hcai  service users research forum 

Healthcare associated infections - service user research forum

London, May 4th 2010


Maria Cann is a core member of the service user research forum and a representative of MRSA Action UK.  If anyone is interested in becoming involved in the research forum there are vacancies.  The group meets around twice annually and communicates on research proposals on a regular basis.  There are opportunities to review research proposals and to be involved in patient led research relating to prevention and raising awareness of healthcare associated infections....

Request from Infection Prevention Society: User perspectives on Catheter Associated Urinary Tract Infection


Heather Loveday had received a request from the Infection Prevention Society for the patient / user perspective on catheter associated urinary tract infections.  These are often the source of bacteraemia and many of our members have been affected in this way.  The reduction in catheter associated urinary tract infections was recognised as a frequent source of bloodstream infections by the Chief Nursing Officer and the reduction in these infections had been set out as a key objective in saving lives.


Discussion focussed around the use of care bundles and whether these needed improving.


The availability of appropriate products and the choices made available to patients was limited; there was anecdotal evidence to suggest that PCTs were limited with their freedom to prescribe.  Some items on the list were not always the cheapest but often less effective.  Anyone wishing to receive information on the equipment that is available to help the patient can contact Susan Bennett directly and she will be able to help.  There needed to be a shift in attitude toward not accepting that getting an infection was inevitable if the insertion of a catheter was required.


Use of silver coated or alternatives that are designed to limit the formation of bio-films was another potential area considered appropriate to research.


The routine insertion of indwelling catheters during surgery without patient consent was discussed.  Routine insertion of cannula on admission had been halted in many hospital trusts as this had been cited as a route for infection.  Research into why clinicians do this and whether trusts had stopped the practice of routinely inserting indwelling catheters and the effects on infections rates was another avenue of interest to the forum.


Training on aseptic non-touch technique was believed to play a large part in preventing these types of infection.  Whilst the environment is not sterile, non-touch technique on key parts can impact significantly on reducing risks of infection.  This would be applicable to anyone involved in clinical care in or outside of hospital.  Information of the training made available to staff and patients was limited and could be researched to identify how to improve compliance with the technique.


The British Association of Catheter Users and Infection Prevention Society would generate a series of questions which would be circulated to the group.


Research for Patient Benefit


A service user/nurse collaborative had submitted an outline grant application with the full submission to be completed by 21 May 2010.


The collaborative nursing and service user study aims to


Elucidate patients' experiences of MRSA screening and also experiences of decolonisation treatment for those who are MRSA positive;


Investigate staff perceptions of MRSA screening;

Identify what interventions and information will improve the screening process and compliance with decolonisation treatment;

Devise, pilot and evaluate a MRSA screening toolkit collaboratively with staff and SURF input to include effective patient information materials, patient-focused staff training materials to improve the provision of information and a patient assessment tool to identify and assist individuals who may require support with decolonisation treatment;

Identify a set of patient reported experience measures to support NHS hospitals in evaluating the patient experience of screening for MRSA and undertaking decolonisation treatment.

A discussion on the submission took place Maria Cann believed this work was essential and should link in to the work of the NHS Institute for Innovation and Improvement, they were conducting workshops with service users and infection prevention specialists from across the NHS to develop a toolkit for staff to assist pre-operative assessment staff with having conversations with patients on the need for MRSA screening and what happens after the screening.  MRSA Action UK advocates post discharge screening to keep a check on bacterial colonisation, since hospital environments are more likely to give patients an encounter with micro-organisms, to include MRSA, due to the high usage of antibiotics and large numbers of vulnerable susceptible patients who are hospitalised.


MRSA Action UK knows that the patient experience shows that joined-up working is needed with the primary care setting, to include domiciliary and social care, particularly with the trend toward aiming for speedier discharge from hospital.  Support is needed prior to and on discharge from hospital.  Decolonisation treatment prior to surgery needs to be conducted effectively for the treatment to work, and vulnerable people are not always equipped to do this effectively.


We believe patient reported experience measures should identify:


Whether the surgery was elective or emergency;

Whether the result was positive or negative;

If they were negative were they still worried and was any further advice given, if so what advice, ie leaflet, referral to pharmacist, other agency;

Where the screening took place - the GP practice; out-patient clinic; hospital, or at home

Who informed the patient of the result?

How they were informed - by letter and a leaflet, whether this included an opportunity for further discussion; face-to-face, whether this was the consultant, GP or other professional; an outside body; whether this was discussed with multiple agencies, why did they choose to go elsewhere for information?  Was the information useful?  Were they worried by any of the information, and were the professionals able to allay their concerns?

For elective patients:  If they were MRSA positive were they given a choice of where to receive the decolonisation treatment?  Would they have preferred to be given a choice, ie at home or in hospital?  Did they believe they were well enough to perform the decolonisation regime at home?  Did they know of the support they could receive through Social Services?

Was the treatment documented in their care plan, and was an integrated care pathway for MRSA included in the care plan?

Recommendations will be made to the NHS based on the toolkit and patient reported experience measures developed and evaluated during the project.  It was agreed to supply supporting information to demonstrate the need for further work to supply information on screening and its impact on patients.


Refresher session on running effective focus groups


Andrea Whitfield presented a session on running effective focus groups followed by a discussion on what areas of research were best suited to using a focus group.  The research provides qualitative data and is good to scope out ideas; they are a dynamic activity that can be used more efficiently than one to one interviews.  People who have had similar experiences can feel more comfortable in speaking about issues.  Focus groups should be planned and structured with some professional input for structuring questions for discussion.  It can be useful to agree some ground rules so that sensitive issues can be discussed in a relaxed manner.  The moderator will need to encourage a balance from participants and avoid generating an atmosphere where participants may dominate the discussion.  Whilst is should be relaxed the environment should be controlled so that those who have not had an input can have a chance to participate.  Active listening is important, summarising points made and repeating these back is important.  Recruiting through hospital trusts, charities and interest groups was a good way to source participants, also church groups and community outreach.  The ideal size for a focus group is between 8 to 10 participants.


Review and focus group on hand hygiene educational intervention produced by City University London


Increasing accountability for infection prevention


City University London have developed a web-based video in which patients and carers discuss the impact of having contracted healthcare-associated infection on their domestic, social and working lives. The researchers wish to explore health professionals� reactions to the video, its potential to be used as an educational tool and in wider research to improve compliance with infection prevention strategies, and embed responsibility and accountability for washing their hands at the point of patient care first time every time.  The service user research forum took part in the evaluation of the video.  The discussion was subject to data protection due to the participation of patients, therefore details are not published on our website.  The stories were very moving and very much like our own experiences.  If you would like to discuss Maria's personal perspective on being affected by a healthcare associated infection then please contact us at info@mrsaactionuk.net  


If you would like to be involved with SURF please contact

Alison Tingle - Principle Research Programme Officer
Heather Loveday - Deputy Director National HCAI Research Network


If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at info@mrsaactionuk.net