As we all enjoy Infection Prevention Week for 2025, I thought I’d take a look into the literature to see whether anybody has done some cost-effectiveness work for an IPC service as a whole. I came across this “Umbrella” review (i.e. a review of reviews!), which looks at the cost-effectiveness of interventions to tackle HCAI and AMR (to include IPC, AMS, diagnostic stewardship), and thought it was worth sharing. The bottom line: there’s a lot of cost-effectiveness evaluations for IPC interventions, most of which are cost-effective, but a bit of a gap around cost-effectiveness of the service as a whole.
Continue readingIPC
Making IPC live for frontline healthcare workers – part 2
I’ve written this post in preparation for next Wednesday’s IPS Journal Club in partnership with the Infection Prevention Society (register here). (Please note, it will be a little earlier in the day than most previous Journal Clubs, so don’t miss it, and yes I stole this paragraph from Jon).
The paper that I have chosen for the Journal Club is this one in the Journal of Infection Prevention, exploring infection prevention behaviour in midwifery staff.
Kerry, Jon and I had an interesting discussion last week about which ‘live’ we use for this journal club. I think I am an advocate for both and will remain rooted to the fence! Why? We are bringing the journal club to you live and also we want everyone to live Infection Prevention and Control!
Why did I choose this article?
- This is a qualitative study which I am reading more and more of as I try to understand and unpick the human behaviour and perception elements of IPC. In my opinion understanding these better can help support optimal delivery of IPC and patient care
- The research was conducted amongst midwives which I was interested to read more about given the high demands on midwifery services and some of the negative press midwifery services have faced in recent years
- I am big fan of ‘thematic analysis’ which was framework used for the analysis of the different themes arising from the semi structured interviews with midwives
Design and methods
- To aim was to understand midwives’ experiences of the barriers and facilitators when adhering to infection prevention and control guidelines
- Semi-structured interviews were conducted with 10 midwives working at a University Hospital in Ireland, to form a qualitative descriptive study
- A range of experience levels among participants were sort, including registration with the national nursing and midwifery board and at least 1 year of experience
- Interviews were audio recorded, transcribed verbatim, and analysed utilising Braun and Clarke’s thematic analysis framework
Key findings
- Two themes were identified from the data analysis; (1) the seesaw for equilibrium; and (2) back to basics: learning on your feet.
Seesaw for equilibrium
- Participants identified the need to find a balance between the demands and uncertainty of everyday practice and the desire to practice safely
- Participants expressed a difficulty in balancing the ability to adhere to IPC guidelines when performing night duty or working long days as well as the physical demands of the participants’ work
- Dealing with the effect of one’s workload and balancing workloads contributed to behaviours deviating from the IPC guidelines in the clinical practice setting.
Back to basics: Learning on your feet
- Participants expressed frustration in having to deal with other disciplines who appeared to adopt a culture of ‘blame the midwife’ when matters relating to IPC were not put in place
- At an environmental level, the ‘old’ and ‘not fit for purpose’ building infrastructure, physical layout and facilities of wards affected the participant’s ability to adhere to IPC guidelines
- Some participants felt there was an overuse of posters (such as poster promoting hand washing), and the behavioural prompter was lost
- Participants experienced a ‘reactive rather than proactive’ approach from hospital management when there was an IPC issue
Strengths and limitations
- The number of participants was 10 and only represents a handful of views
- All the participants were from the same hospital so it would be interesting to extend this out to others to see if the findings are generalizable
Points for discussion
- There are clearly challenges in the delivery of safe maternity care whilst trying to maintain IPC guidelines and factors such as work patterns, environment, and resource availability impact guideline adherence
- Do we need to reconsider visual overload? Do we have too many visual cues which confuse the messaging? How can we make our messaging more concise?
- Strategies like the buddy system, huddle, ISBAR, and behaviour-focused education, along with management support, are crucial.
- There was a narrow focus on certain aspects of standard IPC precautions during the COVID-19 pandemic which led to neglect of other IPC elements. Do we need to revisit IPC guidelines post COVID?
- How do we strike a balance between delivering IPC safe care whilst dealing with the challenges of a busy, emotionally charged and often stressful working environment?
What does this mean for IPC?
- Fear, anxiety, professional integrity, and protection were key motivators for guideline adherence. How can we tackle these perceptions to make IPC guidelines less scary and more deliverable?
