VIPVis: Veterinary Infection Prevention through Visualisation

Lead Research Organisation: Glasgow School of Art

Abstract

Antimicrobial-resistance (AMR) is a major threat to human health. Increasing numbers of resistant infections are leading to many existing antibiotics becoming ineffective. AMR is a challenge in veterinary medicine and AMR bacteria are more likely to emerge and transmit AMR genes where there are higher microbial densities. In previous work, we developed and evaluated an innovative training intervention, supported by a new type of digital tool, for training veterinary practice staff in infection prevention and control (IPC). This comprised an interactive mode of presentation and delivery supported by a 3D graphical simulation tool recreating the interior of a vet practice and the interactions of humans, animals, and microbes, according to rules observed from real-life. Additional visual layers, able to be toggled on/off, enabled normally invisible bacteria to be 'seen' as they spread via contacts within the indoor environment, and allowed the effect of various IPC measures to be seen easily. By 'making visible the invisible' our intention is to reduce microbial contamination in small animal vet practices, hence reduce reliance on antibiotics, and contribute to decreasing the risk of AMR developing. Our aim is to now maximise the impact of this work by migrating our innovative software tool to platforms where it is fit for deployment into a variety of self-paced learning environments to support the on-going training of veterinary practitioners in IPC and extend this further to students undertaking their veterinary studies. The use of the tools we are developing could change the perception of risk of infection to positively influence behaviours to minimise the risk of infection and ultimately the reliance on antimicrobials. By engaging with students at the beginning of their training, and by revisiting the themes throughout their curriculum, we intend to embed best practice as a matter of habit in the next generation of veterinary practitioners. The current tool is a laptop-hosted digital animation designed to support a trainer delivering a short in-house workshop session. In 2019, our intervention was delivered to 51 vet staff during a trial within a large referral vet practice. Participants found the novel approach taken to discussing IPC increased their awareness and appreciation of the issues: comments such as 'very clear', 'informative' and 'showed easy steps on how to prevent infection' were typical of the feedback received. Our trial demonstrated that our prototype intervention was able to meet its training objectives within a 30-minute trainer-led session. However, we found potential barriers to its adoption, but also suggestions for improved flexibility of delivery. Consequently, the objective of this follow-on project is to translate our trainer-led, single device-based activity onto alternative platforms for more flexible, scalable and cost-efficient modes of delivery, specifically mobile-, tablet-, and web-based use. These would facilitate stand-alone, self-paced learning to be used for professional training and for use in educational settings, e.g. for vet students and nurses at different stages of their education. Common to all platforms will be the promotion of reflective practice, e.g. what is perceived as risky practice or behaviour and how to improve this? During its use, data on users' perception of risk and self-reporting of behaviour before and after receiving training would be captured. The ambition is that these stand-alone platforms would achieve the same objective within the 30-minute time-frame but it would also be designed to be flexible enough for more individual self-paced and refresher sessions and as the basis for expanded group teaching and training sessions and seminars. We envisage the tool being available to professional practitioners and veterinary students in mobile or tablet form, and as an online resource forming an innovative element of more extensive and comprehensive training packages.

Planned Impact

Antimicrobial-resistance (AMR) is a growing issue in human and animal health. Increasing numbers of resistant infections are leading to many existing antibiotics becoming ineffective. Consequently, it is predicted that the toll on human life due to AMR will exceed 10 million annually by 2050. Reducing reliance on antibiotics is the first point in the British Veterinary Association (BVA) antibiotics 7-point plan intended to encourage responsible use of antimicrobials by veterinary practitioners. Controlling infections and their spread through consistent adoption of infection prevention and control (IPC) measures is fundamental to achieving this.

Trial of our AMRSim digital animation in a short, trainer-delivered, in-house workshop showed that participants felt significantly more informed about the risk of infection after attending, with 92% agreeing to change their behaviour in terms of infection control at work. Participants responded positively to the use of our 3D graphics suggesting that it made things 'very clear', 'informative' and 'showed easy steps on how to prevent infection'. However, although these findings are encouraging, it became clear, from our trial that the current mode of delivery is neither scalable nor economic due its reliance on being delivered by a trainer in group sessions and so it would have very limited reach. The AMRSim trial trained only 38% of vet staff at the partner practice in 3-days, with between 2 and 11 staff attending each session, requiring support from additional AMRSim team members. Consequently, we now intend to develop fit-for-deployment software for platforms which permit stand-alone, self-paced and flexible modes of learning, and which can be evaluated in a variety of training situations and environments.

