The two-headed monster at #IP2014

After a busy few weeks of holiday followed by personal quarantine, I thought it was time I put pen to paper and shared some of the thoughts I’ve been having whilst reflecting upon my time at Infection Prevention 2014…(#IP2014).

Being an “academic” in a “real-world” situation is a great privilege, it allows you to get a real sense of the current state – something which can be missed if you only rely on feedback from academic papers and conference discussions.

My new role within a medical setting has changed the way I interpret information. It is not that I am no longer optimistic – far from it, I am, and always will be, an optimist – but now I have a wider appreciation for the reality of infection prevention “as it is”. Day to day. On the front line. And this is not a negative, difficult reality view. Or one filtered through an anti-research, anti-forward thinking environment. On the contrary, as I have the pleasure of working with the 2013 IPS Team of the Year, noted for their continuous focus on engagement activities and involvement with research and development, both with IPS and the RCN.

However, it is certainly a different position to be in.  And it made my experience of #IP2014 very different from my previous ones.  Let me explain…

In 2012 and 2013 I experienced the IPS conference through the eyes of a “pure” researcher, eager to know what was “out there” in terms of new data, new approaches and concepts, and potential new technologies to appraise.  I felt optimistic because infection prevention seemed to be moving at such a pace, swept along by incredible passion, determination and enthusiasm.  The wealth of information produced, through conference papers, journal articles, webinars and seminars was mind-blowing, yet incredibly welcome to a researcher “new” to the field.  Now, having completed my thesis and with more experience under my belt, I am much more concerned about what impact all this information could have on the way we work within healthcare. As I see it, from paper to practice.

image from http://www.coloringcrew.com

So I felt very much like a two-headed monster through most of the conference sessions I attended – one brain very excited about recent findings, theoretical discussions and endless potential, whilst my “other” brain was much more pragmatic, continually asking the questions “how would this impact healthcare professionals on any given Tuesday?”, “is this feasible”, and sometimes just a rather pointed “Really?!”.

Team inf_con at #IP2014 (image from @allisoncbradley)

 

The saving grace (that prevented one or both of my heads exploding) was the delightful new experience of attending the IPS conference as part of a team. Each session we attended, together or individually, was followed by the opportunity to discuss implications for our Trust, our staff and our patients. This directly addressed my “paper to practice” dilemma, and kept the two headed monster calm.

Darren sharing one of our posters

As a team we were very excited to be presenting three posters (.pdf here: 1, 2, 3) outlining a diverse selection of our current activities, and also providing an oral presentation on how we won the inaugural IPS Team of the Year award (abstracts available here).  I could not have been more proud of the enthusiasm, excitement and energy displayed by my colleagues; something which I am sure did not go unnoticed by the rest of the #IP2014 community. 

A key aim of my role within the team is to ensure that research is conducted which not only involves healthcare professionals, but which is driven by them. Therefore I was particularly proud to be involved in delivering our posters which outlined research instigated, and conducted, by current active healthcare professionals. It’s exciting to know that this is just the start…

Wonderful memories of #IP2014 (image from @darrenwheldon)

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An open admission…

So here it is.

As we know, I have now safely navigated through the PhD journey, and can officially say I have qualified as a Doctor of Engineering. My thesis, which examines future systems of hand hygiene measurement in healthcare, will soon be available for anyone to read.  Amazing.

Image from: http://manpreetdhuffar.files.wordpress.com/2013/04/photo1.jpg

Even more exciting (not sure I ever thought anything would top that…which shows you how much a PhD can change you!), we also know that I have now started working for the NHS – with the phenomenal IPCT at UHCW. 

Now two weeks into my role as IPC Research Practitioner and I have been blown away by how much I am enjoying myself, how diverse the workload and challenges that face the team are, and crucially how overwhelmingly welcoming the team have been.  I never doubted that for a second, but they have surpassed even my high expectations. I have LOVED every moment I have been there, and am so excited about the plans we have been making.  One thing I know for sure…we’re going to be BUSY!

