Healthcare associated infections - service user research forum 

London, October 5th 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. 

The event on the 5th October focused on:

The INVOLVE conference and developing a poster to advertise and highlight to work of the forum;   Innovation in medical devices and designing out infection, presented by Jennie Wilson, Director of Infection Prevention and Control at Imperial College Healthcare NHS, and Planning and conducting one to one interviews with Dr Peter Harper from Thames Valley University.

INVOLVE conference

The forum worked on developing a poster for the INVOLVE conference in November. Alongside the text and pictures some short "sound bites" were recorded.

These consisted of comments from SURF members on their experiences of activities undertaken by the group. The poster should be more engaging and stand out from others by having an activity to draw the attention of researchers.

We were invited to think about the following questions, answers to questions 2 and 4 were recorded for use at the INVOLVE conference in November:

1)    "What do you feel you have been able to offer to researchers through SURF membership?"
Giving a practical viewpoint to research proposals and collectively having an influence on ideas for research proposals.

2)     "Briefly, how could the relationship between service users and researchers be improved?"
Researchers should involve service users earlier on when considering proposals to identify what is important to them.  This will mean we can work towards more meaningful involvement, and move towards a more patient-led approach.

3)     "How have you benefited from being a SURF member?"
Learning from other service users' experience, you can never share too many patient experiences to be able to listen and learn first-hand about how health policies on antimicrobial resistance and preventing infections can impact on them.

4)    "What skills have you personally developed?" / "What have you learned?"
I've learned a lot about the relationship between healthcare professionals, researchers and attitudes and beliefs about patient involvement.  It takes some commitment and interpersonal skill to be able to try to get them to understand that we really want to be involved in shaping policy and the impact we know this will have on us.

5)    "What are your thoughts/ experiences of the process of putting together a research submission"
It takes a lot of thought and you have to research outcomes of similar projects to make sure policies that may evolve from the research do not have a detrimental effect, ultimately on patients, the wider public and service providers who will need to be able to deliver outcomes.

6)    "What did you learn in the process?"
The complexity involved means you need to be very clear about the outcomes and that everyone involved needs to broadly agree with the desired outcome.

7)    "What can be improved next time?"
Service users can draw on the expertise of service providers and 'experts' in their particular area to feed into the process, this largely depends on being able to access them, most of us have access to this resource and we can improve opportunities to tap into them.

Using technology to prevent healthcare associated infections
Jennie Wilson Deputy Director of Infection Prevention and Control, University College Hospital, London

Jenny gave an interesting overview of how technology can be used to reduce the burden of healthcare associated infections in hospital.  High impact interventions, such as decontamination of equipment, washing hands effectively before and after patient care and attention to asepsis when carrying out clinical care, are essential to keep patients safe from healthcare associated infections.  However there are more things that can be done to eliminate risks to patients.

To understand how we can help to reduce the numbers of bacteria in the healthcare environment it helps to know about their characteristics and the environment that is conducive to their survival.

Keeping surfaces clean and dry can help resistance to bacteria.  This is particularly the case for gram negative bacteria which need a moist environment.  All bacteria need a source of transmission, they can't move themselves.  It is a fact that hands are a vector for transmission in the environment.  Bacteria will stay on surfaces and be transferred by touch and from patient to patient, which is why there is such a focus on hand hygiene and asepsis in clinical care.

Gram positive bacteria, such as Clostridium difficile, can produce spores when moisture and nutrients are taken away and can survive in the environment, in dust and other particles for a considerable period of time, and reinvigorate when moisture and nutrients become available.  There is no universal disinfectant that will work on all bacteria, there is already evidence that some bacteria can develop resistance to disinfectants, so this is only a partial solution to the constantly changing challenges that the bacteria set.

Our own bodies will form a defence to invasive devices such as central venous lines, cannulae and catheters.  Biofilms form on surfaces and proteins develop where bacteria can colonise and grow, this is why it is important to only use invasive devices where absolutely necessary and when they are used it is worth considering the use of technological developments to help avoid infections.

Silver, Chlorhexidine, and antibiotics such as minocycline and rifampcin can be used as interventions to assist.

At UCLH catheter related bloodstream infections have reduced significantly by the use of high impact interventions and advanced technologies, there is efficacy in using silver coated catheters, the cost is 5 pounds versus 1 pound, but the benefits outweigh the cost of the catheters against the cost of a healthcare infection.  The additional benefit is the prevention of readmission.

Other interventions include preparing skin with 2% Chlorhexidine, as this eliminates the skin flora more effectively prior to any invasive procedure being carried out.

A technique known as 'Normothermia' using patient warming can assist, as patients are more susceptible to infection when they undergo lengthy surgery and become cold.

Testing cleanliness of the environment beyond visual inspection can be by use of ATP detection.  Adenine triphosphate (ATP) technology measures molecules that break down glucose, and can be used to detect where there have been cells on surfaces.

The Design Bugs Out programme enabled the development of hospital furniture and devices to minimise surfaces that collect dirt, and can be considered when purchasing equipment for the patients' environment.

Discussion took place around the use of invasive devices; there was little research on the efficacy of using technology such as silver-coated catheters to reduce the incidence of catheter related bloodstream infections, which are a considerable cause of morbidity.  Similarly there was little research on the use of invasive devices and lines routinely, but there was anecdotal evidence to suggest this may be happening.

Comments from the group:

"It's easier to put catheter in place if a patient is incontinent"

"In the ambulance, A&E and triage, stick a cannula in "just in case"

"Why not use oral pain relief rather than a pump and IV line"

"It can be for the benefit of staff rather than the patient"

Invasive devices and lines, are they used unnecessarily, putting patients at risk?  This would be a good starting point for the Research for Patient Benefit programme, similarly the question on the efficacy of using silver-coated catheters would be of considerable benefit it this could be encouraged as standard use for anyone requiring catheter care.


Maria Cann


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