Infection Prevention 2012

MRSA Action UK joined Molnlycke Healthcare in Liverpool from the 1st to 3rd October 2012 for Infection Prevention 2012 

Thank you to Simon Price and his colleagues from Molnlycke Healthcare for giving us the opportunity to attend which presented many opportunities to network and raise awareness of our work. There were many interesting presentations and on day one Maria Cann joined Andrea Whitfield from the HCAI Service Users Research Forum (SURF) to present SURF's poster, titled "Active Public Involvement in Healthcare Associated Infection Research, Developing Collaborative Projects.

Andrea joined David Britt to present'Are they ready? A study of student nurses' infection prevention skills'

This was a patient-led study supported by the researchers from SURF. A background - Curriculum guidelines for undergraduate nurses specify infection prevention and control (IPC) skills and knowledge that must be taught to nurses entering the healthcare profession. Recent research has focused on qualified nurses' practice in areas such as hand hygiene and the effectiveness of training initiatives, but had not explored the competence and confidence of nurses in IPC at the point of qualification. This pilot study was undertaken in one university and involved academics, nurses, teaching staff and service users. The study aimed to explore students' levels of competence in key IPC skills and knowledge, and their self-rated levels of confidence.

The project involved a desk top analysis of the IPC curriculum, a study involving a survey of student nurses and a simulation. Our Vice Chair Helen Bronstein had taken part in the simulation; both Helen and Maria had worked with SURF on the design of the study, which was an original idea of SURF member David Britt. The research concluded that the survey of English universities delivering nurse education indicates variation in Infection Prevention and Control teaching and assessment methods with minimal use of simulated practice.

We were delighted that the presentation received the accolade of best oral presentation at the conference. Maria collected the award on behalf of SURF at the end of the conference. More significantly the research has resulted in work to develop an educational approach aimed at increasing Infection Prevention and Control knowledge and competence through simulation.

We also attended the presentation on the "Trial of hand hygiene monitoring system with immediate feedback"

Sarah Storey of UCLH NHS Foundation Trust, presented the findings from another project that SURF were involved in. The Green Badge scheme developed by Aleric Best of Veraz Ltd, was piloted at UCLH hospital. The badge is empowering for patients as the 'smart' technology can track if healthcare staff have washed their hands prior to giving care to patients and will change colour according to whether healthcare workers are compliant with the five moments of hand hygiene. SURF's role was to advise on the communication with patients.

The research concluded that automated monitoring of hand hygiene with immediate feedback is an effective means of improving hand hygiene compliance. Patients' primary concern was their illness and not feeling unable to challenge staff if they needed to, as was originally feared.

We attended 'How to undertake successful research', presented by Professor Judith Tanner, Professor of Clinical Nursing Research, De Montfort University and Dr David Jenkins, Consultant Medical Microbiologist, University Hospitals of Leicester NHS Trust. The presentation explored how to turn ideas into a research study, identify what support is available and discuss the availability of funding. We took the opportunity to promote including service users in the research highlighting the presentation "Are they ready" and the impact that patient-led ideas can have.

On World MRSA Day we took the opportunity to attend 'Patient Involvement - A requirement for patient safety' presented by Margaret Murphy, Leading on Patients for Patient Safety at the World Health organisation. Margaret spoke of her son Kevin who died as a result of a series of missed diagnoses, lost opportunities, and inappropriate medical care.

Margaret also spoke of Jeanine Thomas of MRSA Survivors Network, and recognised World MRSA Day, as this presentation was delivered on October 2nd - the anniversary of its discovery 51 years ago. The role of patients and their engagement with healthcare providers was something that we were able to relate to as Margaret related some of the saddest cases we had heard. Not listening to desperate pleas from a mother regarding the removal of a healthy kidney leaving their child with no functioning kidney and the consequences that brought was one example that we found difficult to bear, and one that we could personally relate to having not being listened to ourselves when our loved ones were subject to inappropriate treatment.