And my admission?

I am SMUG.

I cannot help it. I have tried to battle it, but to no avail.  I just cannot help randomly smiling whenever I think about how much I am enjoying my new post-doc freedom, the ability to offer an “expert” opinion on real world, patient safety matters, and to be given the opportunity to develop research ideas that could make a difference to the way we think in the IP community.  It’s fantastic, and the picture below sums it up beautifully.

Whilst I enjoyed my PhD journey immensely, there is an element of being “caged” – when all is said and done, the main purpose is to develop as a researcher, and ensure you display skills required to earn the qualification.  Once this has been achieved, the freedom is granted to really focus on the research area…and this feels immense!

Image from: http://www.wayofcats.com/blog/wp-content/uploads/2011/04/Smug.jpg

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Promoting Hand Hygiene

As it is currently International Infection Prevention Week (IIPW) I thought I would write a quick post about hand hygiene promotion today – as it ties in with a lot of recent activities I have been involved in alongside tweaking the (almost complete!) PhD dissertation.

In addition to IIPW, earlier this month saw Global Handwashing Day (UK site here) whilst on May the 5th we celebrated SAVE LIVES: Clean Your Hands, the WHO annual Hand Hygiene awareness day.   Each of these carefully planned and well supported events allows the topic of Infection Prevention (and importantly for me, hand hygiene) to be promoted and discussed at perhaps a wider level than during the rest of the year.  One of the activities I have been involved in is writing a separate blog on human behaviour, technology and the WHO 5 Moments, which has been a great source of feedback and discussion.

Anyone visiting their local hospitals or health centres during these periods has probably noticed promotional material regarding hand hygiene, or seen information about the activities of the IPCT at that particular location.  A few photos from Twitter this week allowed a glimpse at the effort the Countess of Chester Hospitals NHS Foundation Trust IPCT have been putting in to promoting their work (captions their own)….

We’re keeping it clean… reducing MRSA and C.Diff #InfectionPreventionWeek

 

It’s Infection Control Week, keep your hands clean #InfectionPreventionWeek

 

By keeping your hands clean, you are helping your local hospital to stay infection free #InfectionPreventionWeek

 

UHCW IPCT also used Twitter to promote their activities during IIPW.  Every Wednesday they #WIPEWednesday – standing for Wash Hands – Isolate promptly – Prudent Antibiotic prescribing – Environmental Cleaning.  This week they launched their new #WIPE stickers, and followed a board-to-ward strategy to ensure everyone got the message.  Here are just a few of their photos (captions their own):

It’s #WIPEWednesday for #IIPCW today!

What does the W in #WIPE stand for? #WIPEWednesday #AskTheTeam

Our Chief Operating Officer knows what the I is for in #WIPE – he’s got a sticker & a card! #WIPEWednesday #IIPCW

Who knows the P of #WIPE ? Our CEO might be the man to ask? His sticker invites you to! #WIPEWednesday #IIPCW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

They have also been doing some great work with the Paediatric teams and Patients, using creative play to produce some beautiful hand hygiene promotional work:

They maybe our smallest patients, but they’re big on getting involved! #IIPC2013 #ptsafety #handhygiene

Finally they also launched their much awaited #HygieneHop video last week….a must see and share for all interested in Infection Prevention and Hand Hygiene: http://www.youtube.com/watch?v=eGCPPqGweNQ&sns=tw

Enjoy!!

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Checking In….

When I last blogged, way back in mid-April I was in need of a holiday, and was experiencing a mixed bag of events, although on the whole things were turning more positive, with enjoyable times being had with both Women In Science (#WISAnEveningWith) and the #GetStoolSmart campaign at UHCW.

So what has happened since?

