I was really pleased to have the opportunity to speak at IPS this year on how important it is to choose our words carefully and talk the same language to connect with our audience when communicating HCAI and AMR. My main reflection from preparing the talk is that people listen to you when the message is clear and personal, and they lose interest if the message is complicated or not relevant to them. Simple and small changes to the language that we use in the message that we deliver can make a big impact on the way that people respond. You can view my slides here.
I did a Infection Control Matters podcast based on this talk with the wonderful Martin Kiernan:
Detection, removal and prevention of environmental biofilms – Infection Control Matters
- Detection, removal and prevention of environmental biofilms
- The Sink Splash Zone – danger lies within?
- Oral Hygiene – attitudes and practice. Implications for pneumonia prevention.
- Intermittent or indwelling catheter in reducing CAUTI?
- Surgical site infection surveillance by patient-generated images
I started out thinking there would be tons of literature describe how the language that we use to communicate HCAI and AMR is vitally important. And whilst this was true to a degree, I found it challenging to find a way in to the literature. I think it’s fair to say that I only scratched the surface of this topic – but enough to fuel my interest to learn a bit more.
My starting point was a study that I did at GSTT years ago – a point prevalence study of rectal carriage of antibiotic-resistant Gram-negative bacteria. This required us to individually consent over 4,000 patients to a research study over a couple of months (before money and time ran out!). I’ve described before on this blog how we found that a small change to the message that we gave to patients made dramatic improvements in study participation. The original message was bug focused and quite technical. The updated message was more focused on the benefits of participating in the study from an individual point of view.
Within the world of IPC and wider infection services, we have a huge diversity in audience of people we are trying to reach with important messages:
- Patients
- Relatives
- Infection colleagues
- Non-infection colleagues
- Public
- Media
- Regulators
- Execs / Board
Each of the groups on this very non-exhaustive list has a different set of needs and expectations, which means our message needs to be crafted carefully with the audience in mind. It’s no good going to the public with a highly technical message, or to infection colleagues with over-simplified messages. A good example here is from some work done by the Wellcome Trust to examine how our use of language affects perceptions of antibiotic resistance. Terms like “AMR” (which I’m very conscious I’ve used in the title of this blog post!) and even “antibiotic resistance” can be meaningless or having different meanings to the public. For example, “antibiotic resistance” could give false hope along the lines of “well, if it’s only ‘resistant’ and not fully ‘immune’, then treatment might work, right”? I think this is what drove the development of the (helpful) “The drugs don’t work” narrative to sound the alarm around antimicrobial resistance.
It’s easy to forget that the words we use to describe infection-related topics can have a huge impact on patients. Some work undertaken in Ireland found that the way newly identified CPE carriers were described made patients feel like “lepers”, “pariahs”, or “plagued”. There are some simple ways that we can improve this, by, for example, talking about “patients with CPE” rather than “CPE patients”. The CPE doesn’t define them as a patient (or indeed as a person!).
Finally, a nice study on how a differently framed message can result in improved clinical decision making. A team in Oxford found that simplifying the laboratory report around C. dfficile infection resulted in better decision making related to treatment and isolation. You could argue that the new message was in some ways less technically accurate. But if it resulted in better clinical decision making at the end of the process, then the technical accuracy of the message seems less important – counterintuitive though that may seem!
I hope that this may prove to be a useful jumping off point for you into the world of the importance of our language in communicating HCAI and AMR.
Reflections on Infection Prevention and Control 
My observation from wrestling with this issue i (as john knows I do) is that the mistake we always make during a discussion on “terminology” is to make a list of terms and decide what concept they represent. What we really need to do is to make a list of the concepts for which we need an agreed “term” – and then decide what terms are most appropriate to delineate them. An example is terms to describe processes that “reduce microbial contamination on a surface/hands to an “acceptable level”. It was decided by the Europan Standards (EN) committee that the term “disinfection” should apply ONLY to processes where a chemical disinfectant is used to inactivate. This leaves us without a term to describe processes that reduce contamination to an acceptable level by removal (detergent-based cleaning, microfibre cloths etc). This being the case I find guidelines generally use the term “cleaning” interchangeably – sometimes as the term for detergent-based cleaning- and sometimes the term for any process (removal or inactivation) which reduces to an acceptable level – leaving me unclear what they are trying to guide me to do.
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