Saving Lives – an epic quest to promote an evidence-based approach for preventing healthcare-associated infections in the National Health Service in England

Since its inception more than half a century ago, the National Health Service has continued to transform and improve the health and wellbeing of the Nation. Now treating a million people every 36 hours, the NHS provides an unprecedented range of clinical interventions that can mend accidental damage, prevent, identify and manage or cure disease, and prolong quality life. However, hospital care and healthcare interventions are always associated with potential hazards, including the risk of acquiring an infection during care. Those patients most at risk are often the most vulnerable and chronically ill in our society and they and their families suffer needlessly because healthcare-associated infections are largely preventable. During the last decade, the Richard Wells Research Centre (RWR) in the Faculty of Health and Human Sciences at University of West London (formally Thames Valley university) has collaborated with the Department of Health and a variety of other governmental organisations and professional societies to develop an evidence-based approach to preventing healthcare-associated infections. This article describes the impact of our work and our journey in partnerships to support sustainable improvements in patient care, enhance patient safety and ultimately save lives

Social-ecological Heterogeneity Shapes Resilience of Small-scale Fisheries: An Interdisciplinary Analysis of the Mexican Chocolate Clam Fishery in Loreto, Mexico

All benefits provided by natural systems are embedded within coupled social-ecological systems (SESs). Fisheries are clear examples of SESs: through fishing, humans affect ecosystem structure and functioning, and in turn, receive benefits, including sustenance, employment, and cultural value. Resilience, the ability to maintain structure and function in the face of change, is key to sustaining the social and ecological components of fisheries-related SESs and their interactions. Many factors contribute to resilience, including heterogeneity. By identifying heterogeneity in these complex systems, we are better able to understand the capacity of fishery-related SESs to adapt to change, and contribute to management that protects valuable services. In this dissertation, I ask: 1) How are SESs associated with marine fisheries shaped by environmental, social, and institutional heterogeneity, and 2) what are the implications of this variation for resilience and adaptive capacity of fishers and the SES, in the face of changing environmental and socioeconomic conditions? To answer these questions, I employ an interdisciplinary approach focused on the chocolate clam (Megapitaria squalida) fishery in Loreto, Baja California Sur, Mexico. I conducted biological field studies, household surveys, interviews, ethnographic conversations, and developed fisheries models from my empirical work. Together, my results illustrate that management aligned with the biology of target populations and stakeholders’ goals is critical to sustainable fisheries. Heterogeneity among fishers affects their individual capacities to adapt to change. Maintaining a diversity of adaptive strategies is essential for individual adaptive capacity. Likewise, maintaining fishery heterogeneity, by ensuring all fishers are equipped to adapt, will strengthen community adaptive capacity. The chocolate clam provides diverse cultural and provisioning values to communities, and management that considers all benefits will be better equipped to account for the needs and knowledge of diverse stakeholders. Both formal and informal institutions shape fishing practices, and integrating them, via collaborative governance, would increase community participation in management and enhance fishery resilience. My interdisciplinary approach acknowledges the intricate web of human-resource interactions shaping fisheries and reveals how heterogeneity shapes SES resilience. Management that supports diversity in all forms will be better equipped to contribute to the resilience of these highly valuable and dynamic systems

Student nurses' experiences of infection prevention and control during clinical placements

Background: Little is known about nursing students' experiences of infection control in the clinical setting despite its importance protecting patients and reducing risks of occupational exposure. Methods: We conducted an online survey involving a fixed choice Likert-type scale with 19 items and an open question to solicit more detailed information with a national sample of student nurses in the United Kingdom. Results: Four hundred eighty-eight student nurses completed questionnaires. All participants reported lack of compliance for every item on the Likert scale, most frequently from community settings and long-term care facilities for older people. Incidents most commonly witnessed were failure to comply with hand hygiene protocols, failure to comply with isolation precautions, poor standards of cleaning in the patient environment, not changing personal protective clothing between patients, and poor management of sharp instruments. Qualified nurses did not provide good role models. Medical staff were the occupational group most heavily criticized for poor compliance. Conclusion: Students demonstrated sound understanding of infection control and were able to identify lack of compliance on the basis of preclinical classroom instruction. The study findings indicate that ensuring safe infection control practice remains a challenge in the United Kingdom despite its high priority

DIG Social Media Manager Guidebook: Responsibilities Guide

The Social Media Manager Responsibilities Guide clarifies the responsibilities of the Social Media Manager on a monthly, weekly, and daily basis. Previously, the expectations of the Social Media Manager were not thoroughly documented. This document should enhance the organization of the content-sharing process by providing clear timelines and tools for managing DIG’s social media pages. It should be referred to by the Social Media Manager when they take on the role, as well as when they go through the posting process, to ensure no steps are missed