Well, I managed to get away on the eagerly anticipated holiday! As with all such things, it seems a very long time ago now, but it was a wonderful break, and a great opportunity to spend some time outdoors (in all elements…!).  This isn’t a “Postcard From…” blog, but honourable mentions must go to (Dyfi Osprey Project, Welsh Cakes, MOMA Wales, Cadair Idris, and A Nets Catch).  Whilst I cannot say that I switched off from work completely (probably never possible for anyone), it was certainly much more pleasurable to be going through my presentations (Doctoral/IPS)  in my head whilst faced with scenery like this…

Doctoral Work – Getting it “Out There”

I hit the ground running when I got back from holiday, with the WMG Doctoral Conference (Healthcare) on the 29^th April, a positive chance to not only share my PhD progress with peers and WMG, but also to catch up with what other Doctoral students have been up to in the last 12 months. A PhD can be an isolating experience, especially when (like me) you are researching something “different” so spend most of your time working independently – so events like this are a welcome chance to gain feedback both professionally and personally. Fortunately the presentation seemed to be well received, and discussions over lunch were all positive, with great use of the word ‘rigour’…always a good thing to hear about your work when you’ve reached the ‘only writing up now’ stage I think…!

The 9^th May saw a second opportunity to share my work, this time as an Invited Speaker at the IPS Ambulance Forum and Audit and Surveillance Forum Conference (“Every Bug Counts!)” in Birmingham.  This was my first IPS meeting (outside of presenting my Poster at IPS 2012 last year), and I was absolutely blown away by the welcoming, supportive and truly friendly atmosphere; could not have been a more positive experience. Speaking after the ‘event’ that is Martin Kiernan, and with IPS President (not to mention Hand Hygiene legend!) Julie Storr mere meters away I think the word nervous barely covers it, but the excitement of being able to talk about my work, and knowing I was (in a way) representing the brilliant participants at my case study site helped me focus. And I think I got away with it…

Finally, I also found out I’ve been accepted to present my Poster summarising Studies 1 and 2 at ICPIC 2013 in Geneva at the end of June. Excited?  I believe I may have jumped a bit when I read the email. Fortunately I wasn’t in public…  Anyhow, bearing in mind the sheer scale of ICPIC 2013 with the speaker list looking like it has been copied right from my thesis reference section, I think a small amount of bouncing is allowed.

Hand Hygiene – Impressive NHS Activity

Some amazing ideas!

Also since I last blogged I also had a wonderful invite from the team at UHCW to come and judge their exciting Hand Hygiene poster competition, which involved both local primary school children and in-patients, all tasked with getting the vital “Hand Hygiene” message over.  These posters were displayed in the main entrance area of the hospital for over a week, generating much interest from Public and Staff alike, showing the worth of such apparently simple innovations.  Even some of the parents of the children came to see the handiwork of their offspring, and you could see the pride clearly – and also, interestingly, comments like “Oh yes, they’ve been on and on about when we should be washing our hands at home now…”. 

Baked Goodness for all!

Not just your standard poster competition then…!The judging panel found picking winners in each of the age categories nearly impossible, because each child seemed to have managed to put their own unique spin on the challenge, some going with the ‘Big and Bold’ strategy, others using ‘Devil in the Detail’, whilst others were just amazingly beautiful and colourful.  Naturally, we needed cake to help us with our discussions, and fortunately the IPCT office is a haven for such baked goodness….

In the end the winners reflect a real mixture, and the overall winner will be on display at UHCW soon – contact UHCW IPCT for more information.

Global Hand Hygiene Day – My Challenge

In preparation for May 5^th – Global Hand Hygiene Day – Professor Didier Pittet Tweeted a call asking what everyone would personally be doing to mark the event…which made me think about what I could do, specifically, on that date.  I decided, as my main activity in the sphere on Hand Hygiene at the moment is research, to set myself the target of trying to submit my first academic paper to a journal for review on May 5^th.  I chose the Journal of Infection Prevention (JIP), as it is the Journal of the Infection Prevention Society (IPS) who I have found an invaluable source of inspiration, information and support, and I felt that my research may be best suited to their audience at this stage.  Having contacted the Editor (the wonderful Dr Neil Wigglesworth, who I’d met briefly at IFIC 2012) and received a virtually immediate response to confirm that the topic would be fitting for JIP, I knuckled down and (with my co-author!!) managed to get this paper to a format suitable for submission…thus it found itself winging its way off to the reviewers on the 5^th May precisely.   Time will tell as to what feedback is returned, but we’re just looking forward to hearing what ‘outside eyes’ think of the topic, so we can take it from there. Don’t worry, I’ll keep you posted…

