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epic
Initiative - introduction
The epic initiative was established in 1998 as an overlapping series
of long-term government commissioned research projects focused on
contributing to the development of the evidence base which underpins the
practice of infection prevention and control in the National Health Service
(NHS). Funded principally by the DH, all phases of epic involve
extensive collaboration with key stakeholders in this field, especially the
Infection Control Nurses Association (ICNA), the Hospital Infection Society
(HIS), and the Health Protection Agency (HPA).
This initiative
generates significant research funding for our Centre and various phases of
this project continue to be developed. During the current academic year our
research programme has been dominated by completing various phases of epic
projects and setting up the new phases of this enquiry.
The phases of
epic
epic
phase 1: Developing national evidence-based
guidelines for preventing healthcare-associated infections in NHS Hospitals
1999-2001
Following two years of conducting multiple systematic reviews and the
critical appraisal of large volumes of evidence, we developed the phase 1
national guidelines for preventing hospital-acquired infections in England
and Wales which were approved by DH and published in The Journal of
Hospital Infection in January 2001. During 2004-2006 we
completed further systematic reviews to update the evidence base for these
guidelines (see epic2).
epic
phase 1a: Supporting NHS Trusts to implement
national guidance for preventing healthcare-associated infections 2003-2005
This was a collaboration between the Richard Wells Research Centre and the
National Clinical Governance Support Team (part of the NHS Modernisation
Agency) to develop a Clinical Governance Development Programme focused on
preventing HCAI. This programme supported multidisciplinary healthcare teams
in NHS Trusts throughout England to improve infection prevention and control
services, improve practice and reduce the rates of preventable HCAI.
epic
phase 1b:
Updating the Phase 1 Guidelines 2003-2004
Having conducted updating systematic reviews,
we reported changes in evidence in the Journal of Hospital Infection and
the British Journal of Infection Control in in 2004.
epic2 National evidence based
guidelines for preventing healthcare associated infections in NHS hospitals
in England
In
June 2005, the DH contracted us to update the epic phase 1 guidelines. This
involved an additional systematic review in all six topic areas. The
guidelines are complete and will be published as a supplement in the
Journal of Hospital Infection in January 2007. In addition, a patients’
version has been developed and submitted to the DH.
epic
phase 2a: Developing national evidence-based guidelines for
preventing HAI in primary and community care services 2001-2003
These guidelines were developed on behalf of NICE (and DH) and published in
special supplements of the Journal of Hospital Infection and the
British Journal of Infection Control in 2003.
epic
phase 2b: A National Review of the Role and Responsibilities
of Community Infection Control Nurses (CICN) and Communicable Disease
Control Nurses (CDCN) in England 2001-2002
This national review was commissioned by the DH and employed comparative
case studies and a national survey to provide (1) a comprehensive
description of the current roles and responsibilities of CICN and CDCN (2) a
review of the current education and practice preparation of CICN and CDCN
and (3) an analysis of the changes needed to develop these roles in line
with the future pattern of provision of infection prevention and control
services within the newly formed Health Protection Agency (HPA) and Primary
Care Trusts. This report was presented to the HPA Steering Group and
findings were extensively featured in regional and national conferences and
simultaneously published in two peer reviewed journals.
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phase 3: Enhancing the Evidence-base for Infection Prevention
and Control Practices in the United Kingdom (CHART) 2003-2006
In
February 2003 we commenced the initial planning stage of a two year national
clinical trial to ascertain if the incidence of hospital ward-acquired
methicillin-resistant Staphylococcus aureus (MRSA)
colonisation/infection could be reduced by using statistical process control
(SPC) feedback and a structured diagnosis of the underlying causes of MRSA
acquisition. This study, funded by the DH, was conducted in partnership
with the ICNA and 24 NHS Trusts throughout England. Following NHS
Multi-Centre Research Ethic Committee approval in
December
2003, this trial commenced in April 2004 and monthly data was collected
and reported. The study completed in April 2006 and the findings have
been presented at international and national conferences.
epic
international: A comparison of international practices in the management and
control of healthcare-association infections 2003-2004
In 2003, the
National Audit Office (NAO) conducted a Value for Money study to evaluate
improvements that the National Health Service has made in the management and
control of healthcare-associated infections (HAI) as a follow-up to their
report in February 2000 on The Management and Control of
Hospital-acquired Infections in Acute NHS Hospitals. We were
commissioned to develop a component of this study which compared infection
prevention and control practices and policies and the extent and costs of
HAI in England with selected countries in North America, Australasia and the
European Union. Our report was published by NAO in July 2004.
