Hospital Infection Prevention and Control Training
1. service
ecology:
design
issues
for
hospital
infec3on
preven3on
and
control
(IPC)
Prof
Alastair
S
Macdonald
Senior
Researcher
School
of
Design,
The
Glasgow
School
of
Art
Dr
Colin
Macduff
School
of
Nursing
and
Midwifery,
Robert
Gordon
University,
Aberdeen
Dr
David
Loudon
Research
Fellow,
The
Glasgow
School
of
Art
Susan
Wan
Research
Assistant,
The
Glasgow
School
of
Art
Macdonald
et
al,
Service
Ecology,
SERVDES
2016,
Copenhagen,
24
May
2016.
2. visionOn:
a
tablet-‐based
visualisa3on
tool
for
training
staff
-‐
healthcare
associated
infec3ons
(HAIs)
The
Glasgow
School
of
Art
Robert
Gordon
University,
Aberdeen
NHS
Grampian
NHS
Lanarkshire
GAMA
Healthcare
Ltd
Macdonald
et
al,
Service
Ecology,
SERVDES
2016,
Copenhagen,
24
May
2016.
3.
context
An;microbial
Resistance
(AMR)
Recognised
as
one
of
the
most
important
global
issues
for
human
and
animal
health
due
to
the
increasing
numbers
of
resistant
infec3ons
leading
to
many
exis3ng
an3microbials
becoming
less
effec3ve
4.
context
An;microbial
Resistance
(AMR)
Recognised
as
one
of
the
most
important
global
issues
for
human
and
animal
health
due
to
the
increasing
numbers
of
resistant
infec3ons
leading
to
many
exis3ng
an3microbials
becoming
less
effec3ve
Healthcare
Associated
Infec;ons
(HAIs)
HAIs
caused
by
pathogens
which
take
many
forms
-‐
virus,
bacterium,
fungus,
prion
and
parasite:
norovirus,
C
diff
(Clostridium
difficile),
and
MRSA
(methicillin-‐resistant
Staphylococcus
aureus)
-‐
probably
most
widely
known
5.
context
An;microbial
Resistance
(AMR)
Recognised
as
one
of
the
most
important
global
issues
for
human
and
animal
health
due
to
the
increasing
numbers
of
resistant
infec3ons
leading
to
many
exis3ng
an3microbials
becoming
less
effec3ve
Healthcare
Associated
Infec;ons
(HAIs)
HAIs
caused
by
pathogens
which
take
many
forms
-‐
virus,
bacterium,
fungus,
prion
and
parasite:
norovirus,
C
diff
(Clostridium
difficile),
and
MRSA
(methicillin-‐resistant
Staphylococcus
aureus)
-‐
probably
most
widely
known
Infec;on
Preven;on
and
Control
(IPC)
Poor
IPC
can
lead
to
AMR
11.
issues
IPC
training
materials
Lack
of
adherence
to
IPC
protocols
12.
issues
IPC
training
materials
Lack
of
adherence
to
IPC
protocols
Lack
of
understanding
and
awareness
of
pathogens
13.
issues
IPC
training
materials
Lack
of
adherence
to
IPC
protocols
Lack
of
understanding
and
awareness
of
pathogens
…
all
contribute
to
growth
in
AMR
14.
15. Visual
derived
from
covert
observa>onal
data
in:
Smith,
S.J.,
Young,
V.,
Robertson,
C.
and
Dancer
S.J.
(2012)
Where
do
hands
go?
An
audit
of
sequen3al
hand-‐touch
events
on
a
hospital
ward.
The
Journal
of
hospital
infec>on,
80(3),
206–211.
junior
doctor
senior
nurse
auxiliary
nurse
cleaner
common
hand-‐touch
points
The
evidence
base
1:
who
touches
what
?
16.
17.
18.
prior
work
Vis-‐Invis:
Recommenda3on:”
Further
development
of
the
concept
prototypes
for
staff
training
would
be
beneficial
if
the
visualisa>ons
could
be
augmented
with
specific
training
informa>on
and
scenarios
centred
around
the
preven>on
of
HAIs.”
19.
using
visualisa3on
Could
a
visually-‐oriented
interac;ve
tool
raise
awareness
of
loca;on,
survival
and
transmission
of
pathogens
in
the
ward
environment
and
assist
training
in
IPC
across
job
roles
by
reinforcing
the
'why’
behind
IPC
procedures?
20.
approach:
from
hierarchical
to
co-‐dependent
doctors
senior
nurses
auxiliary
nurses
domes;cs
(cleaners)
current
training
model
hierarchical
/
differen>ated
intended
training
model
cross
cohort
/
co-‐dependent
21.
3
stage
par3cipa3ve
process
workshop
workshop
evalua;on
development
development
development
26.
key
themes
pathogen
loca;on
pathogen
survival
pathogen
transmission
MRSA
norovirus
C
difficile
Interven>on
Without
cleaning
With
cleaning
27. Visuals
derived
from
data
in:
Bogusz,
Alexandra
and
Stewart,
Munro
and
Hunter,
Jennifer
and
Yip,
Brigihe
and
Reid,
Damien
and
Robertson,
Chris
and
Dancer,
Stephanie
J.
(2013)
How
quickly
do
hospital
surfaces
become
contaminated
a8er
detergent
cleaning?
Healthcare
Infec3on,
18
(1).
pp.
3-‐9.
