Vision-on: Staff Training Tool for the Prevention of Healthcare Associated Infections

Lead Research Organisation: Glasgow School of Art
Department Name: School of Design


Healthcare associated infections (HAIs) caused by pathogens (infectious agents) such as MRSA, Norovirus, and Clostridium Difficile are a substantial problem in developed and developing countries and within the NHS. In addition to the distress caused to patients who are infected, the cost of HAIs to acute services in NHS Scotland was estimated in the 2007 national prevalence survey at £183 million. The World Health Organisation (2014) global surveillance report on antimicrobial resistance shows that "a post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century". Within this ambit, work to prevent and control Healthcare Associated Infections can in no way rely solely on the production of new antibiotics. Rather, new thinking, new research and development, and new knowledge transfer activities are needed, drawing on knowledge from beyond traditional biomedical science.

The applicants' prior AHRC funded 'Visualising the Invisible' (vis-invis) project is a good example of the contribution that the arts and humanities can begin to make through relevant multidisciplinary working. The vis-invis project investigated ways of making pathogens 'visible' in the context of the hospital ward in a multi-disciplinary collaboration involving a team from design, art, nursing and clinical microbiology. In the study, the team explored conceptions and perceptions of pathogens in relation to clinical settings, and produced prototype digital visualisations which aimed to make the pathogens 'visible' in the context of the hospital ward. From this project, through a series of workshops with key stakeholders including infection control leads, nurses and domestic staff, one of the key findings was that the adaptation of the visualisations for use in training software for healthcare staff would have significant value. This was not foreseen at the outset of the project but emerge through the development of the prototypes and in response to feedback from the workshops. It was clear from these discussions that using the visualisations as part of training would extend the potential of this earlier work to impact in a timely and valuable way - especially given the current scale of the HAI problem and the threat of increasing resistance of pathogens to antibiotics.

Working with a leading UK commercial company in the area of infection control, which specialises in the manufacture of antimicrobial products and infection-control training, two NHS Trusts and a leading microbiology specialist, this follow-on project proposal will create a visual training application, running on a tablet device, which can innovatively exploit existing context-relevant data about the nature, location and prevalence of the pathogens associated with HAIs. The visualisations will make clear the direct relationship between the ward setting and the location, behaviour, causes of spread, and prevention of spread of pathogens. The NHS project partners will be closely involved in the specification, co-design, development and evaluation of the training tool to ensure it satisfies the requirements of current NHS training programmes and to maximise the opportunities for its adoption.

Planned Impact

The Vision-On team has developed a pathway to impact by developing a creative and innovative process of engagement with NHS hospital staff, NHS Trusts, NHS training bodies and healthcare training app developers within a leading commercial company who will all be the main beneficiaries. Successfully developed and implemented, the app has the potential to impact significantly on HAI issues. The programme of activities will build on the outcomes from the multidisciplinary Visinvis project, and provide an innovative approach to communicating information in training about the significant challenge of HAIs.

Commercial integration and adoption: The main outcome from the project will be the integration of the final version of the co-designed visualisations into Gama Healthcare's Clinell training application, running on an Android tablet. This will have a direct and immediate impact from the project, as the work will be made available to GAMA Healthcare's customers, including over 200 training packages already in use in the NHS. It is envisaged that our relationship with GAMA Healthcare will continue beyond the end of the project, providing a platform for future research including the opportunity to obtain feedback from NHS staff who have used the visualisations as part of the training package.

NHS benefit: NHS staff will participate throughout the co-design and co-development process ensuring that the visualisations are relevant and engaging for the target audience. The training tool will be of direct benefit to our NHS partners, as they will be able to use the results from the project as part of their clinical skills training through the use of the enhanced Clinell training package. Foreseen outcomes here will be: improved awareness and understanding of HAIs, and how to control and minimise these; enhanced skills for NHS staff; reduced incidence of hospital acquired infections with resulting economic savings through reduction in HAI-related costs, reduction in human illnesses, distress and deaths; enhanced hospital recovery rates; improved healthcare delivery efficiency; a package immediately implementable into in-ward training and practice; adoption of user-friendly technology and its applications; and improved hospital PR. As mentioned in Objectives, Vision-On intends to explore routes to adoption and impact with NHS trusts; setting up biannual monitoring, beyond the project lifespan, of uptake and impact of training app providing feedback to HEIs to assist in future research in this area.

Design/HEI benefit: Knowledge transfer of design approaches, visualisation and user-interface expertise through collaborative engagement with hospital trust infection-control staff and the NHS training body; development of early-career design research skills working in healthcare-related technology application and development of research capacity in HEIs involved. The results will also be of interest to the AHRC-supported Design4Health network of which the PI is a member.

