537598 editorial2014
BJI0010.1177/1757177414537598Journal of Infection PreventionJournal of Infection Prevention
Editorial: From evidence into practice
T
he Infection Prevention Society (IPS) has three Strategic Aims, the second of which is to “influence and promote the evidence base for infection prevention practice that is adopted universally”. Within the IPS Strategic Plan 2011– 2016 and this year’s Annual Plan there are a number of objectives, plans and priorities to further this aim. In 2014 IPS will, among many activities nationally and locally, be supporting our members and others to utilise the EPIC3 guidelines in practice (Loveday et al, 2014), developing resources to support urinary catheter management and continuing to support and accredit educational events. Underpinning all of this is the evidence itself and the articles in this issue of Journal of Infection Prevention show the breadth of subjects and the range of methodologies and approaches to creating new knowledge that we promote as a journal. The point prevalence survey (PPS) of urinary catheterisation in care homes by Cliodna McNulty and colleagues is timely, as its publication coincides with the publication of the European Centre for Disease Control PPS of healthcare associated infections (HCAI) and antimicrobial use in long-term care facilities (‘Halt-2’: ECDC, 2014). Both of these publications demonstrate that the use of urinary catheters in care homes could potentially be reduced. McNulty and colleagues found that 6.9% of care home residents had a urinary catheter and, importantly that there was ‘significant variation in urinary catheterisation rates in the care homes surveyed’ and that these rates were similar to surveys in England in 2003 and 2009. This figure of 6.9% is very similar to the median percentage for urinary catheter use in the Halt-2 survey of 6.3%, but this masks some dramatic variation across Europe with countries reporting usage figures as high as 33%. The results for the UK participants from England, Wales and Northern Ireland put them below the median but again with considerable variation (ECDC, 2104). As McNulty points out for the comparisons for England, the overall European prevalence is little changed from the first HALT survey in 2010 (ECDC, 2010). Some of the variation could be explained by case mix or other intrinsic factors, but it suggests that in the care home setting, there is still a big potential to reduce urinary catheter usage and thus the risk of catheter associated urinary tract infection. No one could disagree with the conclusions of McNulty and colleagues that these variations need to be explored to develop a proactive, multifaceted, whole health economy approach to reducing the number of urinary catheters in these settings. Staying with quantitative methodologies and also in this issue, Randle et al have described an innovative approach to hand hygiene education involving a particular twist on the use of e-learning. Again this is timely, at least at the time of writing this editorial, as we are all focused on the World Health Organization’s annual global 5 May event for SAVE LIVES: Clean Your Hands, which this year is concentrating on the impact of hand hygiene on antimicrobial resistant organisms. Randle and colleagues observed almost 3,000 hand hygiene opportunities as part of their study, and the paper is data rich with information on compliance with the WHO ‘My 5 Moments for
Hand Hygiene’ that we’re all so familiar with. Interestingly and unusually the study reports opportunities for both staff and patients/ visitors as the intervention was delivered through the bedside multimedia monitors that are common in English hospitals (‘PatientLine’). Readers can judge the results for themselves but the innovation in this approach and its practical application in real world clinical practice will, I hope, stimulate further discussion and further research in this area. JIP welcomes qualitative research as well as quantitative and the Editorial Management Group recognises the importance of qualitative methodologies. Quantitative approaches can tell us ‘what, how many and by how much’, but to give us a rich understanding of ‘why’ we need qualitative researchers. Equally, infection prevention and control practitioners and the teams in which they work, sometimes need to look beyond the sometimes narrow confines of our specialty. The article by Nichols and Manzi does both. At first glance some may question why this article is in JIP; the research used both interviews and observation to examine the impact of space and the physical clinical environment on the proper segregation of waste. Although there are safety and infection prevention risks associated with waste it is perhaps peripheral to the everyday practice of infection prevention teams. However, this is an issue of quality and the development of quality systems that reduce waste and costs are a facet of high reliability, high quality organisations and infection prevention can learn from those organisations. Equally, the qualitative methodology used can inform how we investigate the behaviours of healthcare workers and their interactions with the physical environments and systems in which they work. Such research can lead to the better design of healthcare environments, healthcare systems and work processes and lead to less patient harm. I hope that readers will find these articles and the other content in this issue of JIP stimulating, interesting and useful for practice and personal professional development. Those who are members of IPS can do their part in promoting the evidence base for infection prevention, discuss the articles with colleagues, start a journal club, share on traditional and social media.