Jeanine Thomas promoting World MRSA Awareness Month - Times Square, courtesy of Reuters and PR Newswire

Margaret's closing slide pictured her son Kevin and the pledge of the partnership "in honour of those who have died, those who have been left disabled, our loved ones today, we will strive for excellence so that all people receiving healthcare are as safe as possible, as soon as possible"

We had a very busy day on October 2nd and managed to raise awareness of the significance of the date with many colleagues, this included speakers and also colleagues from industry, and the Conference Centre was full of people wearing blue ribbons to commemorate the day and remember all those lost and affected by MRSA. A gallery of photographs of everyone who helped to raise awareness can be viewed here.

We met Professor Graham Ayliffe, whose name is synonymous with the now well know hand washing technique that we see everywhere. Professor Ayliffe took the time to describe how the technique had evolved when it became evident that parts of the hands were being missed. One of his students had long thumbs and it was proving difficult to clean effectively, which is why the Ayliffe technique includes the action to rub the thumbs separately.

Professor Graham Ayliffe and Derek Butler

Are we too clean for our own good? - the hygiene hypothesis and its implications for Infection Prevention and Control

Professor Sally Bloomfield, Hon Professor London School of Hygiene and Tropical Medicine, Chairman International Scientific Forum on Home Hygiene

Professor Sally Bloomfield gave a very interesting presentation posing the question on the hygiene hypothesis, asking if we are too clean for our own good. The presentation coincided with the publication of the review of evidence and study carried out by Professor Bloomfield, and the following is an extract of the key findings in the report.

Extract from the report:

"Governments are looking at prevention as a means to reduce health spending. Increased homecare is one approach to reducing health spending, but gains are likely to be undermined by inadequate infection control at home. Healthcare workers now accept that reducing the burden of infection in healthcare settings cannot be achieved without also reducing the circulation of pathogens such as norovirus and MRSA in the community. At the same time, people with reduced immunity to infection make up an increasing proportion of the population, currently up to 20%. The largest proportion is the elderly, many of whom have chronic ill health, which further reduces immunity to infection. Much of the care of these vulnerable groups is carried out by family members, who therefore need an understanding of infection prevention to protect them against foodborne and respiratory infections. Infectious diseases can act as co-factors to other diseases that manifest at a later date, such as cancer and chronic degenerative diseases, or as triggers for development of allergic diseases.

Since 2006, the risk of disease related to poor hygiene has not diminished and the need for hygiene promotion has been further recognised, including by proponents of the hygiene hypothesis. The concern about over domestic cleanliness and hygiene practices has been shown to be misplaced, while multi-factorial causes for allergic and other chronic inflammatory disorders, including the role of obesity, physical fitness and socioeconomic influences, have gained importance. The conclusion of this review is that diminished exposure to the immunoregulation-inducing organisms from man's evolutionary past ('Old Friends') is a consequence of an accumulative series of changes in lifestyle that result in loss of contact with mud, animals and faeces, and major alteration of the micro-biota. This is quite distinct from 'hygiene' in the sense of reducing the risk of infectious disease transmission. Relaxing hygiene in a modern urban environment would not expose us to Old friends - only to new enemies like E. coli O104.

Thus the major conclusion is that hygiene, in the sense of decontaminating or disinfecting in the times and places where it matters to prevent infectious disease, is still very much needed. It seems likely that many aspects of our modern civilisation are contributing to the rise in allergies and chronic inflammatory disorders, including several that cannot be safely changed, such as clean water, sanitation, less contaminated food and urbanised living.

There is no evidence that domestic cleanliness has gone too far and, in particular, that it is vital to continue to promote efficient hygiene practice. For those working in the field of infectious disease prevention and hygiene, we need to develop health promotion messages that help people to distinguish between letting children play in mud in the garden but also protecting them against potentially harmful microbes at the appropriate times. Persuading the public to develop lifestyles which reconnect with the natural environment, whilst also using targeted hygiene to protect themselves from infection represents a challenge for our time.