DIG Social Media Manager Guidebook: Strategy Guide

The social media strategy guide is a framework for the DIG directors and the Social Media Manager to get the most out of DIG social media pages. The use of social media should be intentional, and this guide is an important step in creating a consistent, engaging social media presence. Social media pages, when managed well, can be powerful tools to communicate stories and garner support. In 2019, 72% of adults used at least one social media site (PEW). This means that social media is an incredibly powerful tool to reach a large network of donors and partners. It can be used to maintain and build relationships with DIG’s current and potential donors, supporters, and partners

DIG Program Manager Digital Storytelling Resource

Serves as a resource for Program Managers to capture quality images and share detailed captions for effective digital storytelling

DIG Social Media Manager Guidebook: Style Guide

DIG does not currently have an established Social Media Style Guide. A style guide establishes consistent brand messaging across all public communication channels and allows DIG to communicate more consistently and effectively with its current and target audiences. This consistent brand messaging will build loyalty and trust, both of which are important in growing DIG’s donor base and establishing strong partnerships. The style guide will also serve to guide Social Media Managers in crafting captions for posts on social media

Washout policies in long-term indwelling urinary catheterisation in adults

Background  People requiring long-term bladder draining with an indwelling catheter can experience catheter blockage. Regimens involving different solutions can be used to wash out catheters with the aim of preventing blockage. This is an update of a review published in 2010.  Objectives  To determine if certain washout regimens are better than others in terms of effectiveness, acceptability, complications, quality of life and critically appraise and summarise economic evidence for the management of long-term indwelling urinary catheterisation in adults.  Search methods  We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings to 23 May 2016. We also examined all reference lists of identified trials and contacted manufacturers and researchers in the field.  Selection criteria  All randomised and quasi-randomised trials comparing catheter washout policies (e.g. washout versus no washout, different washout solutions, frequency, duration, volume, concentration, method of administration) in adults (aged 16 years and above) in any setting (i.e. hospital, nursing/residential home, community) with an indwelling urethral or suprapubic catheter for more than 28 days.  Data collection and analysis  Two review authors independently extracted data. Disagreements were resolved by discussion. Data were assessed and analysed as described in theCochrane Handbook. If data in trials were not fully reported, clarification was sought from the study authors. For categorical outcomes, the numbers reporting an outcome were related to the numbers at risk in each group to derive a risk ratio (RR). For continuous outcomes, means and standard deviations were used to derive mean differences (MD).  Main results  We included seven trials involving a total of 349 participants, 217 of whom completed the studies. Three were cross-over and four were parallel-group randomised controlled trials (RCTs). Of these, two trials were added for this update (one parallel-group RCT with 40 participants and one cross-over RCT with 67 participants). Analyses of three cross-over trials yielded suboptimal results because they were based on between-group differences rather than individual participants' differences for sequential interventions. Two parallel-group trials had limited clinical value: one combined results for suprapubic and urethral catheters and the other provided data for only four participants. Only one trial was free of significant methodological limitations, but there were difficulties with recruitment and maintaining participants in this study.  The included studies reported data on six of the nine primary and secondary outcome measures. None of the trials addressed: number of catheters used, washout acceptability measures (including patient satisfaction, patient discomfort, pain and ease of use), or health status/measures of psychological health; very limited data were collected for health economic outcomes. Trials assessed only three of the eight intervention comparisons identified. Two trials reported in more than one comparison group.  Four trials compared washout (either saline or acidic solution) with no washout. We are uncertain if washout solutions (saline or acidic), compared to no washout solutions, has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because the results are imprecise.  Four trials compared different types of washout solution; saline versus acidic solutions (2 trials); saline versus acidic solution versus antibiotic solution (1 trial); saline versus antimicrobial solution (1 trial). We are uncertain if type of washout solution has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because the results are imprecise.  One trial compared different compositions of acidic solution (stronger versus weaker solution). We are uncertain if different compositions of acidic solutions has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because only 14 participants (of 25 who were recruited) completed this 12 week, three arm trial.  Four studies reported on possible harmful effects of washout use, such as blood in the washout solution, changes in blood pressure and bladder spasms.  There were very few small trials that met the review inclusion criteria. The high risk of bias of the included studies resulted in the evidence being graded as low or very low quality.  Authors' conclusions  Data from seven trials that compared different washout policies were limited, and generally, of poor methodological quality or were poorly reported. The evidence was not adequate to conclude if washouts were beneficial or harmful. Further rigorous, high quality trials that are adequately powered to detect benefits from washout being performed as opposed to no washout are needed. Trials comparing different washout solutions, washout volumes, and frequencies or timings are also needed