Service Ecology: Design Issues for Hospital Infection Prevention and Control Training - Macdonald, Macduff, Loudon, Wan

service ecology: design issues for hospital infec3on preven3on and control (IPC)

Prof Alastair S Macdonald Senior Researcher School of Design, The Glasgow School of Art

Dr Colin Macduff School of Nursing and Midwifery, Robert Gordon University, Aberdeen

Dr David Loudon Research Fellow, The Glasgow School of Art

Susan Wan Research Assistant, The Glasgow School of Art

Macdonald et al, Service Ecology, SERVDES 2016, Copenhagen, 24 May 2016.

visionOn: a tablet-‐based visualisa3on tool for training staff -‐ healthcare associated infec3ons (HAIs)

The Glasgow School of Art

Robert Gordon University, Aberdeen

NHS Grampian

NHS Lanarkshire

GAMA Healthcare Ltd

Macdonald et al, Service Ecology, SERVDES 2016, Copenhagen, 24 May 2016.

context An;microbial Resistance (AMR) Recognised as one of the most important global issues for human and animal health due to the increasing numbers of resistant infec3ons leading to many exis3ng an3microbials becoming less effec3ve

context An;microbial Resistance (AMR) Recognised as one of the most important global issues for human and animal health due to the increasing numbers of resistant infec3ons leading to many exis3ng an3microbials becoming less effec3ve Healthcare Associated Infec;ons (HAIs) HAIs caused by pathogens which take many forms -‐ virus, bacterium, fungus, prion and parasite: norovirus, C diff (Clostridium difficile), and MRSA (methicillin-‐resistant Staphylococcus aureus) -‐ probably most widely known

context An;microbial Resistance (AMR) Recognised as one of the most important global issues for human and animal health due to the increasing numbers of resistant infec3ons leading to many exis3ng an3microbials becoming less effec3ve Healthcare Associated Infec;ons (HAIs) HAIs caused by pathogens which take many forms -‐ virus, bacterium, fungus, prion and parasite: norovirus, C diff (Clostridium difficile), and MRSA (methicillin-‐resistant Staphylococcus aureus) -‐ probably most widely known Infec;on Preven;on and Control (IPC) Poor IPC can lead to AMR

hospital service ecosystem: 3 key actors


people -‐ doctors, nurses, cleaning staff -‐ their everyday roles and tasks – plus pa3ents & visitors



pathogens -‐ norovirus, C diff, MRSA -‐ loca3on, survival, transmission



pathogens -‐ norovirus, C diff, MRSA -‐ loca3on, survival, transmission

environment – hard hospital beds, bedside areas, curtains, taps, toilets, flooring…; so8 -‐ air currents, humidity, temperature ..

issues

IPC training materials

issues

IPC training materials Lack of adherence to IPC protocols

issues

IPC training materials Lack of adherence to IPC protocols Lack of understanding and awareness of pathogens

issues

IPC training materials Lack of adherence to IPC protocols Lack of understanding and awareness of pathogens … all contribute to growth in AMR

Visual derived from covert observa>onal data in: Smith, S.J., Young, V., Robertson, C. and Dancer S.J. (2012) Where do hands go? An audit of sequen3al hand-‐touch events on a hospital ward. The Journal of hospital infec>on, 80(3), 206–211.

junior doctor senior nurse auxiliary nurse cleaner

common hand-‐touch points

The evidence base 1: who touches what ?

prior work Vis-‐Invis: Recommenda3on:” Further development of the concept prototypes for staff training would be beneficial if the visualisa>ons could be augmented with specific training informa>on and scenarios centred around the preven>on of HAIs.”

using visualisa3on Could a visually-‐oriented interac;ve tool raise awareness of loca;on, survival and transmission of pathogens in the ward environment and assist training in IPC across job roles by reinforcing the 'why’ behind IPC procedures?

approach: from hierarchical to co-‐dependent

doctors

senior nurses

auxiliary nurses

domes;cs (cleaners)

current training model hierarchical / differen>ated

intended training model cross cohort / co-‐dependent

3 stage par3cipa3ve process workshop

workshop

evalua;on

development

development

development

?

?

?

