Symposium 21 Management of infection-related outbreaks: Innovations in Health Protection

Symposium lead and chair:
Bernice West, Director of Doctoral Studies School of Nursing and Midwifery The Robert Gordon University Aberdeen, CeNPRaD, School of Nursing, The Robert Gordon University, Aberdeen, Scotland, United Kingdom b.west@rgu.ac.uk

Symposia focus:

This symposium comprises a set of four research papers each of which is concerned with the management of infection-related outbreaks. The chair of the symposium is involved in the academic supervision of all other presenters.Each paper builds knowledge pertaining to roles, responsibilities, interprofessional working, education and policy development with respect to the management of infection related outbreaks, public health consequences and health protection practices. International and interprofessioanl perspectives are offered to illustrate commonalities of approach. A variety of methodolgies are deployed across the four papers and the authors will make available at the symposium copies of public output.

Source of Funding:

Various funding sources (West NHS\NES) Tonna Research degree studentshipRGU/ FarrySaudi Arabia Minstry of Health/ Maloreh-Nyameke Ghana ministry of health

Level of Funding: Total across all 4 papers £200,000

Abstract 1: Exploring pharmacists’ views and perceptions of pharmacist antimicrobial prescribing in secondary care

Tonna A.(PhD Student), Stewart D., West B., McCaig D. School of Pharmacy, School of Nursing and Midwifery The Robert Gordon University, Aberdeen, AB101FR Scotland, UK

Introduction:

Up to 9% of patients in hospitals may have a health-care associated infection (HCAI) at any one time. (Department of Health, 2005) Micro-organisms associated with HCAI include meticillin-resistant Staphylococcus aureus and multi-drug resistant Clostridium difficile. Optimisation of antimicrobial use is a key to managing and reducing the incidence of further development of resistance. The introduction of non-medical prescribing in the UK is likely to provide opportunities and challenges for pharmacists to help optimise antimicrobial use. (Weller, JMA and Jamieson CE, 2004)

Objective:

To explore the views and perceptions of practising pharmacists relating to pharmacist antimicrobial prescribing in secondary care.

Method:

A qualitative, exploratory approach was adopted. Pharmacists’ perceptions were explored using focus groups in six Scottish regions representing (a) rural and urban areas (b) district general hospitals and large teaching hospitals. Senior hospital pharmacists working in specialities where antimicrobials are crucial to patient management were invited to participate. A topic guide was developed to lead the discussions which were audio recorded and transcribed. The ‘framework’ approach to data analysis was used. (Ritchie, J and Lewis, J, 2003)

Results:

Perceived feasibility and value of pharmacist prescribing of antimicrobials were linked closely to area of care. Barriers to implementation of pharmacist antimicrobial prescribing roles included large throughput of patients, large number of patients likely to be on antimicrobials and not providing a 24 hour pharmacist prescribing service. Preparing the clinical management plan as part of SP was viewed as too time consuming; a lack of diagnostic skills was perceived as the main barrier towards pharmacist IP of antimicrobials.

Conclusions:

Pharmacists feel they have a good knowledge base to prescribe and manage antimicrobial treatment identifying possible opportunities for intervention; they have also highlighted barriers to both pharmacist SP and IP of antimicrobials Work.

References:

  • Department of Health, 2005. Action on Health Care Associated Infections in England. London. Ritchie J and Lewis J, 2003. Qualitative research practice. A guide for social science students and researchers. London: SAGE publications limited
  • Weller TMA and Jamieson CE, 2004. The expanding role of the antibiotic pharmacist. The Journal of Antimicrobial Chemotherapy, 54, pp. 295-8

Abstract 2: Managerial epidemiology: Implication for Outbreak Management, an illusion or a reality?

Theophilus Maloreh-Nyamekye B.A PgDip MSc MCIPS; MBA PhD Student School of Nursing and Midwifery Faculty of Health and Social Care The Robert Gordon University, Aberdeen, Scotland, UK

Aim:

This analysis sets out to critically examine the concept of epidemiology and to advance arguments on the need to consider taking a new look at how it relates to outbreak management from a managerial point of view under the term ‘managerial epidemiology.’ The paper also aims at generating new ideas and future directions for research in the area of disease control.

Background:

The issue of disease outbreaks has become a matter of concern most especially in recent times at local, national and international levels. Although epidemiological concepts abound in the literature, it appears that very little is known about the relationship between epidemiology and managerial issues.

Method of data analysis:

The analysis is purely conceptual and literature based, using the concept of social responsibility based on the European Foundation for Quality Management Excellence (EFQM) Model. The paper also analyses the key of features of outbreaks in terms of chain of control and key responsibilities with emphases on multidisciplinary teamwork.

Discussion of key issues:

Organisational leadership at all levels, proper planning and timely deployment of appropriate resources in their right proportions, coupled with teamwork are very essential in dealing with outbreaks in both short and long terms.