- Rapid guideline changes around COVID led to confusion and frustration so do we need to rethink IPC guidance post COVID? Could a refresh help?
Addressing health inequalities using IPC
Guest blogger Kerry Holden (bio below) has written this blog in preparation for next Wednesday’s Journal Club (register here) writes…
Health inequalities are sadly deeply embedded in society and unfortunately growing, leading to unequal access to services and poor care experiences. These disparities contribute to earlier deaths, reduced healthy life expectancy, intergenerational trauma, and substantial economic costs. However, many of these health inequalities are preventable.
Continue readingCollateral damage in a waterless ICU!
In recent months I’ve read a lot about the infection risks associated with sinks and drains in areas of healthcare organisations which house some of our most sick and vulnerable patients. The retrospective study carried out in Germany, comparing hospital acquired infection (HAI) rates in 552 intensive Care Units (ICUs) with and without sinks was perhaps the most compelling, concluding that ICU rooms with sinks were associated with a higher rate of HAIs (in comparison to those without sinks). I’ve also read with interest how many healthcare organisations have tackled the infection risk posed by sinks and water through the implementation of water-free or water light (which I personally prefer) systems. More and more evidence is emerging that this approach has merit in reducing the transmission of HAIs in ICUs, with a recent systematic review suggesting that sink removal and other water-free interventions in ICUs, helped terminate infection outbreaks.
Continue readingWAAW 2022: A focus on prevention (IPC and vaccination)
Was delighted to introduce our series of events planned to coincide with World Antibiotic Awareness Week 2022 earlier today. I gave a short talk on why preventing infection via IPC measures and vaccination needs to be a cornerstone of our strategy to turn the time on antimicrobial resistance (slides here).
I also shot a short video to get us thinking about how the language we use will influence the degree to which we connect with the various stakeholders that need to collaborate to address antimicrobial resistance:
An optimal Infection Prevention and Control service is at our fingertips
This is a guest post by the marvelous Jude Robinson (bio below) for some work that she has co-led with Emma Burnett…
I had the pleasure to present our completed study findings of the IPS designing an optimal infection prevention and control service (DOIPS) study at the recent Infection Prevention 2022 conference. This is a four phased- mixed method study which began late in 2017, and was completed in the autumn of 2021.
Continue readingCOVID-19 ain’t what it used to be
As the COVID-19 pandemic has swept through various epidemic waves each characterised by a different variant, the trend has been towards more transmissibility but less virulence of SARS-CoV-2. The emergence of the Omicron variant continued this trend, and we are now seeing some data to compare the clinical outcomes of COVID-19 with other variants. A huge Lancet study (1.5m patients!) demonstrates clearly that the risk of hospital attendance, hospitalisation, and death is significantly lower with Omicron compared with Delta. This is important because the consequences of SARS-CoV-2 acquisition are an important factor in deciding on our management strategy – as a hospital group and in general.
Continue readingSetting our IPC priorities for the next 3-5 years
In honour of Infection Prevention and Control Week (#IIPW) 2021, I thought I put up a quick post based on a talk I did on Friday last week about the ‘Future of Healthcare and of Infection Prevention and Control’ (you can download my slides here). I used it as an opportunity to put across my strategic priorities for the next 3-5 years. And COVID-19 is bottom of the list – keep reading to find out why…
Continue readingThe role of IPC, vaccination, and OTC distribution in AMR
I had the privilege of chairing a session in the BSAC Spring Conference webinars yesterday about the role of IPC, vaccination, and OTC distribution in AMR. The session had a talk from Professor Andreas Voss on IPC as a cornerstone of successful stewardship, Dr Elizabeth Klemm on prevention through vaccination, and Dr Abdul Ghafur on community pharmacy and the challenge of over-the-counter (OTC) distribution.
Continue readingThere’s more to IPC & AMS than COVID-19
As parts of the world begin to contemplate life on the other side of this pandemic, it’s time to address that niggle in the back of our minds as our attention has been focussed on COVID-19: what’s been happening with those other HCAI and AMR issues that usually occupy our days (and nights)? This helpful opinion piece in ICHE discusses the impact of COVID-19 on our usual HCAI & AMR practice.
Reflections on Infection Prevention and Control 