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Learning and Development Session 13:00 – 16:30 Tuesday 30 th May 2017

Learning and Development Session 13:00 – 16:30 Tuesday 30 th May 2017. Housekeeping. Welcome and introductions. Jen MacDonald - Researcher and ChaiN for SHAIPI Coordinator Dr Lesley Price - Researcher Professor Alistair Leanord - SHAIPI work stream 1

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Learning and Development Session 13:00 – 16:30 Tuesday 30 th May 2017

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  1. Learning and Development Session 13:00 – 16:30 Tuesday 30th May 2017

  2. Housekeeping

  3. Welcome and introductions • Jen MacDonald - Researcher and ChaiN for SHAIPI Coordinator • Dr Lesley Price - Researcher • Professor Alistair Leanord - SHAIPI work stream 1 • Professor Chris Robertson - SHAIPI work stream 2 • Professor Jacqui Reilly - SHAIPI work stream 3

  4. SHAIPI work stream 1: Understanding and managing HAI through studying the bacteria that cause HAI using innovative laboratory techniques Professor Alistair Leanord University of Glasgow

  5. Interconnections of work streams Feedback loop for WS1,2&3

  6. Omics team • Alistair Leanord • Tom Evans • Stephen Fox • Cosmika Goswami • Colin McCowan • Robin Young Matt Holden Kerry Pettigrew Martin McHugh

  7. Work underway • Looking at where and which E.coli cause infection • Looking at where and which S.aureus cause infection • Looking at where and which Enterococcus cause infection • Developing methods to rapidly identify outbreaks of infection in the NHS

  8. Type of work undertaken • By necessity laboratory based • Utilising samples collected in the NHS • Utilising information collected as part of National clinical, surveillance datasets • Have used what was already existing • Next period will require new collections

  9. New tools

  10. Example of Patient Analysis Pathway Patient with UTI CHI identification SMR1 ECOSS Data linkage Analytic platform Risk modelling Validated models nRTS High resolution typing AMR genotyping E. coli Targeted IPC Interventions SICPs/TBPs evidence for generic Interventions Targeted prevention and Management Evaluation of Patient and practitioner Experience

  11. The challenge of the healthcare delivery model

  12. Community Advisors may get involved in lab-based research in the following ways • Identifying public priorities for research from a range of possible ways forward • Being a co-applicant on research funding applications • Clarifying the publics’ understanding of issues related to the research that can be helpful in supporting funding applications • Suggesting clear and understandable text for research documents that needs to be understandable by non-specialists or the public in funding applications or research outputs • Helping to disseminate research findings to the public by contributing to the production of resources or participation in the delivery of the information • Being a co-author on public facing publications such as The Conversation enabling the research findings to reach a wider audience and raise the project profile

  13. SHAIPI work stream 2: Using data and computer systems to answer questions, solve problems and make decisions about the management of HAI Prof Chris Robertson University of Strathclyde Chris Robertson, Marion Bennie University of Strathclyde and Health Protection Scotland / Information Services Division Colin McCowan University of Glasgow Charis Marwick University of Dundee

  14. Work Package Three Aspects • Data linkage • Statistical modelling • Stratified risk assessment

  15. Data Linkage Key datasets: • ECOSS-microbiology • HMUD-medication use in hospital • PIS-primary care prescribing • SMR-hospital activity and deaths • SSIRS-surgical site infections • Laboratory results

  16. Data Linkage • Takes data about individual people • Totally anonymous • From a variety of healthcare sources • Links this information together • To provide information about associations between • Activities and outcomes

  17. Example • Prescriptions of antibiotics by GP to a person with a lung infection • Impact on the risk of being admitted to hospital

  18. Statistical Modelling • Techniques to estimate the association between exposures and outcomes • Expressed as risks • Not everyone reacts exactly the same way so there is variation • Statistical analysis is the scientific method of coming to reasoned and reproducible conclusions in the presence of variability

  19. Scotland’s Population http://www.gov.scot/Topics/People/Equality/Equalities/DataGrid/Age/AgePopMig

  20. Risk of Community Acquired Clostridium Difficile (CA-CD) by age in Scotland Using data for period 2010-2013 Rate per person per year http://www.hps.scot.nhs.uk/haiic/sshaip/resourcedetail.aspx?id=3201

