Safe at the Point of Care: Reducing the Impact of Healthcare-Associated Infection
Submitting InstitutionGlasgow Caledonian University
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
Healthcare Associated Infections (HAI) can be an unintended consequence
of healthcare delivery. They are caused by a range of organisms but are
often preventable. GCU-led research has reduced avoidable infections in
healthcare in the UK and Europe by stimulating policy debate and
investment in new healthcare practice and influencing policy decisions,
evidence guidelines, and educational practices. Important changes have
been made to national and international approaches to meticillin-resistant
Staphylococcus aureus (MRSA) screening with cost savings of £7.5
million to the NHS. 28 European countries now use the HAI point prevalence
survey validation method determined by our research.
HAI research has been undertaken at GCU for 17 years, with outputs of
more than a 100 peer reviewed publications over this period. The HAI
research team is led by Professor Jacqui Reilly, who has established a
strong relationship between HAI laboratory-based research and its
application to HAI prevention in the NHS. A strategic partnership with NHS
Health Protection Scotland (HPS) has enabled this research to have an
impact on national policy in Scotland and in Europe.
In 1996, the first point prevalence survey (PPS) of HAI in the UK
indicated that 10% of hospital patients acquired an infection. Reilly's
groundbreaking PhD investigated HAI surveillance, identifying the risk
factors for surgical site infection, and evaluated a change in practice
designed to decrease the incidence of these infections. Subsequent
prevalence surveys of HAI were conducted by Reilly et al in 20061 [grants
(G) 1] and 20112 [G2]. The 2006 survey1 established
the cost of HAI to the NHS in Scotland as £183million a year and that Staphylococcus
aureus (S. aureus) was the organism most commonly causing
Subsequent work evaluating the antimicrobial treatment of S. aureus
infections (in collaboration with Dr Susan Lang) focused on complex
biofilm-associated infections, [G3-5]. This generated important
information on the action of antibiotics against these recalcitrant
infections3. Our research on S. aureus was developed
further with world-leading research on MRSA screening led by Reilly4,5
[G6-10]. This included approaches to screening, anatomical sites to screen4
and investigated the clinical and cost effectiveness of alternate
approaches to managing risk of this infection5. We discovered
that, by using a standard set of questions clinicians could identify those
at high risk of being a carrier of the infection. Screening only these
high risk patients was more cost effective, and as clinically effective,
as screening everyone4,5. In 2009, the HAI team evaluated the
acceptability of MRSA screening and showed that it was broadly acceptable
to patients, staff and the wider public, but that aspects of communication
and information could be improved to maximise acceptability6.
Moreover, we identified the need for national guidance and patient
information on MRSA screening.
In 2010, Reilly led a large European-wide study [G11] to evaluate optimal
methods for validation of PPS across ten countries in order to provide an
evidence base for European policy and practice. The study found concurrent
blinded data collection to be the most practical approach and recommended
that inter-rater reliability was tested formally prior to conducting
validation. These findings influenced future validation studies and PPS
studies in the European Union and have since been adopted by the European
Centre for Disease Prevention and Control for the prevention and control
of healthcare-associated infections.
Professor Jacqui Reilly
Dr Lang (Senior Lecturer)
Dr Kay Curry (Reader)
Dr Christina Knussen (Reader)
Dr Lesley Price (Lecturer)
References to the research
1. Reilly J,
Stewart S, Allardice GA, Noone A, Robertson C, Walker A, S Coubrough S.
Results from the Scottish National HAI Prevalence Survey. Journal of
Hospital Infection (2008); 69(1):62-8. (doi:
2. Reilly J, Cairns S, Fleming S, Hewitt D, Robertson C, Malcolm
W, Nathwani D and Williams C Results from the second Scottish national
prevalence survey: the changing epidemiology of healthcare-associated
infection in Scotland Journal of Hospital Infection (2012); 82:
170-174. (doi: 10.1016/j.jhin.2012.07.024).
3. Smith K, Perez A, Ramage G, Lappin D, Gemmell CG, Lang S.
Biofilm formation in Scottish clinical isolates of Staphylococcus
aureus. Journal of Medical Microbiology (2008);
57(8):1018-23. (doi: 10.1099/jmm.0.2008/000968-0).
4. Matheson, A, Christie, P, Stari T. Kavanagh K, Gould IM,
Masterton R, Reilly J Nasal Swab Screening for Methicillin-Resistant Staphylococcus
aureus-How Well Does It Perform? A Cross-Sectional Study Infection
Control and Hospital Epidemiology (2012); 33(8): 803-808.
5. Reilly J, Stewart S, Christie P, Allardice G, Stari T, Matheson
A, Masterton R, Gould IM, Williams C. Universal screening for
meticillin-resistant Staphylococcus aureus in acute care: risk
factors and outcome from a multicentre study. Journal of Hospital
Infection, (2012); 80(1):31-5. (doi: 10.1016/j.jhin.2011.09.008).
6. Currie K, Knussen C, Price L and Reilly J Methicillin-resistant
Staphylococcus aureus screening as a patient safety initiative:
using patients' experiences to improve the quality of screening practices
Journal of Clinical Nursing (2013); (doi: 10.1111/jocn.12366).
1. Reilly J (CARC appointment in NHS) (2004-2006) Scottish
Government Health Directorate, £500,000 National prevalence survey of HAI.
2. Reilly J (CARC appointment in NHS) (2010-2011) Scottish
Government Health Directorate, £350,000 National prevalence survey of HAI.
3. Lang S (2006-07) Wyeth, £50,000. Antibiotic-induced stress on
pathogenic bacteria capable of forming biofilms on prosthetic devices:
implication for therapeutic efficacy.