The final presentation of the three day conference was "How to identify, expose, and challenge Bad Science" presented by Dr Ben Goldacre, Author and Academic

Dr Ben Goldacre described himself as a doctor and an epidemiologist and gave an interesting perspective on how to identify, expose and challenge bad science. The following is an edited transcript of some of the items featured in his thought provoking presentation:

"Epidemiology is the science of how we know in the real world if something is good for you or bad for you. And it's best understood through example as the science of those crazy newspaper headlines. And these are just some of the examples.

Because real science is all about critically appraising the evidence for somebody else's position. That's what happens in academic journals and at academic conferences. The Q&A session after a post-op presents data is often a blood bath. And nobody minds that. We actively welcome it. It's like a consenting intellectual smoke and mirrors activity.

10 years ago Risperidone, which was the first of the new-generation antipsychotic drugs, came off copyright, so anybody could make copies. Everybody wanted to show that their drug was better than Risperidone, so you see a bunch of trials comparing new antipsychotic drugs against Risperidone at eight milligrams a day. Again, not an insane dose, not an illegal dose, but very much at the high end of normal. And so you're bound to make your new drug look better. And so it's no surprise that overall, industry-funded trials are four times more likely to give a positive result than independently sponsored trials.

When you look at the methods used by industry-funded trials, that they're actually better than independently sponsored trials. And yet, they always manage to get the result that they want. So how does this work? How can we explain this strange phenomenon? Well it turns out that what happens is the negative data goes missing in action; it's withheld from doctors and patients. And this is the most important aspect of the whole story. It's at the top of the pyramid of evidence. We need to have all of the data on a particular treatment to know whether or not it really is effective. And there are two different ways that you can spot whether some data has gone missing in action. Reboxetine is a drug that I myself have prescribed to patients. And I'm a very nerdy doctor. I hope I try to go out of my way to try and read and understand all the literature. I read the trials on this. They were all positive. They were all well-conducted. I found no flaw. Unfortunately, it turned out, that many of these trials were withheld. In fact, 76 percent of all of the trials that were done on this drug were withheld from doctors and patients. Now if you think about it, if I tossed a coin a hundred times, and I'm allowed to withhold from you the answers half the times, then I can convince you that I have a coin with two heads. If we remove half of the data, we can never know what the true effect size of these medicines is.

And this is not an isolated story. Around half of all of the trial data on antidepressants has been withheld, but it goes way beyond that. The Nordic Cochrane Group was trying to get a hold of the data on that to bring it all together. The Cochrane Groups are an international nonprofit collaboration that produces systematic reviews of all of the data that has ever been shown. And they need to have access to all of the trial data. But the companies withheld that data from them, and so did the European Medicines Agency for three years.

This is a problem that is currently lacking a solution. And to show how big it goes, this is a drug called Tamiflu, which governments around the world have spent billions and billions of dollars on. And they spend that money on the promise that this is a drug which will reduce the rate of complications with flu. We already have the data showing that it reduces the duration of your flu by a few hours. But I don't really care about that. Governments don't care about that. I'm very sorry if you have the flu, I know it's horrible, but we're not going to spend billions of dollars trying to reduce the duration of your flu symptoms by half a day.

We prescribe these drugs, we stockpile them for emergencies on the understanding that they will reduce the number of complications, which means pneumonia and which means death. The infectious diseases Cochrane Group, which are based in Italy, has been trying to get the full data in a usable form out of the drug companies so that they can make a full decision about whether this drug is effective or not, and they've not been able to get that information. This is undoubtedly the single biggest ethical problem facing medicine today. We cannot make decisions in the absence of all of the information."

The conference was very interesting and it was good to be able to network with colleagues from across healthcare and hear so many informative presentations.