Impact case study database

Impact on Scottish HAI Screening Policy leading to an increase in uptake and a reduction in HAI

Recommendations from the 2016 BESH study [R1] were adopted by HPS to make fundamental changes to the Scottish National HAI screening programme in 2017. The results demonstrated the barriers and enablers to implementation of HAI screening in Scottish hospitals. Recommendations for improving HAI screening were presented by Currie to the Scottish National Antimicrobial Resistance and HAI Committee (August 2017), with Scottish Government HAI policy advisors in attendance [S1]. Consequently, HPS were funded by the Scottish Government to implement the recommendation to enhance feedback to practitioners on their level of compliance with HAI screening policies, across all Scottish Hospitals. This resulted in an increased uptake of MRSA screening policy from 75% in 2017 [S2 figure 19 page 45] to 87% in 2019 [S3 page 4] and an associated year-on-year decrease of 17.1% (p< 0.001) in MRSA infections in Scottish hospitalised patients [S2 page 38] in the year following implementation of the policy.

Impact on ECDC’s HAI Survey Methodology leading to more robust estimates in 28 European countries

For the first time in 2010 Reilly led a validation of the ECDC HAI point prevalence survey involving five countries. As a result of this study [R2] important changes were made to the 2016 protocol requiring all 28 participating countries to perform a concurrent validation study alongside the HAI survey [S4 page 1]. Demonstrating the importance of this, ECDC provided funding of 10,000 euros to each country to support the implementation of the validation studies [S6]. Both the protocols for the 2016 survey [S5 page 37] and the validation studies [S4 pages 1 & 3] were based on Reilly’s 2010 research. The findings of the validation studies were used to adjust the results of each country’s survey resulting in the identification of an additional 10% of infections, or 450,000 HAI [S6], and significantly improved estimates of the number of HAI in the 28 European countries. This is important as the results of these surveys are used to prioritise investment in surveillance and prevention efforts by countries across the European region. A higher and more robust estimate of the burden of HAI supports appropriate allocation of national resources for managing HAI. In addition, the impact of Reilly’s 2010 validation study has extended beyond Europe. Based on this research, Reilly provided methodological expertise [S7 page 7] for the first Australian point prevalence survey in 34 years conducted in 2018. The methodology [S6 page 8] adopted by Australia was based on the ECDC protocol that was informed by Reilly’s research [R2].

Impact on Scottish healthcare policy and practice

Reilly’s 2016 Scottish point prevalence survey [R3, 4] led to a refresh of the Scottish Government Antimicrobial Resistance and HAI Strategy Group strategy to take account of the recommendations in the study report. To address the increase in Escherichia coli infections and prevent urinary tract infections they made prevention of Gram-negative infections a priority [S8 page 40] resulting in a number of changes to Scottish healthcare practice. These included implementation of a hydration campaign (2017) [S8 page 46] and the launch of a national urinary catheter passport (2017) [S8 page 46] and an enhanced surveillance dashboard for Escherichia coli infections (2018) [S8 page 45].

Impact on WHO’s guidance leading an increase in the proportion of countries with national IPC programmes

The research findings from our systematic review on the effectiveness of national level IPC interventions in 2015 [R5] directly informed the WHO’s guidance on “Core Components for National IPC Programmes” [S9 page 22]. Professors Price & Reilly were invited to present the findings (March 2016) to a WHO panel of global IPC experts who fully incorporated the recommendations of the review into the new guidelines (November 2016) The systematic review provided the evidence base that enabled the WHO guidelines for the core components of national level IPC programmes to move from being based on expert opinion to becoming evidence-based [S9 page 29]. These WHO guidelines are now being implemented by countries worldwide to support global action to maximise the prevention of HAI. The implementation of these guidelines has led to an increase in the proportion of countries, across the six WHO regions, with a national IPC programme from 41% in 2015 to 63% in 2018 [S10 page 99].