Conclusions:

The paper argues that since the management of disease outbreak is complex and resource driven, a multidisciplinary approach is required at all levels notably strategic (national), tactical (regional) and operational (institutional and community) levels involving all stakeholders. This is needed before (pre-outbreak stage), during (outbreak stage), and after (post-outbreak stage) every outbreak. The paper concludes that researchers need to concern themselves with ‘managerial epidemiology’. Finally, the author welcomes further exploration of the key issues raised specifically in relation to, the utility of EFQM Excellence model

References:

  • European Foundation for Quality Management (EFQM) Model (1999) A procurement pilot project [ http://www.business-excellence.org.uk/efqm_model.htm- Accessed on 11/03/05] Sabatier, P. (1986), ‘Top-down and Bottom-up Approaches to Implementation Research: a Critical Analysis and Suggested Synthesis,’ In Journal of Public Policy, 6(1), 21- 48

Abstract 3: Control of infection by vaccination: a successful story describing elimination of neisseria meningitidis carriage from the throat of pilgrims visiting Saudi Arabia

A. M. Alhehini, F. J. R. Abadi, A. M. Abdulaziz, A. A. Hadhoud , N. A. Baeshin, & S. H. Qari, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; 3Medical Microbiology Department, National Liver institute, Al-Menophya University, Egypt. 4 Medical Microbiology and Immunology, Faculty of Medicine, , Zagazig University, Zagazig, Egypt 6 Department of Biological Sciences, Faculty of Science, Umm Al-Qura University, Makkah, Saudi Arabia

A large outbreak of Neisseria meningitidis serogroup A occurred in Saudi Arabia during the annual pilgrimage of Hajj in 1987. The sources of the infection were pilgrims coming from Sub-Saharan Africa where carriage of serogroup A is endemic. The agents of the outbreak belonged to a serogroup A clone which was also responsible for meningococcal meningitis outbreaks in other countries among pilgrims returning from the Hajj pilgrimage or among their close contacts. In response, Saudi health authorities promulgated a vaccination policy against the organism as a prerequisite to obtain a visa to travel to the Kingdom. This policy resulted in a remarkable reduction of the Hajj-associated meningococcal meningitis outbreaks. A study was conducted to investigate the carriage of meningococci among pilgrims in 2006 Hajj pilgrimage and compared with two other Saudi populations. Throat samples were taken from a large number of pilgrims of different countries (n=382) and 150 university students and 150 prison inmates. No positive sample of N.meningitidis was isolated from pilgrims or students although some samples were identifies as non-meningitidis isolates of Neissria species. However, thirteen positive isolates (9%) of the samples taken from inmates’ throat proved to be N.meningitidis of serogroup A(n=6), B(n=4) and W135(n=3). The isolates were subjected to Restriction Fragment Length Polymorphism (RFLP). Three strains (one sample from a Nigerian inmate and two from two Ethiopian inmates) belonged to serogroup W135, four strains (all isolated from Ethiopian inmates) belonged to serogroup B and six strains (two strains from two Nigerians and four strains were isolated from four Ethiopian inmates) belonged to serogroup A. Interestingly, all serogroup A showed exactly the same DNA fingerprinting and the same holds true for serogroup B and serogroup W135 The study proved that that the policy of vaccination against the organism was successful.

Turning a team of experts into an expert team: an evaluation of a reflexive education programme Bernice JM West and Michael H Lyon Hive Design and Consultancy Aberdeen with colleagues from HAI Directorate NES Edinburgh; HAI Directorate HPS Glasgow.

Background:

Considerable literature exists which illustrates in the problems associated in ad hoc team working and the need for explicit guidance on roles. responsibilities, communication strategies and self evaluation. Within infection control and health protection the management of outbreaks usually involves ad hoc team working.

Aim:

At the request of two national agencies in Scotland (NES and HPS) the primary authors (West and Lyon) were invited to facilitate the development of an interprofessional education programme to enhance team-working in the area of Health care associated infections (HAI) outbreak management.

Method:

A three phase evaluation procedure was deployed. Firstly using systematic literature reviewing techniques and expert panel discussions a reflexive open-learning workbook was designed. Secondly this workbook was tested on two Incident Management Teams working in the NHS in Scotland. Thirdly an innovative approach to team building using magically enhanced training (MET) was tested with a multiprofessional group who had completed the workbook.

Findings:

Indicate success in enhancing ways of working for ad hoc teams but also show the pedagogic challenges of providing interprofessional education on the topic of team working and outbreak management. Secondary findings suggest that the debriefing process for those involved in outbreaks is crucial for subsequent service development. Finally the evaluation processes have indicated the value of MET when combined with more traditional pedagogies.

Conclusion:

The education programme will be used to inform a national programme on the management of HAI related outbreaks. Word count 236 References NHS Education Board for Scotland and Health Protection Scotland (2006) Management of infection related incidents: a reflexive educational programme for core members of Incident Management Teams NES Edinburgh Scotland.