The Big Issues
Safer Patients
Which actions cut healthcare associated infection (HCAI)?

Tackling healthcare associated infections (HCAI) such as MRSA demonstrates the breadth of HaCIRIC's mission. Our focus on 'whole systems' is helping to unravel the complex relationship between technology, medical practice, service delivery, the built environment and HCAI. Success could offer global improvements. It could help to cut costs and demand on healthcare systems as well as raising quality of outcomes and influencing building redesign.

That's why HaCIRIC is studying ways to test possible scenarios for healthcare change. We are assessing whether modelling, simulation and visualisation (MSV) can successfully involve stakeholders - predicting impacts on them and the system as a whole - and facilitate successful innovation.

In Britain, HCAIs are generally falling, but we don't know what works best. That's why HaCIRIC is examining which initiatives are most effective and whether redesign of the underlying built infrastructure could also make a difference.

More wash hand basins?

Thanks to specific Government funding, NHS trusts invested in developments such as more wash hand basins with sensor taps, new bedside curtains and separate staff changing rooms. Later this year, we will publish our findings on how well these are used and which are effective. We will also publish a design guide.

Single rooms?

Are single rooms cost effective in reducing HCAI? We are planning the first infection control 'before and after' study into a brand new hospital, at Pembury, which is the NHS's first all single room hospital. The results could have a major, international impact on hospital redesign decisions. We are also monitoring Hillingdon hospital's single bed unit as well as studying Great Ormond Street hospital, where there is a variety of spaces within one floor. We should learn a great deal about the impact of single rooms on infection control, clinical outcomes and costs. Our research partners on this project are Maidstone and Tonbridge Wells NHS Trust, Laing O'Rourke, the Center for HealthCare Design, and HealthCare Projects.

Change management?

Our team has a strong methodological base in this complex area and is considering how to embed learning into ward level practice. Risk assessment tools and gaming based training tools are being considered as well as new work on anti-microbial window glass. This work provides the grounding for expansion of the programme with University College London Hospital and the UK's Medical Research Council and in patient safety more broadly in conjunction with the ECHAA network, for future funding from the European Union.

Routine cleaning?

Ward cleanliness is typically assessed using subjective methods, primarily visual inspection. But is this adequate? Our research compares such assessments with objective methods, employing quantitative microbiological data. It uses a hygiene surveillance tool - 3M Clean-Trace - to evaluate the cleanliness of high contact surfaces and the general hospital ward environment. Our research partners are Loughborough University's Department of Chemistry, Leicester Hospitals NHS Trust and Wolverhampton New Cross NHS Trust.

Altering the movement of people?

With University College Hospital and Great Ormond Street NHS Trust, and UCL we want to identify whether people's movement increases cross contamination of spaces. We are also testing whether the physical design of healthcare facilities influences movement and if it could cut the spread of infection. The work includes microbiologists, statisticians and space syntax modellers. The core HaCIRIC funding is enabling others, such as the £1m EPSRC investment in 21st century infectious diseases with the Challenge Fund project at University College Hospital, London, to collaborate in the data collection and analysis.