Further applications: The problem of infection due to pathogens is equally applicable to other areas, and we will consider a transferable approach to the app for application in care homes. The visually engaging nature of the software application could be adapted for uses in additional public engagement activities, for example, in the hospitality and catering sector, environmental health, and in schools.

Concluding seminar: At the end of the twelve months, the outcomes of the project will be discussed in a concluding seminar involving Gama Healthcare, Health Protection Scotland (HPS), senior infection control officers (SICO), Advisory Group, the NHS Trusts involved, and the research team.

Outputs: Academic outputs, such as journal and conference papers will also be prepared, for both the design and infection-control communities.


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Description The VisionOn team produced a prototype, proof-of-concept tool for the in-ward training of hospital staff in the infection prevention and control (IPC) of healthcare associated infections (HAIs). Developed over three stages during a 12-month process, involving a commercial partner, two NHS boards and 150 NHS nurses, doctors, cleaning and other staff and students in its co-development and evaluation, this interactive and navigable tablet-based training tool used dynamic visualisation methods to make visible pathogen location, survival and transmission in the ward-based context.

The prototype tool was found to contain information relevant for different staff cohorts, with a mix of experience levels, and to increase participants' awareness about pathogens, explain 'why' IPC procedures should be followed, and reinforce understanding of how HAIs occur.

The tablet-based visualisations were also found to be engaging and supportive of different learning styles and they offered staff a new perspective on pathogens, being able to 'see' them contextualised in the virtual ward, making them seem more real.

We were successful in taking this work forward in a subsequent grant (AMRSim)
Exploitation Route We are interested in taking forward the development of the app as a teaching tool for use by hospital staff, dependent on further funding. The principles used in developing this are being used in the development of a new tool within a new funded grant.

We have been able to further develop this work in the AMRSim project AHRC Grant No: AH/R002088/1. This has led, in turn, to a AHRC follow-on funding application for further development (details described under the AMRSim project details).
Sectors Digital/Communication/Information Technologies (including Software),Education,Healthcare

Description Poster presentation and invited oral presentation at Champions Challenged 2016 Conference (NHS Grampian) 21st June, Aberdeen; Conference abstract and invited presentation (Establishing proof of concept for a tablet-based dynamic visualisation tool for use in staff training for the prevention of healthcare associated infections) at Infection Prevention Society 2016 annual conference, Harrogate, 28 September 2016. The work has also been the subject of a poster and oral presentation at Infection Prevention and Control, in Charlottetown, Prince Edward Island, Canada, June 18-21 2017.
First Year Of Impact 2015
Sector Healthcare
Impact Types Policy & public services

Description AHRC AMR in the Indoor and Built Environment
Amount £247,994 (GBP)
Funding ID AH/R002088/1 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 12/2017 
End 12/2019
Description D-Health symposium: design research in healthcare (Lucerne, Switzerland) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I presented a keynote to 50 individuals from the Competence Center Design & Management of Lucerne University of Applied Sciences and Arts - Art & Design and their guests from the worlds of healthcare science and professional design practice as part of a symposium. We discussed current challenges in the healthcare sector and what design research could contribute to developing solutions. This facilitated new contacts with individuals primarily in Switzerland but also from the US and wider afield.
Year(s) Of Engagement Activity 2016
Description Infection Prevention Society 2016, Harrogate 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was a summary presentation of the AHRC-grant supported visinVis and visionOn projects at the Infection Prevention Society (IPS) conference in Harrogate, September 2016, which had a large international audience of academics, practitioners and industry. The presentations were recorded and were to be made available via the IPS website in due course.
Year(s) Of Engagement Activity 2016
Description Learning in Later Life 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other audiences
Results and Impact Lecture to 3Ls (Learning in Later Life) Students' Association, Architecture & Design Club 2015-2016 programme at the University of Strathclyde. Title of presentation: Co-designing innovations for healthcare'. The visionOn presentation is one of three research case studies presented.
Year(s) Of Engagement Activity 2016
Description Presentation at Infection Prevention Conference 2016, Aberdeen 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact NHS Grampian will hold an Champions Challenged Conference in collaboration with the Infection Prevention Society (IPS) at the Aberdeen Exhibition and Conference Centre. This popular one-day conference entered its eighth year in 2016 and "continues to deliver an informative, stimulating and educational programme delivered by highly regarded experts in the field of infection control". The conference is designed to appeal to Infection Prevention and Control Teams, Health Protection Teams, Allied Health Professionals, Nursing and Midwifery Staff, Facilities Staff, Medical Staff, Dental Staff, University Staff / Students and those involved, or with an interest, in healthcare. We were invited to present our visionOn work as part if the conference programme and to present a poster at the event. Additionally, we held informal demonstrations of our tablet-based prototype training tool to infection prevention and control (IPC) managers during breaks in the event. We received strong interest in making the tool available to IPC managers.
Year(s) Of Engagement Activity 2016