Infection prevention and control developing the evidence challenging

Infection prevention and control: developing the evidence, challenging the interventions and moving towards implementation science Dr Lesley Price on behalf of: Applied infection prevention & control interventions programme The ‘SHIP’ Research Group (Safeguarding Health through Infection Prevention) Scottish HAI Prevention Institute (SHAIPI) Consortium

Overview of presentation: The Problem Hand hygiene Reduces infections Compliance is suboptimal Our contributions Developing Evidence for Hand Hygiene Practice Challenging Hand Hygiene Interventions Implementation of IPC guidance: 2

Evidence for the effectiveness of the WHO 6 step hand hygiene technique 3 v 6 step hand hygiene RCT Systematic Review of hand hygiene techniques The 6 step was microbiologically more Provides evidence of the effective at reducing the Impact median log 10 bacterial count. effectiveness of the 3 v 6 article in the top 5% of all technique but is Only 65% of participants research outputs scored by inconclusive about which could perform the technique is most effective Altmetric. correctly. Correct technique Society for Healthcare greater reduction in bacterial Epidemiology of America load. William Jarvis Award 2017. Invitation to WHO Hand Hygiene Expert meeting 2019.

Follow up studies from the 3 v 6 RCT – could it be how we teach it? 1 year follow up no significant difference in recall of the 6 steps between participants and nonparticipants. Inconclusive re multimodal or single intervention more effective. Lack of robust design & theoretical underpinning.

Need to think beyond the practitioner what can healthcare facilities and countries do? • Interventions were categorised according to type: multimodal, education, care bundles, policy, Impact surveillance and monitoring and feedback. • Provided evidence for the • Evidence of effectives in all categories but best WHO Core evidence for multimodal interventions and Components for monitoring and feedback. National IPC

Next steps: continuing to develop the evidence base for the most effective hand hygiene technique • Currently Ph. D project exploring the contribution of each of the 6 steps in reducing the bacterial load. • Currently conducting a systematic review on hand hygiene with regard to volume of product, time and hand size. • Developing a CRT comparing normal practice against 3 different adapted 6 step techniques. 6

Next steps: challenging hand hygiene interventions • Currently undertaking study looking at how many days deliberate practice is required before proficiency is developed. • Developing a CRT to test the contribution of each of the 5 components of the WHO multimodal hand hygiene strategy. 7

Next steps: developing the evidence base for implementation of IPC guidelines • 2 Ph. D projects evaluating the process of implementing the WHO’s Core Component for IPC Guidelines: • National level in Brazil & Scotland • Hospital level in Uganda 8

Summary & conclusion: • SHAIPI’s predecessor (SIRN) funded a study that initiated this programme of work (3 v 6 RCT). • SHAIPI has facilitated a programme of work bulding on this study by: • Funding a systematic review on hand hygiene techniques • Funding an overview of systematic reviews on hand hygiene interventions • Funding an evaluation of a Guinness World Record • Funding a Ph. D studentship • Pump priming the Systematic Review on National IPC intervention • Currently funding the Deliberate Practice Study & the development of 2 CRTs. 9

• In addition in recognition of this programme of work GCU has matched funded two other Ph. D studentships. • The work within this programme has been acknowledged by the CDC, WHO & SHEA and changed the WHO’s IPC guidelines. • This programme of work is contributing to the evidence base for hand hygiene and other IPC interventions, has had international impact & has and is contributing to IPC research capacity building. 10

Thank you. Any questions? l. price@gcu. ac. uk