4. Lang S, Price L (2011) Scottish Infection Research Network,
£10,000. To develop an in vitro model of nasal colonisation by
MRSA to investigate the efficiency of mupirocin decolonisation.
5. Lang S (2013-14) Pfizer, £54,000. The role of linezolid in the
treatment of staphylococcal infections; induction of a stress response,
impact on virulence and therapeutic options.
6. Reilly J (CARC appointment in NHS) (2008-11) Scottish
Government Health Directorate, £7.1 million. Multicentre MRSA screening
7. Currie K, Price L, Knussen C (2009-11), National Services
Scotland, £63,000. The acceptability of MRSA screening.
8. Christie P, Smith A, Reilly J (CARC appointment in NHS)
(2010-12) Scottish Government Health Directorate, £998,000. The
effectiveness of MRSA screening: a prospective cohort study of body site
screening and clinical risk assessment.
9. Ritchie L, Reilly J, Godwin J (2010-13) Scottish Infection
Research Network, £165,000. The effectiveness of admission risk assessment
and pre-emptive cohorting of high risk patients to control MRSA.
10. Currie K, Loveday H et al. (2012-13) Department of Health, UK,
£65,000. The patient experience of MRSA screening and decolonisation.
11. Reilly J, Price L, Godwin J (2011-13) European Union,
£160,000. A validation study of PPS in 10 European countries.
Details of the impact
HAI research at GCU has impacted on health and welfare, and public policy
and services. It has reduced avoidable infections in healthcare in the UK
and Europe by stimulating policy debate on HAI4-6, investment
in MRSA screening and approaches to validation of prevalence surveys. This
has resulted in changes to: policy decisions, investment in new healthcare
practice, evidence guidelines, and educational practices impacting on
patients, clinicians and policy makers [S1-10].
The large scale PPSs led by Reilly et al in Scotland in 2006 and
20111,2 determined HAI priorities and was a key driver in the
decision to invest funds in NHS Scotland to prevent and control infection
[S1-2]. Funding of £56million was invested in a number of areas in order
to reduce HAI from 2008-11; with £7million of this focussed on MRSA, in
recognition of the public health importance of the organism identified in
our research [S3].
Our research on MRSA screening4-6 has stimulated debate on the
national policy for screening, which resulted in the introduction of a
national strategy for MRSA screening in NHS Scotland [S3]. In addition, it
demonstrated that nasal passages and perineum were the most appropriate
sites to screen4. As a result of the adoption of these
practices into the strategy, healthcare practice is therefore now more
effective as screening is targeted at those at risk, with resulting cost
savings of £7.5million to NHS Scotland annually [S8]. The user (patient)
experience has been improved by using the GCU acceptability study findings6
to improve the national patient information leaflet and videos produced by
HPS [S6-7]. These are accessible online and in a range of languages [S7].
Further impact of our innovative research on the acceptability of MRSA
screening6 has been demonstrated by two further research calls
by the UK Department of Health [S4].
The findings from GCU research on MRSA have been used to develop a
national education programme on MRSA screening [S7]. It is an
online short course developed by NHS National Education Scotland in 2011,
and is targeted at all healthcare workers in Scotland. By September 2013,
1,456 had completed the course. In evaluations of the course 96% of
participants stated that they thought it would have a lot or some positive
impact on their day to day work as their knowledge, awareness and
understanding of the policy and procedures had increased.
There is evidence from national statistics that our MRSA screening
research4,5 and subsequent change in policy is now having an
impact on patient outcomes with reduced infections rates [S5]. HPS noted
in the 2012 national statistics for Scotland that `the proportion of S.
aureus bloodstream infections, which were MRSA, had significantly
reduced in the last year from 19% to 14% [S5]. This compares favourably
with other European countries with a similar history of high endemic
proportions of this organism and is associated with the introduction of
the national policy for MRSA screening in NHS Scotland.
Investment has also been made in policy to control other HAIs,
highlighted by the PPS study1, including infection control and
antimicrobial prescribing guidance and hand hygiene campaigns [S2], and
these changes to policy and practice in the intervening period have
resulted in a lower prevalence of HAI (9.5% in 2006 versus 4.9% in 2011)
28 European countries now use the PPS validation method determined by our
research [S10]. Each member state in Europe participates in an annual
network meeting and the HAI team has presented the findings of the
research and worked with the European Centre for Disease Control to change
the policy for future validation and point prevalence surveys [S10]. Our
research also contributed to a change to the European training programme
for PPS (delivered by Reilly with other experts in Europe). To-date the
training has been delivered face to face to over 60 national
representatives. These national representatives are then responsible for
cascaded the training, using web based education, to staff within 1,149
hospitals across the 28 European countries [S10].
Sources to corroborate the impact
- Title: Survey shows hospital infections Date: 11th July 2007 Link: http://news.bbc.co.uk/1/hi/scotland/6290094.stm
- Title: The Healthcare Associated Infection Task Force: Report on the
Scottish Government's Two HAI Programmes Between January 2003 &
Date: June 2008
- Title: Routine MRSA screening for Scottish hospitals Date: 23rd
- Title: R&D calls for proposals Date: 15th July 2011
- Title: The Annual Surveillance of Healthcare Associated Infection
Report January — December 2011 Date: May 2012
- Title: MRSA Screening Pathfinder Programme for Public Date: June 2011
- Title: MRSA Screening Programme Date: December 2011
- Title: NHS Scotland MRSA Screening Pathfinder Programme: Economic
Analyses Date: February 2011
- Title: ECDC PPS of HAI and AM use: pilot validation study Date
- Title: Point prevalence survey of healthcare-associated infections and
antimicrobial use in European acute care hospitals 2011-2012 (page 22)
Date: July 2103