SHAIPI and SIRN Collaborative Infection Research Background

SHAIPI and SIRN Collaborative Infection Research

Background • • • HAI costs £ 183 M annually Occurs in 5% of the acute hospital population Major policy area for Scottish Government Changing epidemiology of organisms (E coli/S aures) AMR is now a recognised threat A lot of practice in HAI control has little or no evidence base

Scottish Infection Research Network • Formed in 2006 at the request of the Scottish Government • Supported 33 projects: £ 1 k- £ 4. 3 M. Total £ 6 M. • Secretariat based in Glasgow University • Scottish Government secretariat funding for 17 -18.

SIRN Remit § Build a sustainable, high quality research infrastructure § Build capacity within the HAI research community § Develop and support effective collaborative relationships § Develop and shape high quality research bids § Initiate a research stream to evaluate current HAI practice § Endorse and promote HAI related research that is scientifically credible and has practical application § Generate, apply and disseminate HAI knowledge that enhances delivery and quality of patient care

Consortium • A National consortium over 5 years • Developing and utilising 3 National strengths • Based on 9 key priority areas identified by SGHD • Translational • Self sustaining

Biosciences Scottish HAI Prevention Institute (SHAIPI) Informatics Behavioural science (Practice based interventions)

Scottish Healthcare Associated Infection Prevention Institute (SHAIPI) Strategic vision To become a recognised Institute for excellence in HAI Research utilising 1. Rapid knowledge transfer 2. State of the art laboratory techniques 3. Informatics 4. Novel interventions and developing evidence for existing interventions To tackle threat to public health from emergent HAI and antimicrobial resistance in a co-ordinated fashion

SHAIPI 19 Co. Is, 5 HEIs ( Glasgow University (genomics, informatics); Glasgow Caledonian University (applied infection prevention, patient experience); Strathclyde University (clinical informatics, statistics), Dundee University (informatics, pharmacology), St Andrews University (genomics, informatics) 3 HBs Grampian, Tayside, Fife Strategic partners working with this consortium include: PHI: epidemiology and access to European network of 28 countries Farr institute: access to UK health informatics research network, health policy advice IPS: Infection control practitioners and potential for CARC capacity building in Scotland through internships and international partnerships through the Society HENs (Health economics network): developing health economic analysis of interventions SMVN (Scottish Microbiology and Virology Network): microbiology samples, isolates and laboratory data SICSAG (Scottish Intensive Care Society Audit group) and Scottish Critical Care Trials Group: provide a network to develop a National clinical dataset, identify and trial interventions. Scottish Reference laboratories: organism specific expertise, national collections and datasets SAPG (Scottish Antimicrobial Prescribing Group): focussed on optimising prescribing practice and reducing antimicrobial resistance. Sanger Centre

Interconnections of Workstreams Feedback loop for WS 1, 2&3

Years 1 and 2: Laying the Foundations • Develop an understanding of the epidemiology of the key organisms causing HAI in Scotland.

Years 1 and 2: Laying the Foundations • Phase 1 risk modelling using existing IIP national data providing initial risk estimates for being a case and risk modelling for the outcome of cases for: – – C. difficile, S. aureus E. coli VRE

Mortality and discharge status using National datasets Cases Controls Total N % Mortality at 2 months 3304 953 28. 8 9516 1362 14. 3 Died in hospital within 2 months 3304 731 22. 1 9516 855 9. 0 Discharged within 2 months 3304 2022 61. 2 9516 7542 79. 3 Still in hospital at 2 months 3304 551 16. 7 9516 1119 11. 8 After adjustment the hazard ratio (HR) of death for Cases relative to Controls HR 2. 12 (95% CI 1. 93, 2. 33)

Importance of IPC • Little evidence existed on the components required for effective national IPC interventions • The previous WHO guidance on national IPC components was based on expert opinion • WHO recently commissioned this systematic review

Search Results Additional records identified through other sources (n = 139) Identification Records identified through database searching (n = 9, 960) Screening Full-text articles assessed for inclusion criteria (n = 355) Studies included (n = 29 reported in 30 articles) Included Records screened (n = 9, 777) Eligibility Records after duplicates removed (n = 9, 777) Records excluded (n = 9, 422) Full-text articles excluded, with reasons (n = 326) Not primary research studies, no intervention, not national implementation, not HAI, not CRT, NRT, ITS, CBA studies

Summary WHY? HOW? WHAT? • To inform development of international guidance on national IPC programmes • Systematic review – the first to evaluate IPC interventions at the national level • Multimodal interventions were supported by the highest number of studies and showed the most impactful results • Good quality evidence was limited to a small number of studies • Best available evidence to inform international recommendations comes from individual studies on IPC multimodal interventions and a study on surveillance, monitoring and feedback

Years 3 to 5: Patient centred outputs • Provide a responsive typing facility that can be used for outbreak control • Targeted interventions on the epidemiology of causative HAI organisms • Phase 2 risk modelling of HAI focussing on E. coli / S. aureus outcomes • Integration of risk models in service delivery

SHAIPI Wider Deliverables • Strengthen HAI translational applied research capacity within Scotland via development of researchers at various career stages – 6 additional Ph. D studentships • Improved capacity to capture externally funded research grants – £ 2. 13 M additional funding • Collaborations – HPS developed Scottish AMR Research Consortium (SARC) • Produce REF 2020 returnable research outputs of 3 and 4 star – 21 papers – 21 conference presentations • Translate research into learning opportunities for under-and postgraduate students and NHS practitioners – Regular SHAIPI research events including annual International Advisory Droup meeting • European and international collaboration in research – WHO Evidence for IPC work

Pie in the Sky? Patient with UTI CHI identification SMR 1 ECOSS Data linkage n. RTS High resolution typing AMR genotyping E. coli Analytic platform Risk modelling Validated models Targeted IPC Interventions SICPs/TBPs evidence for generic Interventions Targeted prevention and Management Evaluation of Patient and practitioner Experience

FIN www. glasgow. ac. uk/sirn