What research is important to help keep research into healthcare associated infections in the spotlight?

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James Lind Alliance - Priority Setting Partnership (Healthcare associated infections)

Selecting the top ten priorities for research

Healthcare-associated infections (HCAI) are normally defined as infections that affect patients in a hospital or other healthcare facility, and are not present or incubating at the time of admission. They also include infections acquired by patients in the hospital or facility that appear after discharge, and occupational infections among healthcare professionals. HCAIs are the most frequent adverse event in healthcare delivery worldwide. HCAI is believed to cost the NHS at least £1bn annually and causes at least 5000 deaths every year. Many patients’ hospital stays are prolonged having a major impact on them and their families.

There are a number of different prevention, identification and treatment options for HCAI. It is important that we undertake research to try to understand which of these are effective and make a difference to those affected. Research should focus on questions that are important to people with, or at high risk of, HCAI, those who care for them and healthcare professionals who treat, identify and try to prevent infections.

We collected more than 250 questions from our initial survey. The committee which included patient representatives and clinicians narrowed this down to 50 questions. In the second survey, the responses helped to identify the importance of these questions. The findings focussed on identification, prevention and treatment of HCAI. This encompassed blood stream, chest, wound and urinary tract infections, infections related to the use of catheters and other devices and hospital cleanliness. The use of antimicrobials and antimicrobial resistance, such as in the case of MRSA. The final workshop concluded the top priorities for further research:

Healthcare Associated Infections Top Priorities

1. How can infections be identified early?

2. How can we change the behaviour of healthcare professionals to follow best practices in preventing and controlling HCAI?

3. Can point-of-care testing (bedside testing) in the primary care or secondary care setting improve patient outcomes and decrease antibiotic resistance?

4. What is the most effective cleaning agent to prevent multi-drug resistant organisms?

5. Can antibiotic stewardship policies (including decreased antibiotic prescription) decrease antibiotic resistance, and do they cause any harm to the patients?

6. How can we educate patients to look for clinical signs of HCAI?

7. What is the role of change of bacteria in patients or the environment in the development of infection in hospital?

8. In people with antibiotic resistant bacteria, what is the impact of single room isolation compared with open-ward care in the overall care and mental health of the person with antibiotic resistance and in preventing transmission of infections to others?

9. Does infection prevention and control training of patients and carers help in the prevention of infection in vulnerable patients being cared for in their own homes?

10. How can the development and severity of urinary tract infections in elderly be decreased?

The following questions were also discussed and put in order of priority at the workshop:

11. How can we alter the public perception of antibiotics in order to ensure that antibiotics are not sought for conditions for which there is no benefit?

12. How does individualised antimicrobial dosing compare with standard dosing regimen in patients admitted in intensive care unit with infections?

13. Is screening and isolation of patients with antibiotic resistant bacteria effective (in decreasing transmission of infections and deaths)?

14. How effective is alcohol gel in preventing HCAI?

15. How can we improve general hygiene and hand hygiene in hospital visitors?

16. Is outpatient antibiotic therapy better than inpatient antibiotic therapy in people requiring intravenous antibiotics?

17. Can nanotechnology (that is working with very small particles) result in better treatments for infection?

18. How can chest infections be prevented in elderly people admitted to hospital?

19. Does antibiotic prescription based on point-of-care (bedside) C-reactive protein to diagnose bacterial infection decrease amount of antibiotic prescription, antibiotic resistance, and hospital admission due to community-acquired pneumonia?

20. Does keeping intravenous lines connected for 72 hours decrease HCAI compared to frequent connection and disconnection of intravenous lines in patients with intravenous lines?

21. How can we improve the resources available to healthcare professionals, volunteers, and cleaners and improve their knowledge and training for better identification, prevention, and treatment of HCAI?

22. How can we improve the antimicrobial prescription by junior doctors?

23. Should the requirement for urinary catheters be periodically reviewed in people with long-term urinary catheter?

24. What are the alternatives to single room isolation of people with antibiotic resistant bacteria so that the care of such people can be improved?

25. Do sensor operated taps, toilet lids, and door opening in hospitals prevent HCAI?

26. Are single-day antibiotics better than longer course of antibiotics in treating urinary tract infection?

27. What is the risk posed to the patients admitted in hospital by visitors in spreading all infections including Norovirus and flu?

28. How can we improve the awareness of health-care professionals about sepsis?

29. What is the best antibiotic treatment for urinary tract infection?

30. Are bacteriophages better than antibiotics in people with antibiotic resistant bacteria?

Further details on the top ten priorities are available on the James Lind Alliance website

Email: Dr Kurinchi Gurusamy

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James Lind Alliance - Priority Setting Partnership (Healthcare associated infections)