General PhD Progress

From a writing-up point of view progress is still being made; albeit a ‘non-linear, backwards/forwards, apparently quite normal’ PhD type way. I think it is best illustrated by the medium of cakes consumed recently, each representing either a breakthrough or breakdown in writing progress….

Fuel for IPS Talk run through…

The PG Hub turned 1!

Celebrating breakthrough in Study 1 writing

Dark times…not always bad…

Part of the PG Hub “Dissertation Station” season

Cake selection for Happy Monday!

And the eagle-eyed amongst you, if you haven’t been distracted by all that cake, may have spotted actual pages of thesis hidden in amongst those snap shots. Proof that amongst all those sugar hits, words are emerging….there’s even talk of “sense” and “logic”… But let’s not get too carried away yet…

Back to writing for today now – revisiting my Literature Review section at the moment to add-in a section on Effective Hand Hygiene, covering Soap and Water, ABHR, Technique and, of course, the 5 Moments…

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For HCAI – Use ICE

That’s why it sparkles! – The Westminster Clock (“Big Ben”) being cleaned in August, 2007 (Photo credit: Wikipedia)

I took two days off at the end of last week, which I had looked forward to for approximately ever* and had a glorious time on Thursday marvelling how beautiful our capital looks in the Autumn sunshine.  Big Ben was literally shining, and it was impossible not to feel proud as you wove through the crowds of tourists taking photographs.  A happy day.  And topped off perfectly by some superb theatre in the evening.  Such a day certainly helps with the lows that can so suddenly hit…and which can leave you sofa-d for a few days….!  Still, am back vertical now, and just about to write up a draft of my background chapter, which introduces the topic of HCAI (Healthcare Associated Infections), explaining their prominence, burden and the factors we have at our disposal to counter them…including, naturally, Hand Hygiene.

It is when revisiting all the stats I have on HCAI that it is easy to become ‘lost in numbers’, a little blasé about figures such as 300,000 annual cases, or £9billion – and forget that each ‘case’ represents an individual story, which doesn’t just end upon hospital discharge.  And thus a presentation I attended by Derek Butler of MRSA Action UK at the UHCW Infection Prevention and Control Study Day on Wednesday 14th November was aptly timed.  He used very personal cases (Step-Father and Father) to illustrate how critical Information, Communication and Education (ICE) are in our work towards Patient Safety.  Particularly, how important it is to remember that the Patient is not only an individual, but more often than not a member of a network of family and friends, all of whom play a part in the wider picture of care, including the prevention of infection.

These individuals should be seen as allies, who can help maintain required standards, and to do this must be kept informed. Information, though, is not enough, and Healthcare Professionals need to always ensure they too lead by example – thus for Hand Hygiene, if we want visitors to perform Hand Hygiene to protect Patients and themselves, we need to ensure that Healthcare Professionals do too. Always. Once we can make sure that both parties understand this need, it will surely be much easier to ‘encourage’ those slower on the uptake, and we will finally start to see these big numbers, representing real people, begin to fall….

*(I may be being less scientific than usual with that calculation…)

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Study Design – Deciding what is possible….

Currently I am practicing good Infection Control and am in quarantine – which has thrown a spanner in the works with regard to my active research at UHCW, but on the positive has given me time to work on planning my next phase of work.