ISSN
1835-‐5617
Surfaces
decontaminated
aRer
detergent
cleaning
the
evidence-‐base
2:
survival
28. Visuals
derived
from
data
in:
Bogusz,
Alexandra
and
Stewart,
Munro
and
Hunter,
Jennifer
and
Yip,
Brigihe
and
Reid,
Damien
and
Robertson,
Chris
and
Dancer,
Stephanie
J.
(2013)
How
quickly
do
hospital
surfaces
become
contaminated
a8er
detergent
cleaning?
Healthcare
Infec3on,
18
(1).
pp.
3-‐9.
ISSN
1835-‐5617
Re-‐contamina;on
exceeding
proposed
cleanliness
standards
aRer
24
hours
24
hours
later
Surfaces
decontaminated
aRer
detergent
cleaning
the
evidence-‐base
2:
survival
29.
itera3ve
prototyping
feedback
-‐
pathogen
survival
stage
1
sample
stage
1
mock-‐ups
“It
gave
a
beSer
understanding
of
exactly
what
MRSA
is.”
(cl2)
cleaner
“I
was
shocked
that
the
norovirus
is
like
an
aerosol
effect
in
the
room.
It
spreads
everywhere,
over
furniture,
chairs,
floors,
on
hands
and
clothes.”
(cL6)
cleaner
“Thought
provoking
visuals.
Especially
highligh>ng
mode
of
transmission
and
how
long
they
s>ck
around
such
as
c-‐diff.
You
could
have
an
anima>on
of
how
bug
travels
between
rooms
throughout
wards
and
ul>mately
through
hospital”
(dr2)
doctor
“Should
be
moving
pictures
rather
than
s>lls,
should
use
proper
wards
and
superimpose
the
virus
over
the
image
of
real
environments
to
give
a
more
real
feel
to
the
message,
show
different
areas
in
the
hospital
not
just
ward
based.”
(n9B)
nurse
30.
synthesised
narra3ves
embodied
data
democra3c
discourse
stage
1
mock-‐ups
‘…
affirm
…
’
‘…
misunderstand
…’
‘…
be
good
to
have
...’
‘…
need
more
informa>on
about
…’
(n=30)
for
each
of
6
x
stage
1
prototypes
Feedback
data
-‐
workbooks
-‐
transcripts
of
discussions
in
response
to
each
prototype
38. virtual
ward
features
Micro
/
macro
view
Zoom
in
/
out
camera
interac;ve
visuals
Temporal
dimension
Pathogen
specific
Effects
of
cleaning
learning
points
Example
-‐
pathogen
survival
1. Different
pathogens
have
different
survival
3mes
within
the
ward
environment
depending
on
whether
adequate
cleaning
has
taken
place
2. Pathogens
are
invisible
to
the
naked
eye
so
the
ward
can
appear
‘clean’
but
may
not
be
3. At
24
hours
aner
cleaning
a
surface,
the
microbial
level
can
grow
and
return
to
the
pre-‐
clean
levels
layered
informa;on
Relevant
to
each
pathogen
type
Risk
to
pa>ent
More
detail
only
if
required
39.
Visualisa3ons
were
engaging
and
suppor;ve
of
different
learning
styles
Offered
staff
a
new
perspec;ve
on
pathogens,
being
able
to
‘see’
them
contextualised
in
the
virtual
ward,
making
them
seem
more
real.
ini3al
findings
1
40.
ini3al
findings
2
Informa3on
relevant
for
different
staff
cohorts,
with
a
mix
of
experience
levels
Increased
par;cipants’
awareness
about
pathogens
by
explaining
‘why’
(through
dynamic
visuals
and
informa>on)
IPC
procedures
should
be
followed
Reinforced
understanding
of
how
HAIs
occur
41.
Further
applica;ons
were
suggested,
including
induc3ons
for
new
starts,
educa3on
in
schools/universi3es,
and
refresher
courses.
ini3al
findings
3
42. 1:
the
need
for
par7cipa7ve
approaches
which
challenge
the
top-‐down
hierarchical
healthcare
paradigm
to
develop
training
materials
more
effec7ve
across
the
different
cohorts
within
a
complex
service
ecosystem
-‐
‘IPC
is
everyone’s
business’
-‐
Just
one
transgressor
spoils
IPC
for
all
healthcare
service
design
issues
43. 2:
use
the
evidence-‐base
but
design
data
to
be
accessible,
contextualised
and
meaningful
across
the
different
job
roles
to
enable
beFer
engagement,
par7cipa7on
and
co-‐development
-‐
(the
usual
mode
of
academic
data
presenta>on
is
‘privileged’
and
inappropriate
for
training
non-‐academics)
healthcare
service
design
issues
44. 3:
visualisa7on
can
help
untangle
the
complexity
between
the
various
actors
-‐
Improving
awareness
and
understanding
healthcare
service
design
issues
✔
✔
✔
✔
IPC
45. Will
the
tool
help
improve
adherence
to
IPC
protocols?
ques3on
✔
✔
✔
✔
?
Awareness
√
Adherence
?
Understanding
√
IPC
47. Publica;on
of
detailed
findings
Stage
4
prototype
embodying
105
x
stage
3
feedback
datasets
Development
of
new
‘modules’
In-‐ward
feasibility
trial
next
48.
The
visionOn
project
is
funded
by
the
Arts
and
Humani3es
Research
Council’s
Follow-‐On
Funding
for
Impact
and
Engagement
(Grant
Ref:
AH/M00628X/1)
with
support
from
NHS
Grampian,
NHS
Lanarkshire
and
GAMA
Healthcare
Ltd.
The
research
team,
advisory
group
and
partners
www.visionon.org
acknowledgements
a.macdonald@gsa.ac.uk