  21. Absolute Risk Woman aged 60 risk is 0.0001 1 in 10,000 10 in 100,000 There are about 33,000 women aged 60 in Scotland

  22. Relative Risk Woman aged 60 risk is 0.0001 Woman aged 90 risk is 0.0010 Relative risk is 10 Risk of CA-CD is 10 times greater for a 90 year old woman compared to a 60 year old woman

  23. Interpretation • Relative risks can be very large • Absolute risks are small • A risk of 0.0010 is still small • 1 in 1000 women aged 90 • About 8000 women aged 90 in Scotland

  24. Interpretation • Although the risk is small • Some individuals do contract the infection • For them, in particular, and for the health service, in general, • The consequences are great • Try and identify the individuals at highest risk

  25. Risk model for community acquired Clostridium Difficile

  26. One year risk of CDI No other risk factors 2.1 per 100,000 70 Irritable Bowel Disease 3.5 per 100,000 4C 4C 2 inpatient stays in last year 5.3 per 100,000 4C 4C 15 prescribed items in total last year 12.9 per 100,000 28 days of antibiotics in previous 6 months 27.8 per 100,000 28 days of 4C antibiotics in previous 6 months 102.8 per 100,000

  27. Summary • Data about individual people (anonymous) • From a variety of healthcare sources • Linked together • Using statistical modelling • To enable doctors to manage patients better to reduce risk of healthcare associated infections

  28. Involvement • Communication of risk about - individuals and - groups of individuals • Helping to develop guidance that is useful for patients and doctors

  29. Professor Jacqui Reilly SHAIPI work stream 3: Improving HAI prevention practices by developing evidence of their effectiveness and promoting the implementation of these practices by healthcare staff, patients and the public

  30. Overview What is in work stream 3 and why? How does it synergise with the other work streams in SHAIPI and extant research at GCU? What have we delivered in year 1 and plans for year 2? What are planning next and how can you help?

  31. WP1: Evidence for Infection Control Precautions What are these precautions and why do they matter? • Ten things for every patient every time to prevent HAI? • What are they? What are the gaps in the evidence in SICPs? • There is limited evidence for most measures What are our priorities for delivery? • Evidence for hand hygiene and glove use • Patient experience and acceptability What is the potential impact? • National and international guidance policy and practice

  32. How does it synergise with the other work streams in SHAIPI and extant research at GCU?

  33. Optimising IPC measures for emerging threats = Projects initiated in year one across work streams

  34. Building on existing collaboration

  35. Building on existing IPC research at GCU

  36. What has been delivered?

  37. Examples from patient and staff experience programme:

  38. HPS Norovirus Outbreak Guidance Season Preparedness, control measures & practical considerations for optimal patient safety and service continuation in hospitals Chief Nursing Officer Fiona McQueen added: “There may also be times when hospitals or care homes will ask you not to visit during an outbreak to prevent further spread of the virus. During the winter season please check with the hospital or care home before you go to visit. Temporarily suspending visiting to affected wards allows infection prevention and control teams to monitor the situation and also reduce, as much as possible, the chance of norovirus being passed onto a relative or loved one or transferred between patients and visitors”. [SGHD Norovirus Advice, 26th November 2015]

  39. What next?

  40. Summary: You have seen the work stream, team and plan Where we have involved the public and patients in the research process to date and where we would like to do more Any questions?

  41. Small group discussions An opportunity to ask questions about the previous presentations • Meet the lead of each work stream in a small group • Gain a deeper understanding of the type of research being conducted in each work stream • Gain a deeper understanding of the types of public involvement activities available in each work stream

  42. Small group discussions An opportunity to influence how the group (ChaiN for SHAIPI) works and communicates • Contribute to decision-making and development of documents about how the group (ChaiN for SHAIPI) works • Contribute to decision-making and development of documents about how the group (ChaiN for SHAIPI) communicates

  43. Summing up Likely forthcoming involvement opportunities Organise date for the next Learning and Development session (October 2017) Content of the next Learning and Development session – suggestions?

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