? ?

key themes pathogen loca;on

24 hours 1 week

5 months 7 months

key themes) pathogen loca;on pathogen survival

key themes pathogen loca;on pathogen survival pathogen transmission


MRSA norovirus C difficile


MRSA norovirus C difficile

Interven>on

Without cleaning

With cleaning

Visuals derived from data in: Bogusz, Alexandra and Stewart, Munro and Hunter, Jennifer and Yip, Brigihe and Reid, Damien and Robertson, Chris and Dancer, Stephanie J. (2013) How quickly do hospital surfaces become contaminated a8er detergent cleaning? Healthcare Infec3on, 18 (1). pp. 3-‐9. ISSN 1835-‐5617

Surfaces decontaminated aRer detergent cleaning

the evidence-‐base 2: survival

Visuals derived from data in: Bogusz, Alexandra and Stewart, Munro and Hunter, Jennifer and Yip, Brigihe and Reid, Damien and Robertson, Chris and Dancer, Stephanie J. (2013) How quickly do hospital surfaces become contaminated a8er detergent cleaning? Healthcare Infec3on, 18 (1). pp. 3-‐9. ISSN 1835-‐5617

Re-‐contamina;on exceeding proposed cleanliness standards aRer 24 hours

24 hours later

Surfaces decontaminated aRer detergent cleaning

the evidence-‐base 2: survival

itera3ve prototyping feedback -‐ pathogen survival stage 1 sample

stage 1 mock-‐ups “It gave a beSer understanding of exactly what MRSA is.” (cl2) cleaner

“I was shocked that the norovirus is like an aerosol effect in the room. It spreads everywhere, over furniture, chairs, floors, on hands and clothes.” (cL6) cleaner “Thought provoking visuals. Especially highligh>ng mode of transmission and how long they s>ck around such as c-‐diff. You could have an anima>on of how bug travels between rooms throughout wards and ul>mately through hospital” (dr2) doctor “Should be moving pictures rather than s>lls, should use proper wards and superimpose the virus over the image of real environments to give a more real feel to the message, show different areas in the hospital not just ward based.” (n9B) nurse

synthesised narra3ves embodied data democra3c discourse stage 1 mock-‐ups

‘… affirm … ’ ‘… misunderstand …’ ‘… be good to have ...’ ‘… need more informa>on about …’

(n=30) for each of 6 x stage 1 prototypes

Feedback data -‐ workbooks -‐ transcripts of discussions in response to each prototype


stage 2 prototype

(n=30) (n=18)

© The Glasgow School of Art visionOn 2016

stage 2


stage 2


stage 2 prototype

stage 3 prototype

(n=30) (n=18) (n=102)

(N=150)

stage 1 mock-‐ups Each successive itera7on embodied feedback from across job-‐roles

itera3ve prototyping: survival of pathogens

stage 2 prototype

stage 3 prototype

The

workshop 1

workshop 2

stand-‐alone evalua;on

3 stage par3cipa3ve process


stage 3

virtual ward

features

Micro / macro view Zoom in / out camera

interac;ve visuals

Temporal dimension Pathogen specific Effects of cleaning

learning points

Example -‐ pathogen survival

1.  Different pathogens have different survival 3mes within the ward environment depending on whether adequate cleaning has taken place

2.  Pathogens are invisible to the naked eye so the ward can appear ‘clean’ but may not be

3.  At 24 hours aner cleaning a surface, the microbial level can grow and return to the pre-‐clean levels

layered informa;on Relevant to each pathogen type

Risk to pa>ent More detail only if required

Visualisa3ons were engaging and suppor;ve of different learning styles Offered staff a new perspec;ve on pathogens, being able to ‘see’ them contextualised in the virtual ward, making them seem more real.

ini3al findings 1

ini3al findings 2 Informa3on relevant for different staff cohorts, with a mix of experience levels Increased par;cipants’ awareness about pathogens by explaining ‘why’ (through dynamic visuals and informa>on) IPC procedures should be followed Reinforced understanding of how HAIs occur

Further applica;ons were suggested, including induc3ons for new starts, educa3on in schools/universi3es, and refresher courses.

ini3al findings 3

1: the need for par7cipa7ve approaches which challenge the top-‐down hierarchical healthcare paradigm to develop training materials more effec7ve across the different cohorts within a complex service ecosystem -‐ ‘IPC is everyone’s business’ -‐ Just one transgressor spoils IPC for all

healthcare service design issues

2: use the evidence-‐base but design data to be accessible, contextualised and meaningful across the different job roles to enable beFer engagement, par7cipa7on and co-‐development -‐ (the usual mode of academic data presenta>on is ‘privileged’ and inappropriate for training non-‐academics)


3: visualisa7on can help untangle the complexity between the various actors -‐ Improving awareness and understanding


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IPC

Will the tool help improve adherence to IPC protocols?

ques3on

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?Awareness √ Adherence ? Understanding √

IPC

Proof of concept Demand from NHS IPC managers

achievements

Publica;on of detailed findings Stage 4 prototype embodying 105 x stage 3 feedback datasets Development of new ‘modules’ In-‐ward feasibility trial

next

The visionOn project is funded by the Arts and Humani3es Research Council’s Follow-‐On Funding for Impact and Engagement (Grant Ref: AH/M00628X/1) with support from NHS Grampian, NHS Lanarkshire and GAMA Healthcare Ltd. The research team, advisory group and partners www.visionon.org

acknowledgements

[email protected]