Following the emerging themes produced from Study 1 and 2 (including interviews with Healthcare Professionals) the design for Study 3 has had to change.  It is no longer feasible to carry out the Inherent/Elective categorisation task as originally planned, as there is too much ‘noise’ around the concepts of Hand Hygiene triggers such as “Patient Contact” and “Contaminated Items”.  Therefore, instead of using existing audit data for a retrospective analysis, the new design involves an in-situ observational study collecting fresh Hand Hygiene data relating to specific activities deemed “Inherent” or “Elective” by current Healthcare Professionals.

From a conceptual point of view, this seems simple.  Indeed, when discussing the idea with others the idea – to see whether people perform Hand Hygiene more at certain points than others, and then whether this behaviour is stable – seems both clear and interesting; however when delving slightly deeper, the actual quantitative analysis required to investigate this theory appears much more complex.  Issues such as the use of binary (dichotomous) data, and a within-subjects design, makes the study actually quite abnormal.   However, after much design/re-design and discussions with some great sources of help, I think we may be getting close to a solution.  Today I thus have to just confirm that  the McNemar and Cochran Q are potentially solutions, and then I can firm up the design…

Whilst statistics are difficult in such cases, as has been said to me recently, the good part is once you have found the correct design, the actual carrying out is relatively simple. I cannot say how much I am looking forward to that part…!  The redesign of Study 3 has really shown how hard it can be to decide what is possible in research – having to compromise what you find interesting with what is possible to quantify or work into a design.  Patience, logic and the understanding that future work is always an option.  Lessons learnt…!

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“Out of the Office”

A change of scenery yesterday – spent some time with my young “research consultant” (5yrs) – who accompanied me to campus for a very early University taster session…  We had a great time, including an interesting peak inside the IDL, a wander around the beautiful campus (feeding ducks and dodging showers!) , and watched some of the Olympics on the big screen currently up in the Piazza.   Oh, and there was cake…naturally!

It was an enjoyable time, and a vital break from some heavy weeks of both active research and data analysis – and has given me a much needed ‘fresh’ feel with which to approach today.  Next week I have a promising meeting set up at my NHS host site, and an interview with a great Healthcare Professional about the Audit Process; looking forward to the information both these very different opportunities may bring.

Our website is now open for comments and discussions, and those at UHCW are welcome to join – please email me, or click here, for more details.

Next week I will be updating about the plans for future research – currently things are looking rather intriguing….

Enjoy the Olympics!

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Productive Friday, brilliant weekend, excellent Monday

After a great morning spent at UHCW on Friday shadowing the Hand Hygiene Audit process (thank you to my brilliant facilitator!!), the weekend of sunshine was thoroughly enjoyed – strolls down country lanes, a lazy picnic by a duck pond, and a walk through fields of buttercups and growing crops – there are few better ways to keep the energy levels up during a research project, surely…?

 And today kicked off in a similarly good theme, as I have had my Poster Abstract accepted for the Health Protection Agency (HPA) Conference which will take place in September, located here at the University of Warwick. 

My poster, entitled “The Potential Role of Technology to Improve Hand Hygiene Auditing and prevent Hospital Acquired Gastrointestinal Infections” addresses the key question –

“Do current technologies measure healthcare professional Hand Hygiene compliance accurately and at appropriate moments, thus helping to reduce Hospital Acquired Gastrointestinal Infections?”

– and will provide a ‘story so far’ update as to the research involving Healthcare Professionals this summer at UHCW.

Things are looking good!

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Conference Abstract

As promised, I have now uploaded the abstract for the WMG Doctoral conference – you can read it here.

This week I have submitted a poster Abstract for the Health Protection Agency (HPA) Conference to be held in September at the University of Warwick, on the topic of Hospital Acquired Gastrointestinal Infection (namely Clostridium Difficile).  I hope to be able to attend and discuss this issue with the other delegates, as it represents the very starting point of my PhD research, almost 3 years ago…

The research has come almost full circle now, as I am off to UHCW today to perform my first real active research, which both excites and terrifies me in almost equal measure.  Things are, finally, moving quickly!!

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