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Birgand G, Charani E, Ahmad R, et al., 2022, Interventional research to tackle antimicrobial resistance in Low Middle Income Countries in the era of the COVID-19 pandemic: lessons in resilience from an international consortium., International Journal of Infectious Diseases, Vol: 117, ISSN: 1201-9712
This article summarizes the consequences of the COVID-19 pandemic, on an international project to tackle the antimicrobial resistance (AMR). The research leadership and process, the access to data and stakeholders were deeply disrupted by the national and international response to the pandemic, including the interruption of healthcare delivery, lockdowns, and quarantines. The key principles to deliver the research through the pandemic were mainly the high degree of interdisciplinary engagement with integrated teams, an equitable partnership across sites with capacity building and leadership training. The level of pre-existing collaboration and partnership were also keys to sustain connections and involvements throughout the pandemic. The pandemic offered opportunities for realigning research priorities. Flexibility in funding timelines and projects inputs are required to accommodate variance introduced by external factors. The current models for research collaboration and funding need to be critically evaluated and redesigned to retain the innovation which has been shown to be successful through this current experience.
Ahuja S, Peiffer-Smadja N, Peven K, et al., 2022, Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery A Systematic Scoping Review, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E345-E352, ISSN: 0003-4932
Charani E, Holmes A, Bonaconsa C, et al., 2021, Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa, Clinical Microbiology and Infection, Vol: 27, Pages: 1455-1464, ISSN: 1198-743X
Objectives To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high infection risk surgical pathways. Methods An qualitative study, ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCP) and patients was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings.Results Between July 2018–August 2019 data were gathered from 190 hours of non-participant observations (138 India, 72 SA); interviews with HCPs (44 India, 61 SA); patients (6 India, 8 SA), and, case studies (4 India, 2 SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing, implicit roles of HCPs (including nurses, and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care is lacking.ConclusionsIdentifying the implicit existing HCPs roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimised care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads is essential for integrated AMS and infection-related care. Keywords: antibiotic prescribing, infection control, ethnography, low- and middle-income country, surgery
Birgand G, Mutters N, Otter J, et al., 2021, Variation of national and international guidelines on respiratory protection for healthcare professionals during the COVID-19 pandemic, Jama Network Open, Vol: 4, Pages: 1-5, ISSN: 2574-3805
Zhu J, Ferlie E, Castro-Sánchez E, et al., 2021, Macro level factors influencing strategic responses to emergent pandemics: a scoping review, Journal of Global Health, Vol: 11, Pages: 1-16, ISSN: 2047-2978
Background: Strategic planning is critical for successful pandemic management. This study aimed to identify and review the scope and analytic depth of situation analyses conducted to understand their utility, and capture the documented macro-level factors impacting4pandemic management. Methods: To synthesise this disparate body of literature, we adopted a two-step search and 6review process. A systematic search of the literature was conducted to identify all studies since 2000, that have 1) employed a situation analysis;and2) examined contextual factors influencing pandemic management. The included studies are analysed using a seven-domain systems approach rom the discipline of strategic management. Findings: Nineteen studies were included in the final review ranging from single country (6) to regional, multi-country studies (13). Fourteen studies had a single disease focus, with 5 studies evaluating responses to one or more of COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS),Influenza A (H1N1),Ebola virus disease, and Zika virus disease pandemics. Six studies examined a single domain from political, economic, sociological, technological, ecological or wider industry(PESTELI), 5 studies examined two to four domains, and8studies examined five or more domains. Methods employed were predominantly literature reviews. The recommendations focus predominantly on addressing inhibitors in the sociological and technological domains with few recommendations articulated in the political domain. Overall, the legislative domain is least represented. Conclusions: Ex-post analysis using the seven-domain strategic management framework provides further opportunities for a planned systematic response to pandemics which remains critical as the current COVID-19 pandemic evolves.
Ahmad R, Atun R, Birgand G, et al., 2021, Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments, Journal of Global Health, Vol: 11, Pages: 1-11, ISSN: 2047-2978
Background Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.Methods A cross-sectional electronic survey of health and non-healthcare professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.Results 928 respondents from 66 countries (57% healthcare professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. Conclusions The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.