More information on WHO SAVE LIVES: Clean Your Hands at: http://www.who.int/gpsc/5may/en/ The IPS Annual Plan 2014 can be accessed at: http://www.ips. uk.net/files/7213/9454/5165/IPS_Annual_Plan_2014_-_web_ version.pdf
Disclaimer The opinions expressed in editorials are the author’s own and not those of their employers, the journal, or any other organisation. Neil Wigglesworth Editor [email protected]
© The Author(s) 2014
Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav 10.1177/1757177414537598
VOL. 15 NO. 4 July 2014
Journal of Infection Prevention
119
References European Centre for Disease Prevention and Control (ECDC). (2010) Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. May–September. ECDC: Stockholm. European Centre for Disease Prevention and Control (ECDC). (2014) Point prevalence survey of healthcare-associated infections and
a ntimicrobial use in European long-term care facilities. April –May 2013. ECDC: Stockholm. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto L, Wilcox M. (2014) epic3: National evidencebased guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection 86(S1): S1–70.
About the Infection Prevention Society The Infection Prevention society works together with healthcare colleagues, professional bodies, industry, government agencies and voluntary organisations in the prevention and control of infection. Our main aim is to advance the specialty of infection prevention and control through education, professional development of our members and research. With the continued need to prevent and control existing, re-emerging and new infections the Society is at the forefront of initiatives across the United Kingdom and Eire in both hospital and community settings. Members of the Society are active locally, regionally, nationally and internationally in cross boundary activities that support the quality and clinical governance agenda in providing safe and effective patient care. The Journal of Infection Prevention is provided as a benefit to members of the Infection Prevention Society. For more details please visit http://www.ips.uk.net
120 Journal of Infection Prevention
July 2014 VOL. 15 NO. 4
BJI0010.1177/1757177414537598Journal of Infection PreventionJournal of Infection Prevention
Editorial: From evidence into practice
T
he Infection Prevention Society (IPS) has three Strategic Aims, the second of which is to “influence and promote the evidence base for infection prevention practice that is adopted universally”. Within the IPS Strategic Plan 2011– 2016 and this year’s Annual Plan there are a number of objectives, plans and priorities to further this aim. In 2014 IPS will, among many activities nationally and locally, be supporting our members and others to utilise the EPIC3 guidelines in practice (Loveday et al, 2014), developing resources to support urinary catheter management and continuing to support and accredit educational events. Underpinning all of this is the evidence itself and the articles in this issue of Journal of Infection Prevention show the breadth of subjects and the range of methodologies and approaches to creating new knowledge that we promote as a journal. The point prevalence survey (PPS) of urinary catheterisation in care homes by Cliodna McNulty and colleagues is timely, as its publication coincides with the publication of the European Centre for Disease Control PPS of healthcare associated infections (HCAI) and antimicrobial use in long-term care facilities (‘Halt-2’: ECDC, 2014). Both of these publications demonstrate that the use of urinary catheters in care homes could potentially be reduced. McNulty and colleagues found that 6.9% of care home residents had a urinary catheter and, importantly that there was ‘significant variation in urinary catheterisation rates in the care homes surveyed’ and that these rates were similar to surveys in England in 2003 and 2009. This figure of 6.9% is very similar to the median percentage for urinary catheter use in the Halt-2 survey of 6.3%, but this masks some dramatic variation across Europe with countries reporting usage figures as high as 33%. The results for the UK participants from England, Wales and Northern Ireland put them below the median but again with considerable variation (ECDC, 2104). As McNulty points out for the comparisons for England, the overall European prevalence is little changed from the first HALT survey in 2010 (ECDC, 2010). Some of the variation could be explained by case mix or other intrinsic factors, but it suggests that in the care home setting, there is still a big potential to reduce urinary catheter usage and thus the risk of catheter associated urinary tract infection. No one could disagree with the conclusions of McNulty and colleagues that these variations need to be explored to develop a proactive, multifaceted, whole health economy approach to reducing the number of urinary catheters in these settings. Staying with quantitative methodologies and also in this issue, Randle et al have described an innovative approach to hand hygiene education involving a particular twist on the use of e-learning. Again this is timely, at least at the time of writing this editorial, as we are all focused on the World Health Organization’s annual global 5 May event for SAVE LIVES: Clean Your Hands, which this year is concentrating on the impact of hand hygiene on antimicrobial resistant organisms. Randle and colleagues observed almost 3,000 hand hygiene opportunities as part of their study, and the paper is data rich with information on compliance with the WHO ‘My 5 Moments for
