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Methicillin-resistant Staphylococcus aureus (MRSA) are strains of bacteria which are resistant to a range of commonly used antibiotics and as a result are difficult to treat and cause significant morbidity and mortality amongst hospitalised patients and individuals with compromised immunity. Research conducted by Professor Peter Hawkey at the University of Birmingham has demonstrated that by rapidly screening patients for MRSA on hospital admission and then using an effective decolonisation treatment, the rate of MRSA acquisition can be significantly reduced. The Department of Health (DoH), who commissioned the research, used the results of the work to formulate guidance, which was published in 2008, for universal MRSA screening in England. This has contributed to the sustained reduction in MRSA infection in England, which is indicated by the fall in MRSA bacteraemia rates from 7,274 in 2002 to 1,185 in 2011 (-83.7%).
Research by Professor Judith Stephenson and colleagues at the UCL Institute of Women's Health into the effectiveness of chlamydia screening has led to guidance to health policy makers in the EU about national strategies for chlamydia control, and has influenced NICE guidelines on the subject. In particular, our work has informed debate on the value for money of the National Chlamydia Screening Programme (NCSP). Stephenson advised the National Audit Office on this topic, and a resulting report led to the NCSP focusing on chlamydia testing in sexual health services and primary care rather than screening in low risk groups. These changes are expected to make considerable cost savings to the NHS.
Healthcare-associated infections (HCAI) and antimicrobial resistance pose a constant threat to patients accessing healthcare in a range of settings. HCAI prolong recovery; delay discharge from hospital and, in extreme circumstances, cause serious disability or death. This case study describes the impact of the Epic (evidence-based practice in infection control) research programme that focuses on the translation of evidence into national infection prevention and control guidelines for the NHS. Through evaluation of initiatives to reduce the threat of HCAI and associated disability to patients, and by generating evidence to support the development of government policy, Epic has led to safer care for people during periods of health-related vulnerability, and saved lives.
Two significant impacts have resulted from King's College London (KCL) research on preventing infections of the so-called antibiotic-resistant MRSA `superbug' associated with hospital treatment. KCL's research exemplifies NIHR's stated "end-to-end" strategy for translating discoveries made in individual infections to population benefit through treatment and prevention.
First, KCL research contributed to Department of Health guidelines. Following the publication of those guidelines, NHS Trusts set out stronger procedures for screening patients for MRSA and for routine `decolonisation' — involving the use of antibacterial shampoo, bodywash and nasal cream by patients. This made a major contribution to the dramatic 75% fall in MRSA cases reported by Public Health England between 2008/09 and 20012/13.
Second, KCL research showed that some MRSA strains are more easily transmitted and more virulent than others. Specifically, we identified a molecule produced by one such strain of bacteria that enabled it to adhere to and colonise a host. We patented this molecule as a rational vaccine component to prevent MRSA infection, and the Novartis pharmaceutical company took up this patent in 2009.
Antenatal screening aims to identify genetic carriers of sickle cell/thalassaemia in order to provide prospective parents with "informed choice". Throughout the period January 2008-July 2013, the NHS in England has used a Family Origins Questionnaire in connection with sickle cell/thalassaemia screening derived from our research programme. The original policy issue concerned whether or not it is possible/desirable to target antenatal screening for sickle cell/thalassaemia by means of an ethnicity question. The policy problem was that socially constructed "ethnicity" categories correspond imperfectly and to an unknown degree with actual prevalence of genetic carriers. The screening question based on our research now guides the offer of initial screening and/or further laboratory tests for all pregnant mothers in England.
Abdominal aortic aneurysms (AAAs) affect more than 4% of British men aged 65-74 and are responsible for over 6,800 deaths annually. The MASS trial showed that screening could reduce AAA-related mortality by 42%, and the Health Economics Research Group (HERG) demonstrated, through the MASS trial, that AAA screening was cost-effective. HERG thus helped inform the policy announced by UK ministers in 2008 to introduce a national screening programme for all men reaching 65. By Spring 2013 it was fully introduced in England — offering screening to 300,000 men annually; the latest Annual Report (2011-12) claimed an uptake rate of 75%. In 2008 the DH estimated the health gain from a screening programme would be at least 130,000 QALYS over 20 years. Internationally, MASS is the most significant trial of AAA screening, and provides the most robust evidence-based model of its cost-effectiveness. It extensively influenced AAA screening guidelines, policies and services, including in the USA and Europe.
Research led by Dr Holmes has identified a novel variant of methicillin-resistant Staphylococcus aureus (MRSA) in livestock. This represents a previously unidentified reservoir of infection which has had impact on the epidemiology of MRSA and its management. This research also impacts on antibiotic use in agriculture and its role in the emergence of antibiotic resistance. As a consequence of these research findings commercial tests and testing protocols have been developed to detect the new MRSA variant, which are now used widely in clinical settings throughout Europe. The discovery has also been used to inform policy decisions at a governmental level in the USA and Europe.
The research reported here has influenced the Scottish Government's Hepatitis C Action Plans and led to changes in practice in services providing sterile injecting equipment to people who inject drugs (PWID) in Scotland and to reductions in risk behaviours for hepatitis C infection among this population. Specifically, there has been an increase in the availability and uptake of sterile equipment used to prepare and inject drugs and a reduction in sharing of such equipment by PWID. More recent research is beginning to indicate that the changes in Government policy and practice are helping to reduce recent (incident) hepatitis C infections among PWID.
The UK Faecal Occult Blood Test Screening Programme, based on Dundee-led research (Steele), offers bowel cancer screening through mailed test kits followed up with colonoscopy when faecal blood is detected. It is estimated to prevent about 2,000 UK deaths annually. Steele's Screening Research Unit also trialled immunological faecal occult blood testing, which was subsequently incorporated into the Scottish screening algorithm. In addition to demonstrating a 27% reduction in bowel cancer deaths through participation in Faecal Occult Blood screening, the Unit has researched the incidence of interval cancers and the impact of repeated invitations, development of new tests, and strategies for increasing participation. All of these drive the National Screening Programme, and will further reduce mortality.
The University of Liverpool (UoL) has provided pivotal evidence for the introduction and development of national screening programmes for diabetic retinopathy (DR). Technician based screening, which has been introduced since 2008, is now covering over 1.9 million UK people at risk and employing over 1,000 technicians across 96 programmes. Sweden and Scotland have introduced 2 and 3 year screening for patients with no DR based on UoL work on extended screen intervals. The UoL led the revision of the St. Vincent Declaration, the principal policy statement of the WHO on the management of diabetes, and has continued to develop pan European policy and influence national policies in several European countries (including Italy, Germany, Spain).