Deschanvres C, Haudebourg T, Peiffer-Smadja N, et al., 2021, How do the general population behave with facemasks to prevent COVID-19 in the community? A multi-site observational study, Antimicrobial Resistance and Infection Control, Vol: 10, ISSN: 2047-2994
OBJECTIVE: The appropriate use of facemasks, recommended or mandated by authorities, is critical to prevent the spread of COVID-19 in the community. We aim to evaluate frequency and quality of facemask use in general populations. METHODS: A multi-site observational study was carried out from June to July 2020 in the west of France. An observer was positioned at a predetermined place, facing a landmark, and all individual passing between the observer and the landmark were included. The observer collected information on facemask use (type, quality of positioning), location and demographic characteristics. RESULTS: A total of 3354 observations were recorded. A facemask was worn by 56.4% (n=1892)of individuals, including surgical facemasks (56.8%, n=1075) and cloth masks (43.2%,n=817). The facemask was correctly positioned in 75.2% (n=1422) of cases. The factors independently associated with wearing a facemask were being indoors(adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 2.28-3.19), being in a mandatory area (aOR, 6.92; 95%CI, 5-9.7), female gender (aOR, 1.75; 95%CI, 1.54-2.04), age 41-65 years (aOR, 1.7; 95%CI, 1.43-2.02) and age >65 years (aOR, 2.28;95%CI, 1.83-2.85). The factors independently associated with correct mask position were rural location (aOR, 1.38; 95%CI, 1.07-1.79), being in an indoor area (aOR, 1.85;95%CI, 1.49-2.3), use of clothmask (aOR, 1.53; 95%CI, 1.23-1.91), and age >40 years (aOR, 1.75 95%CI 1.37-2.23).CONCLUSIONS: During the initial phase of the COVID-19 pandemic, the frequency and quality of facemask wearing remained low in the community setting. Young people in general, and men in particular, represent the priority targets for information campaigns. Simplifying the rules to require universal mandatory facemasking seemed to be the best approach for health authorities.
Birgand G, Peiffer-Smadja N, Fournier S, et al., 2020, Assessment of air contamination by SARS-CoV-2 in hospital settings, Jama Network Open, Vol: 3, ISSN: 2574-3805
IMPORTANCE: Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OBJECTIVE: To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEW: The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between December 1, 2019, and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScopingReviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS: Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples from close patients’ environment (17.4%) were positive for SARS-CoV-2 RNA, without difference according to the setting (intensive care unit, 27 of 107[25.2%]; non–intensive care unit, 39 of 364 [10.7%];P< .01), the distance from patients (<1 m, 3 of118 [2.5%]; 1-5 m, 13 of 236 [5.5%];P= .20). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) were positive, all from close patient envi
Tsioutis C, Birgand G, Bathoorn E, et al., 2020, Education and training programmes for infection prevention and control professionals: mapping the current opportunities and local needs in European countries, Antimicrobial Resistance and Infection Control, Vol: 9, Pages: 1-12, ISSN: 2047-2994
BackgroundStudies have repeatedly highlighted the need for homogenisation of training content and opportunities in infection prevention and control (IPC) across European countries.ObjectivesTo map current training opportunities for IPC professionals, define local needs and highlight differences, across 11 European countries (Cyprus, France, England, Germany, Greece, Italy, Netherlands, Poland, Romania, Spain, Switzerland).SourcesFrom July 2018 to February 2019, IPC experts directly involved in IPC training and education in their countries and/or internationally were invited to complete a prespecified set of questions in order to provide a detailed description of IPC training opportunities and needs in their country.ConclusionsIPC training among nurses and doctors varies greatly across countries, with differences in content and type of training (e.g., standardised curriculum, educational programme, clinical experience) duration, as well as in assessment and recognition/accreditation. The observed heterogeneity in IPC training between European countries can be eliminated through establishment of interdisciplinary region-wide training programmes, with common learning objectives, shared know-how and supported by national and international professional bodies.
