious diseases: A narrative review of current applications, Clinical Microbiology and Infection, ISSN: 1198-743X

BACKGROUNDMachine learning (ML) is a growing field in medicine. This narrative review describes the current body of literature on ML for clinical decision support in infectious diseases (ID). OBJECTIVESWe aim to inform clinicians about the use of ML for diagnosis, classification, outcome prediction and antimicrobial management in ID.SOURCESReferences for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, ACM Digital Library, arXiV and IEEE Xplore Digital Library up to July 2019.CONTENTWe found 60 unique ML-CDSS aiming to assist ID clinicians. Overall, 37 (62%) focused on bacterial infections, 10 (17%) on viral infections, nine (15%) on tuberculosis and four (7%) on any kind of infection. Among them, 20 (33%) addressed the diagnosis of infection, 18 (30%) the prediction, early detection or stratification of sepsis, 13 (22%) the prediction of treatment response, four (7%) the prediction of antibiotic resistance, three (5%) the choice of antibiotic regimen and two (3%) the choice of a combination antiretroviral therapy. The ML-CDSS were developed for intensive care units (n=24, 40%), ID consultation (n=15, 25%), medical or surgical wards (n=13, 20%), emergency department (n=4, 7%), primary care (n=3, 5%) and antimicrobial stewardship (n=1, 2%). Fifty-three ML-CDSS (88%) were developed using data from high-income countries and seven (12%) with data from low- and middle-income countries (LMIC). The evaluation of ML-CDSS was limited to measures of performance (e.g. sensitivity, specificity) for 57 ML-CDSS (95%) and included data in clinical practice for three (5%). IMPLICATIONSConsidering comprehensive patient data from socioeconomically diverse health care settings, including primary care and LMICs, may improve the ability of ML-CDSS to suggest decisions adapted to various clinical contexts. Currents gaps identified in the evaluation of ML-CDSS must also be addressed in order to know the potential impact of such tools for cli

Journal article

Troughton R, Mariano V, Campbell A, Hettiaratchy S, Holmes A, Birgand Get al., 2019, Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy, Antimicrobial Resistance and Infection Control, Vol: 8, ISSN: 2047-2994

Background. Despite a large literature on surgical site infection (SSI), the determinants ofprevention behaviours in surgery remain poorly studied. Understanding key social andcontextual components of surgical staff behaviour may help to design and implementinfection control (IC) improvement interventions in surgery.Methods. Qualitative semi-structured interviews were conducted with surgeons (n = 8),nurses (n = 5) theatre personnel (n = 3), and other healthcare professionals involved in surgery(n=4) in a 1500-bed acute care London hospital group. Participants were approached throughestablished mailing lists and snowball sampling. Interviews were recorded and transcribedverbatim. Transcripts were coded and analysed thematically using a constant comparativeapproach.Results. IC behaviour of surgical staff was governed by factors at individual, team, and widerhospital level. IC practices were linked to the perceived risk of harm caused by an SSI morethan the development of an SSI alone. Many operating room participants saw SSI preventionas a team responsibility. The sense of ownership over SSI occurence was closely tied to howpreventable staff perceived infections to be, with differences observed between clean andcontaminated surgery. However, senior surgeons claimed personal accountability for ratesdespite feeling SSIs are often not preventable. Hierarchy impacted on behaviour in differentways depending on whether it was within or between professional categories. One particularknowledge gap highlighted was the lack of awareness regarding criteria for SSI diagnosis.Conclusions. To influence IC behaviours in surgery, interventions need to consider the socialteam structure and shared ownership of the clinical outcome in order to increase theawareness in specialties where SSIs are not seen as serious complications.

Journal article

Azevedo-Coste C, Pissard-Gibollet R, Toupet G, Fleury É, Lucet J-C, Birgand Get al., 2019, Tracking clinical staff behaviors in an operating room, Sensors, Vol: 19, ISSN: 1424-2818

Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors’ movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.

Journal article

Birgand G, Azevedo C, Rukly S, Pissard-Gibollet R, Toupet G, Timsit J-F, Lucet J-Cet al., 2019, Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery, Infection Control & Hospital Epidemiology, Vol: 40, Pages: 566-573, ISSN: 0899-823X

Objectives:We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.Design and setting:This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.Results:We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.Conclusions:This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.

