support from ips to attend this conference no …prof. brett mitchell, university of newcastle,...

ChallengeandOpportunitiesinInfectionPreventionandControlProf.BrettMitchell,UniversityofNewcastle,Australia

BroadcastlivefromtheInfectionPreventionSocietyconference

AWebberTrainingTeleclasswww.webbertraining.com

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DisclosuresSupportfromIPStoattendthisconference

Nofundingreceivedforthispresentation

Receivedcompetitiveresearchfundingfromgovernmentfundingagencies(NHMRC,Commonwealthgovernment)

Receivedcompetitiveresearchgrantsfromnon-governmentfundingagencies(HCFFoundation,ACIPC,Covidien,AustralianCollegeNursing)

Consultancy(DepartmentofForeignAffairsandTrade,MSD

Editor-in-Chief,Infection,DiseaseandHealth




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e

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Evidence




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EVIDENCEVsTHEORY

Reverseonus

Vs

GuidelinefortheInfectionPreventionandControlof……..

(2001)




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Howarerecommendationsinguidelinesdeveloped?• GRADE(GradingofRecommendations,Assessment,Development&Evaluations)

• Riskofbias• Imprecision• Inconsistency• Indirectness• Publicationbias

• Formulaterecommendation• Qualityofevidence• Benefits/harms• Preferencesandbias• Resources

Eversensethatthereareguidelinesandrecommendationforlotsofthings?

Someareuseful,somearenot..

Confusing?




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Describethediversityofprofessionalandgovernmentsponsoredinfectionpreventionandcontrolguidelinesinpast10years

•Whatisthebreadthanddiversityofrecommendations?

•Whatisthestrengthoftheevidenceunderpinningrecommendations?

•Whattopicshavethelowestandhigheststrengthofrecommendations?




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Itseemedlikeagoodidea…

31guidelines

1870individualrecommendations

22%usedGRADE

Mixtureofprocessestoformulaterecommendations

Strengthofrecommendationsvaried

GRADE(Recommendetc)Strongtoweak

AtoD1to5

Hybrid(e.g.ModerateBII)

20+differentrecommendationtypes




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Synthesisedcategory StrengthofevidenceLevel1 Meta-analyses,SystematicreviewofRCTs

Level2 Well-designedRCTs,Strongrecommendationfromhighqualityevidence

Level3 Welldesignednon-randomisedstudiesincludingobservationalstudies(case-control,cohortandcross- sectional),Moderaterecommendation

Level4 Descriptivestudies, Expertopinion,Weakrecommendationfromlowqualityevidence

Level5 Poor/insufficientevidence,Verylowqualityevidence

Level6 Recommendedbestpractice, Goodpracticepoint

Level7 Unresolvedissue,Norecommendation

Level8 Legislatedrequirement,OHSrequirement

Descriptivestudies,Expertopinion,Weakrecommendationfromlowqualityevidence

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Meta-analysis&RCTs

StrengthofrecommendationsacrossallIPCguidelines

Percen

tage

Strengthofrecommendation




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WhatIPCtopicsarerecommendationsfocussedon?

Categories n(%)

Devices 316(16.9)TBP 315(16.8)HandHygiene 171(9.1)Cleaning 154(8.2)Sterilisation 150(8.0)Implementation 111(5.9)Education 89(4.8)Screening 89(4.8)Antimicrobialprophylaxis 69(3.7)Personnel 72(3.9)

Heatmap

Proportionofrecommendations

LevelofevidenceCategory




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IllustratesthechallengesinIPC

Butwhataboutopportunities?




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Infectionpreventionandcontrolgivesusincredibleopportunities




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Infectionpreventionandcontrolopportunities

• Workinavarietyofsettings

• Workinmultidisciplinaryteam

• Weneedtounderstandandworkwithclinical,behaviouralandpoliticalfactors

Givesusincredibleskillsifutilisedcaninfluencepatientoutcomes

Infectionpreventionandcontrolopportunities

• Clinicalroles• Infectiousdiseaseunit• Infectionpreventionandcontrol• LeadTrustIPCservice• PublicHealth• State-widelevelforIPC• Communicabledisease• Healthpolicyandstrategy

• Teaching• Research




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OpportunitiesinIPC

Reviewofguidelines&thediversityofskillsneededinIPCillustratestheenormous

opportunitywehavetoimprovepracticeandpatientoutcomes




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Influencingpatientcareandoutcome

Collaboration

Infectionpreventionandcontrolopportunities–Influencepatientcareandoutcomes

POLICY

PRACTICE

RESEARCH] • Patients

• Relatives• Clinicians• Researchers• Policy• Society




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Exampleoflowhangingfruit&collaboration

• Whatproductshouldweusetocleanthemeatalareawith,priortourinarycatheterinsertion?

• Guidelinesindicategapinevidence• Practicevariation• Lowqualityevidenceonthistopic• Potentialimpactsignificant• Candesignastudytoanswerthis

Exampleoflowhangingfruit&collaboration




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Opportunityforclinicians,academics&industryinpartnership




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OpportunitiesinIPCarisefromourchallenges

Utiliseouruniqueskillset

Collaboration

WehavechallengesinIPC,theyarereal

Thinkaboutlowhangingfruit..biggestbang




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[email protected]

Twitter:@1healthau




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support from ips to attend this conference no …prof. brett mitchell, university of newcastle,...

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