Charani E, Singh S, Mendelson M, et al., 2020, Building resilient and responsive research collaborations to tackle antimicrobial resistance – lessons learnt from India, South Africa and UK, International Journal of Infectious Diseases, Vol: 100, Pages: 278-282, ISSN: 1201-9712
Research, collaboration and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR related strategies and policies AMR is recognised as an important contributor to success. Interdisciplinary, inter-sector, as well as inter-country collaboration is needed to span AMR efforts from the global to local. Developing reciprocal, long-term, partnerships between collaborators in high-income and low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case-studies spanning local to international research collaborations to co-design, implement and evaluate strategies to tackle AMR, we evaluate and build upon the ESSENCE criteria for capacity building in LMICs. The first case-study describes the local co-design and implementation of antimicrobial stewardship in the state of Kerala in India. The second case-study describes an international research collaboration investigating AMR across surgical pathways in India, UK and South Africa. We describe the steps undertaken to develop robust, agile, and flexible antimicrobial stewardship research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case-studies were sustained through the current severe acute respiratory syndrome corona virus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile antimicrobial stewardship programmes.
Birgand G, Blanckaert K, Deschanvres C, et al., 2020, Testing strategies for the control of COVID-19 in nursing homes: Universal or targeted screening?, Journal of Infection, ISSN: 0163-4453
Peiffer-Smadja N, Rawson TM, Ahmad R, et al., 2020, machine learning for clinical decision support in infectious diseases: a narrative review of current applications (vol 26, pg 584, 2020), CLINICAL MICROBIOLOGY AND INFECTION, Vol: 26, Pages: 1118-1118, ISSN: 1198-743X
Birgand G, Haudebourg T, Grammatico-Guillon L, et al., 2020, Intraoperative door openings and surgical site infection: a causal association?, Clinical Infectious Diseases, Vol: 71, Pages: 469-470, ISSN: 1058-4838
Masson C, Birgand G, Castro-Sanchez E, et al., 2020, Is virtual reality effective to teach prevention of surgical site infections in the operating room? study protocol for a randomised controlled multicentre trial entitled VIP Room study, BMJ OPEN, Vol: 10, ISSN: 2044-6055
Peiffer-Smadja N, Rawson TM, Ahmad R, et al., 2020, Machine learning for clinical decision support in infectious diseases: A narrative review of current applications, Clinical Microbiology and Infection, Vol: 26, Pages: 584-595, 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
Birgand G, Troughton R, Mariano V, et al., 2020, How do surgeons feel about the “Getting it Right First Time” national audit? Results from a qualitative assessment., Journal of Hospital Infection, Vol: 104, Pages: 328-331, 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.
Birgand G, Mutters NT, Ahmad R, et al., 2020, Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study, Antimicrobial Resistance and Infection Control, Vol: 9, ISSN: 2047-2994
BackgroundUsing case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.MethodsIn this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics.ResultsBetween January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p
Peiffer-Smadja N, Dellière S, Rodriguez C, et al., 2020, Machine learning in the clinical microbiology laboratory: has the time come for routine practice?, Clinical Microbiology and Infection, ISSN: 1198-743X
Birgand G, Haudebourg T, Grammatico-Guillon L, et 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
Birgand G, Schouten J, Ruppe E, 2019, Less contact isolation is more in the ICU: the con position., Intensive Care Medicine, ISSN: 0342-4642
Vaillant L, Birgand G, Esposito-Farese M, et 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
Ahmad R, Zhu NJ, Leather AJM, et 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
Troughton R, Mariano V, Campbell A, et 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.
Azevedo-Coste C, Pissard-Gibollet R, Toupet G, et 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.
Birgand G, Azevedo C, Rukly S, et 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.
Hue R, Coroller-Bec C, Guilloteau V, et al., 2019, Highly drug-resistant bacteria: Is intra- and inter-hospital communication optimal?, Médecine et Maladies Infectieuses, ISSN: 0399-077X
Legeay C, Hue R, Berton C, et 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.
Charani E, Smith I, Skodvin B, et 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
Troughton R, Birgand G, Johnson AP, et 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.
Perozziello A, Routelous C, Charani E, et 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.
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