The aim of the experiment was to image infection spread in a simulated hospital ward setting. Three dummy patients were given profiles and treated with coloured UV powder and solution, which mimicked different infectious conditions. Two nurses took part in the experiment, carrying out routine tasks with the patients, and either employing normal hand hygiene practices, or no hand hygiene practices. ;xNLx;Between each task, the lights were dimmed and the nurses, patients, beds and equipment were photographed under a strong UV light to detect spread of the UV material.;xNLx;;xNLx;Project team: Dr Emma Roe (Geography and Environment), Dr Jacqui Prieto (Health Sciences), Prof Lisette Schoonhoven (Health Sciences), Dr Sandra Wilks (Microbiology), Dr Xunli Zhang (Engineering and the Environment), Dr Charlotte Veal (Geography and Environment), Dr Paul Hurley (Geography and Environment), Dr Robert Zmijan (Electronics and Computer Science).
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Mr Blue is colonised with a bacterium called Staphylococcus aureus. This is a common ‘commensal’ organism (which means it lives harmlessly on the skin), but has the potential to cause infection when deposited on susceptible sites such as a wound or other break in the skin or an invasive device (including an intravascular device or indwelling urinary catheter). Blue UV powder and solution was placed on Mr Blue's arms, bed, sheets and bed rails. The nurses were told, via their task sheet: "Mr Blue is 83 years old and was admitted last night following a fall. He was found to be dehydrated, so had IV fluids overnight, which can be discontinued this morning now that he is maintaining good fluid intake. He lives on his own after having recently lost his wife and has not been coping well at home."
The experiment was set up on the basis that Mr Red’s diarrhoea should be considered to be potentially infectious given the risk factors for C. difficile (having a course of broad-spectrum antibiotics). We could say he has unconfirmed C. diff – until a stool specimen is sent to the lab for investigation, his diagnosis would be uncertain but precautions would be needed in the interim. Red powder and solution was placed on his body, bed, sheets and bed rails. The nurses were told, via the task sheet "Mr Red is 78 years old and was admitted yesterday with pneumonia, for which he is on IV antibiotics (co-amoxiclav). He is on oxygen via nasal speculae and his saturations have remained above 93%. He is also receiving IV fluids. He has had an episode of diarrhoea this morning."
The experiment was set up on the basis that Mr Green, with the indwelling urinary catheter drain, has had a confirmed E.coli infection caused by an antimicrobial-resistant strain of the organism. The E.coli bacteria are producing ESBL (‘extended-spectrum beta lactamases’), enzymes which confer resistance to many penicillin and cephalosporin antibiotics. This makes the infection more difficult to treat. Nurses were told, via their task sheet: "Mr Green is 72 years old. He was admitted three days ago with confusion, secondary to a catheter-associated urinary tract infection. He has a long-term catheter for chronic urinary retention. Microbiology results have confirmed an ESBL E. coli infection and Mr Green was commenced on oral antibiotics (trimethoprim) for this."
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Mr Blue requires his bed sheets to be changed. He will need to remain in bed for this as he has not yet been fully assessed by the medical team. His IV fluids can be discontinued.
Closing curtains. Lowers bed rail, touches button. Takes out controller and lowers bed. Lifts left arm and pulls top sheet and blanket back. Takes shoulder and hand and rolls patient across. Holds patients shoulder and hand. Rolls patient back. Pulls bottom sheet off. Lifts pillow. Collects all sheets at bottom of bed. Straighten out bottom sheet. Lifts pillow. Tucks sheet in. Rolls patient back. Continues to tuck bottom half of sheet in. Collects up dirty sheet. Accidentally pulls off hand gel pump. Touches this and puts it back on end of bed. Puts sheets in clothes bin. Continues to flatten out sheets. Spread top sheet across bed. Collects blanket and begins to unfold. Spreads blanket out. Gathers together top sheet and blanket and folds under by feet. Repeat with top of blanket and top sheet gathered together and folded over. Takes out controller and lifts bed up. Puts back on side of bed Rests on clothes bin. Open curtains.
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Pulls curtains around. Puts down bedrails, button for lowering. Takes controllers and lowers bed. Lifts right arm of patient and pulls covers back. Rolls patient away and adjust patients gown. Places bedpan under patient, touches lower back and leg. Touches gown and sheets as pull the blanket and top sheets back up. Takes controller and lifts bed back up. Straightens top sheet and blanket. Moves IV drip out of the way. Strokes blanket. Begins to pull back blanket and top sheet. Lifts patients arm and pulls back blanket and top sheets. Assists rolling patient from his back. Removes bedpan. Collects wipes and disposable bin. Takes three wipes and cleans patient holding side of back and gown. Removes bedpan(s). Rolls patient. Tidies sheets and removes antiseptic wipes. Still holding bedpans. Takes controller and lowers bed. Replaces controller. Lifts bed rail and straightens sheets. Opens curtains. Still holding bedpans.
Mr Red is due a dose of IV antibiotics. He may also require use of a bedpan and will need a stool specimen if he has further diarrhoea.
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Task 3: Holding empty bed pan. Touches top sheet and blanket and catheter tube. Touches rails, lifts catheter, lifts tube to get waste product into catheter. Touches valve. Touches sheet, clips catheter back on. Takes chart and pen. Rests board on table. Touches table. Takes pen lid off. Mr Green Obs: Overrunning with catheter task. Take pulse oximtry and clips on to finger. Rests on handrail. Takes controller and raises the bed. Places back on bedrail. Removes pulse oximtry and places on table. Takes out chart and pen and fills in form. Rests on bedrail. Picks up pulse oximtry and pen and moves to next patient. Mr Blue obs: Pushes in obs machines. Takes off stethoscope and pulse oximtry and puts on bed. Pulls back top sheet and blanket. Puts oximtry on patients fingers and places stethoscope around neck. Takes blood pressure off obs machine and puts around patients arm. Moves cable out of way and flatten sheets. Pumps up blood machine and holds stethoscope to patients arm. Removes blood pressure and places it back on obs machine. Pulls top sheet and blanket back over patient. Takes off pulse oximtry and places on obs machine. Continues to pull sheets back up. Mr Red obs: Holding pen from previous task. Picks up chart. Places fingers on patients wrist and takes pulse. Rests other hand on bed rail. Takes controller off top of bed and raises bed. Touches sheets as puts back. Opens curtains.
Mr Green needs his urinary drainage bag emptying and the urine volume recording on his fluid balance chart. All patients will require a routine set of observations (blood pressure, pulse and temperature). Mr Red will also need his respiration rate checking.
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The two nurses leave the lab to be interviewed by Emma Roe and Charlotte Veal, about their experiences of touching during the experiment, Jacqui Prieto, Rob Zmijan and Paul Hurley continue to photograph the ward and to clean up all coloured traces from the first phase of the experiment.
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