Journal article

Hue R, Coroller-Bec C, Guilloteau V, Libeau B, Birgand Get al., 2019, Highly drug-resistant bacteria: Is intra- and inter-hospital communication optimal?, Médecine et Maladies Infectieuses, ISSN: 0399-077X

Journal article

Legeay C, Hue R, Berton C, Cormier H, Chenouard R, Corvec S, Birgand Get al., 2019, Control strategy for carbapenemase-producing Enterobacteriaceae in nursing homes: perspectives inspired from three outbreaks, Journal of Hospital Infection, Vol: 10, Pages: 183-187, ISSN: 0195-6701

Three outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) in three nursing homes in western France were retrospectively assessed. In all, ten cases of colonization or infection with CPE were detected upon admission in neighbouring hospitals. Antibiotic consumption or high frailty was infrequent among them. Nursing homes should be included in a regional strategy to limit CPE spread.

Journal article

Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Brigand G, Poda A, Ahmad R, Singh S, Holmes AHet al., 2019, Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries – a qualitative study, PLoS ONE, Vol: 14, ISSN: 1932-6203

BackgroundMost of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.Materials and methodsHealthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.Results54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, on

Journal article

Troughton R, Birgand G, Johnson AP, Naylor N, Gharbi M, Aylin P, Hopkins S, Jaffer U, Holmes Aet al., 2018, Mapping national surveillance of surgical site infections (SSIs) to national needs and priorities: an assessment of England’s surveillance landscape, Journal of Hospital Infection, Vol: 100, Pages: 378-385, ISSN: 0195-6701

BackgroundThe rise in antimicrobial resistance has highlighted the importance of surgical site infection (SSI) prevention with effective surveillance strategies playing a key role in improving patient safety. This study maps national needs and priorities for SSI surveillance against current national surveillance activity.MethodsThis study analysed SSI surveillance in NHS hospitals in England covering 23 surgical procedures. Data collected were: (i) annual number of procedures, (ii) SSI rates from national reports, (iii) national reporting requirement (mandatory, voluntary, not offered), (iv) priority ranking from a survey of 84 English NHS hospitals, (v) excess length of stay and costs from the literature. The relationships between estimated SSI burden, national surveillance activity, and hospital-reported priorities were explored with descriptive and univariate analyses.FindingsAmong the 23 surgical categories analysed, top priority ranking by hospitals was associated only with current surveillance (r=0.76, p<0.01) and mandatory reporting (33% vs 8 and 4%, p=0.04). Percentage of hospitals undertaking surveillance, mandatory reporting, and the selection of priorities did not match SSI burden. Large bowel surgery (LBS, voluntary) and caesarean section (not offered) were the two highest contributors of total SSIs per annum, with 39,000 (38%) and 17,000 (16%) respectively, while the four orthopaedic categories (all mandatory) contributed 5,000 (5%). LBS also had the highest associated costs (£119m per annum).ConclusionCurrent surveillance and future priorities were not associated with SSI rate, volume, or cost to hospitals. The two highest contributors of SSIs and related costs have no (caesarean section) or limited (LBS) coverage by national surveillance.

Journal article

Perozziello A, Routelous C, Charani E, Truel A, Birgand GJC, Yazdanpanah Y, Lescure FX, Lucet J-Cet al., 2018, Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study, International Journal of Antimicrobial Agents, Vol: 51, Pages: 829-835, ISSN: 0924-8579

ObjectiveTo describe current antimicrobial stewardship program (ASP) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities.MethodsWe conducted a qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASP across five French hospitals. Five infectious disease specialists and one microbiologist were interviewed between April and June 2016.ResultsStewards had dedicated time to perform ASP activities in two university-affiliated hospitals while in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, while direct counselling on wards required appropriate staffing. ASPL aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive e.g. education measures were preferred to coercive ones. ASPL faced several challenges in implementing ASP: overcoming physicians' or units' reluctance, and balancing the influence of medical hierarchy and professional boundaries.ConclusionBeyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study about ASP in France exploring stewards' experiences and points of view.

Journal article

Birgand GJC, Mutters N, Ahmad R, Tacconelli E, Lucet J-C, Holmes Aet al., Infection control specialists' perception of antimicrobial resistance in European hospitals. The Percept-R study., ECCMID

Conference paper

Troughton R, Mariano V, Holmes A, Birgand Get al., 2018, Understanding the determinants of infection control practices insurgery: The surgeon sets the tone, European Congress of Clinical Microbiology and Infectious Diseases

Poster

Birgand G, Castro-Sánchez E, Hansen S, Gastmeier P, Lucet J-C, Ferlie E, Holmes A, Ahmad Ret al., 2018, Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.