Hand Hygiene’ that we’re all so familiar with. Interestingly and unusually the study reports opportunities for both staff and patients/ visitors as the intervention was delivered through the bedside multimedia monitors that are common in English hospitals (‘PatientLine’). Readers can judge the results for themselves but the innovation in this approach and its practical application in real world clinical practice will, I hope, stimulate further discussion and further research in this area. JIP welcomes qualitative research as well as quantitative and the Editorial Management Group recognises the importance of qualitative methodologies. Quantitative approaches can tell us ‘what, how many and by how much’, but to give us a rich understanding of ‘why’ we need qualitative researchers. Equally, infection prevention and control practitioners and the teams in which they work, sometimes need to look beyond the sometimes narrow confines of our specialty. The article by Nichols and Manzi does both. At first glance some may question why this article is in JIP; the research used both interviews and observation to examine the impact of space and the physical clinical environment on the proper segregation of waste. Although there are safety and infection prevention risks associated with waste it is perhaps peripheral to the everyday practice of infection prevention teams. However, this is an issue of quality and the development of quality systems that reduce waste and costs are a facet of high reliability, high quality organisations and infection prevention can learn from those organisations. Equally, the qualitative methodology used can inform how we investigate the behaviours of healthcare workers and their interactions with the physical environments and systems in which they work. Such research can lead to the better design of healthcare environments, healthcare systems and work processes and lead to less patient harm. I hope that readers will find these articles and the other content in this issue of JIP stimulating, interesting and useful for practice and personal professional development. Those who are members of IPS can do their part in promoting the evidence base for infection prevention, discuss the articles with colleagues, start a journal club, share on traditional and social media.
More information on WHO SAVE LIVES: Clean Your Hands at: http://www.who.int/gpsc/5may/en/ The IPS Annual Plan 2014 can be accessed at: http://www.ips. uk.net/files/7213/9454/5165/IPS_Annual_Plan_2014_-_web_ version.pdf
Disclaimer The opinions expressed in editorials are the author’s own and not those of their employers, the journal, or any other organisation. Neil Wigglesworth Editor [email protected]
© The Author(s) 2014
Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav 10.1177/1757177414537598
VOL. 15 NO. 4 July 2014
Journal of Infection Prevention
119
References European Centre for Disease Prevention and Control (ECDC). (2010) Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. May–September. ECDC: Stockholm. European Centre for Disease Prevention and Control (ECDC). (2014) Point prevalence survey of healthcare-associated infections and
a ntimicrobial use in European long-term care facilities. April –May 2013. ECDC: Stockholm. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto L, Wilcox M. (2014) epic3: National evidencebased guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection 86(S1): S1–70.
About the Infection Prevention Society The Infection Prevention society works together with healthcare colleagues, professional bodies, industry, government agencies and voluntary organisations in the prevention and control of infection. Our main aim is to advance the specialty of infection prevention and control through education, professional development of our members and research. With the continued need to prevent and control existing, re-emerging and new infections the Society is at the forefront of initiatives across the United Kingdom and Eire in both hospital and community settings. Members of the Society are active locally, regionally, nationally and internationally in cross boundary activities that support the quality and clinical governance agenda in providing safe and effective patient care. The Journal of Infection Prevention is provided as a benefit to members of the Infection Prevention Society. For more details please visit http://www.ips.uk.net
120 Journal of Infection Prevention
July 2014 VOL. 15 NO. 4