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MRSA evidence review - Systematic review of interventions to prevent the
transmission of meticillin-resistant Staphylococcus aureus (MRSA) in hospital 2004-2005
This review, commission by DH on behalf of the Joint MRSA Working Party,
was published in the Journal of Hospital Infection. in 2006.
epic
update – Monitoring the changing evidence for the prevention
of HCAI
During 2006
we completed two contracts with DH to conduct a
systematic review to identify changes in evidence, emerging technology and other national and international evidence
and guidelines for preventing HCAI, and to prepare briefs for and respond to
departmental and ministerial enquires. We reviewed and advised on an
e-learning infection prevention and control programme developed by NHSE
Scotland for use by the NHS in England. In addition, we conducted evidence
reviews to inform NHS Trust staff uniform policies and laundering, ie the
role of uniforms in transmitting infection.
epic2
National
evidence based guidelines for preventing healthcare associated infections in
NHS hospitals in England
In June 2005, the DH contracted us to update the epic phase 1 guidelines.
This involved an additional systematic review in all six topic areas. The
guidelines are complete and are published as a supplement in the Journal
of Hospital Infection February 2007. In addition, a patients’
version has been developed and submitted to the DH.
Other Activities
National Health Service
University (NHSU) 2004-2005 onwards
We have developed in collaboration with Intuition (Dublin) a blended e-learning infection prevention
and control programme for the NHS.
This initiative was funded by the NHSU and was transferred to the
NHS Core Learning Unit. The programme is now
offered in NHS Trusts throughout England. This has been a major development
for our Centre as it is intended that this multidisciplinary programme will
be mandatory for all 1.3 million clinical and non-clinical employees of the
NHS.
Living Well with HIV/AIDS – Expert Patient Initiative
Having originally developed the evaluation tools and strategy
for this pan-London DH Expert Patient Initiative, we are under contract to
conduct an annual evaluation of this programme in NHS Trusts and
corresponding local government authorities in east and west London sectors.
Evaluation analyses have been presented at several international
conferences.
National Healthcare-associated Infection
Research Network
During 2006 the National HCAI Research Network was established within RWR on
behalf of DH.
The key aims of the HCAI Research Network are to contribute
to the strategic development of the national research agenda in this field
and support and manage DH funded HCAI-related research.
The Network is already managing and supporting major projects recently
funded through the Department’s Policy Research Programme’s call for
research into the cost-effectiveness of interventions for the control of
HCAI. These include a diverse range of studies such as those focusing on the
role of managing the hospital environment, environmental decontamination,
MRSA carriage in care home settings and modelling MRSA intervention
policies.
An Advisory Board for the HCAI Network, chaired by Professor Charles Easmon,
Deputy Chairman of the Health Protection Agency Board, is being established
and its primary function will be to advise on national priorities for HCAI
research.
In addition, the Network is developing plans to:
-
coordinate with other research funders to explore how best
to bring relevant research into the managed Network;
-
enhance research capacity and capability in this area (by
providing relevant interdisciplinary research training and opportunities
for methodological support and advice to HCAI researchers);
provide support to research groups for research governance
and ethical approval processes.
The
Network has established its own website which provides more detailed
information about its activities
www.hcainetwork.org
Support to
Faculty Research and Educational Programmes
Increasing Faculty Research
Capability and Capacity
As our contribution to the Faculty’s Research Capability and
Capacity programme, RWR have developed and implemented an in-service programme
designed to facilitate staff to develop more effective evidence-based
teaching strategies. Centre staff teach and are also module leaders for the
quantitative and qualitative modules in the University’s MA Research Methods
programme and the core research modules of the Faculty’s BSc programmes.
Teaching and Research Mentorship
All Centre staff members offer teaching and research
mentorship to Faculty colleagues each academic year. This includes our
contribution to monthly Faculty research surgeries. Our teaching input into
the complete span of Faculty educational programmes focuses on infectious
diseases, evidence-based practice, critical appraisal and applied research
methods.
Certificates in Professional Practice
The Centre implements modules throughout the year focused on
general infectious diseases, tuberculosis and infection control as part of
the Faculty’s contractual obligations to the North West London and Thames
Valley Workforce Development Confederations
MSc in
Health Protection and Patient Safety
We have started the development of a MSc in Health Protection
and Patient Safety to cater for a wide range of infection control, health
protection and patient safety practitioners. We would anticipate this
programme to be validated during the current academic year and offered
from 2007-08 onwards.
Contributions to University and Faculty Committees
Members of the Centre are involved in appropriate research
committees, including the University Research Committee, Faculty Research
Committee (FRC), University and Faculty Research Assessment Exercise (RAE)
sub-committees, Faculty Research Ethics Committee, Faculty Research
Institute Advisory Committee, Academic Board and the Academic Planning
Committee. Prof. Robert Pratt is Chair of the Faculty RAE sub-committee
and the
University website review sub-committee. Dr. Carol Pellowe is the Deputy
Director designate for the Joanna Briggs Institute Collaborating Centre initiative. Heather
Loveday is the Chairperson of the Faculty Research Ethics Committee.
Support to our Professions
Centre staff are actively involved in relevant professional organisations,
eg Prof. Robert Pratt is a life member of ICNA and Patron of the National HIV
Nurses Association (NHIVNA), and he and other Centre colleagues act as
consultants and advisers to a wide range of organisations and government
agencies, e.g., DH, NAO, ICNA, NHIVNA,. All Centre staff are frequent presenters
at relevant, national and international conferences.
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