Journal article

Birgand GJC, Zahar JR, Lucet JC, 2018, Insight into the complex epidemiology of multidrug-resistant Enterobacteriacae, Clinical Infectious Diseases, Vol: 66, Pages: 494-496, ISSN: 1058-4838

Journal article

Kardaś-Słoma L, Lucet J-C, Perozziello A, Pelat C, Birgand G, Ruppé E, Boëlle P-Y, Andremont A, Yazdanpanah Yet al., 2017, Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis, BMJ Open, Vol: 7, ISSN: 2044-6055

Objective Several control strategies have been used tolimit the transmission of multidrug-resistant organisms inhospitals. However, their implementation is expensive andeffectiveness of interventions for the control of extendedspectrumbeta-lactamase-producing Enterobacteriaceae(ESBL-PE) spread is controversial. Here, we aim to assessthe cost-effectiveness of hospital-based strategies to preventESBL-PE transmission and infections.Design Cost-effectiveness analysis based on dynamic,stochastic transmission model over a 1-year time horizon.Patients and setting Patients hospitalised in a hypothetical10-bed intensive care unit (ICU) in a high-income country.Interventions Base case scenario compared with (1)universal strategies (eg, improvement of hand hygiene (HH)among healthcare workers, antibiotic stewardship), (2)targeted strategies (eg, screening of patient for ESBL-PEat ICU admission and contact precautions or cohorting ofcarriers) and (3) mixed strategies (eg, targeted approachescombined with antibiotic stewardship).Main outcomes and measures Cases of ESBL-PEtransmission, infections, cost of intervention, cost ofinfections, incremental cost per infection avoided.Results In the base case scenario, 15 transmissions and fiveinfections due to ESBL-PE occurred per 100 ICU admissions,representing a mean cost of €94 792. All control strategiesimproved health outcomes and reduced costs associated withESBL-PE infections. The overall costs (cost of intervention andinfections) were the lowest for HH compliance improvementfrom 55%/60% before/after contact with a patient to80%/80%.Conclusions Improved compliance with HH was the mostcost-saving strategy to prevent the transmission of ESBLPE.Antibiotic stewardship was not cost-effective. However,adding antibiotic restriction strategy to HH or screening andcohorting strategies slightly improved their effectiveness andmay be worthy of consideration by decision-makers

Journal article

Birgand GJC, Les indicateurs à diffusion publique au Royaume-Uni, Congrès de la société francaise d'hygiène hospitalière SF2H

Conference paper

Birgand GJC, 2017, The year in Infection Control, ASM Microbe

Conference paper

Birgand GJC, Impact du comportement sur le risque infectieux au bloc opératoire, Journée nationale du réseau ISO RAISIN

Conference paper

Charani E, Ahmad R, Tarrant C, Birgand G, Leather A, Mendelson M, Moonesinghe SR, Sevdalis N, Singh S, Holmes Aet 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.

Journal article

Birgand GJC, How to improve reliability in HAI surveillance? Local opportunities, European congress of microbiology and infectious diseases

Conference paper

Troughton R, Castro Sanchez EM, Birgand GJC, Holmes AHet al., 2017, Post-discharge surveillance of surgical site infections: is anyone getting it right?

Poster

Loison G, Troughton R, Raymond F, Lepelletier D, Lucet JC, Avril C, Birgand GJCet al., 2017, Dress code and traffic flow in the operating room: A multicentre study of staff discipline during surgical procedures., Journal of Hospital Infection, Vol: 96, Pages: 281-285, ISSN: 0195-6701

This multi-centre study assessed operating room (OR) staff compliance with clothing regulations and traffic flow during surgical procedures. Of 1615 surgical attires audited, 56% respected the eight clothing measures. Lack of compliance was mainly due to inappropriate wearing of jewellery (26%) and head coverage (25%). In 212 procedures observed, a median of five people [interquartile range (IQR) 4–6] were present at the time of incision. The median frequency of entries to/exits from the OR was 10.6/h (IQR 6–29) (range 0–93). Reasons for entries to/exits from the OR were mainly to obtain materials required in the OR (N=364, 44.5%). ORs with low compliance with clothing regulations tended to have higher traffic flows, although the difference was not significant (P=0.12).

Journal article

Birgand GJC, Troughton R, Moore L, Charani E, Rawson TM, Castro-Sanchez E, Holmes AHet al., Blogging in infectious diseases and clinical microbiology: Assessment of the 'blogosphere' content, Infection Control and Hospital Epidemiology, 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.

Journal article

Iwami M, Ahmad R, Castro Sanchez E, Birgand G, Johnson AP, Holmes AHet 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

Journal article

Troughton R, birgand G, holmes A, hopkins Set al., 2016, Mapping Priority Areas for Surveillance of Surgical Site Infections in England, FIS/HIS 2016

Poster

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