By making tools for infection prevention and control (IPC) and antimicrobial stewardship (AMS) more accessible and engaging, by making it possible to 'see' the conditions for how infection might be spread, we expect this work to impact positively on the key stakeholders, i.e., vet practitioners across their various roles - surgeon, nurse and auxiliary; veterinary students at various points in their education, and veterinary bodies and associations such as the BVA and the Royal College of Veterinary Surgeons (RCVS), with the intention to positively influence behaviours to minimise the risk of infection and ultimately the reliance on antimicrobials.

By delivering a fit-for-deployment software tool that can be used with veterinary students during their education, we wish to embed a life-long awareness of infection control that has lasting positive impact on the way they approach AMS once qualified and in practice.

For the first 3-5 years, the University of Surrey (UofS) wish to explore the commercial potential of the outputs from this project, as well as exploiting them exclusively for its own students through its SurreyLearn VLE and with their partner practices and also through a standalone Massive Open Online Course (MOOC) e-learning programme for vets and vet nurses, a series of modules outlining how AMR develops and how to prevent it.

Thereafter, the use of the data will be made widely available, with attribution, for non-commercial use only, potentially without permission, to create derivative works (along Creative Commons lines). Data will be licensed under CC-BY-NC 4.0 for non-commercial re-use. Any commercial re-use would need to be agreed with, and between, GSA and UofS.

Publications

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Description VIPVis was a follow-on study from the prior AMRSim study to develop a training tool for changing perception and raising awareness of risk of infection during veterinary surgical procedures. VIPVis was essentially concerned with creating a stand-alone training app from the prototype created in the prior AMRSim study. From this further work in VIPVis, we had three further findings.

1 'Seeing' the risk: From the prior AMRSim findings, the team understood that their approach to visualisation was able to positively change the perception of risky behaviours and an understanding of how to mitigate infection risk. In the VIPVis study the team were able to understand, in further depth from qualitative data from participants' workshop responses, just how well their visual approach helped participants 'see' the contamination risks.

2 Potential to influence behaviour through changed perception: The team were interested in how improved 'seeing' of the contamination risk could potentially change perception and influence behaviour. In the VIPVis study the team were able to understand, in further depth from qualitative data from participants' responses, just how well their visual approach influenced participants' motivation to change their behaviour.

3. Applying the principles to other procedures: Scenarios modelled in the animations were derived originally from prior AMRSim video data documenting the preparation stage for a specialist orthopaedic procedure used to treat ligament rupture in the knee joints of dogs. These particular video data were collected from a large referral practice, a partner in the AMRSim study. As many smaller veterinary practices do not have the facilities or expertise to conduct such orthopaedic procedures, the team were interested in the extent to which the learning outcomes from viewing this specific procedure could be applied to other more commonly practiced procedures, such as bitch spaying (ovariohysterectomy). Responses from our participants positively confirmed that the educational principles learnt through the approach taken in this training tool to this specialist orthopaedic procedure, were transferable and applicable to other surgical procedures.

The above findings are given in more explicit detail in the output: Macdonald. A.S., McCorry, O., Poyade, M., Trace, C. & Chambers, M. (2023). The art of serious storytelling: using novel visual methods to engage veterinary practitioners in reducing infection risk during preparation for surgery. In O. Varsou (ed.) In: Teaching, Research, Innovation and Public Engagement: New Paradigms in Healthcare. Springer, Cham, pp. 91-107. 10.1007/978-3-031-22452-2_8
Exploitation Route The findings from our work and our prototype app are currently being evaluated in a PhD study co-funded by the University of Surrey School of Veterinary Medicine and the pharmaceutical company Zoetis. This study will involve collecting data from a number of veterinary practices of different types and scales and will compare the differences between using our tool or more traditional training materials in different arms of the study.

Separately, we have also had recent interest from NHS Education for Scotland (NES) in using aspects of our visualisation approaches for their ARHAI (Antimicrobial Resistance Healthcare Associated Infection) service; discussions are ccurrently at a very preliminary stage.
Sectors Education,Healthcare,Pharmaceuticals and Medical Biotechnology

URL https://doi.org/10.1007/978-3-031-22452-2
 
Description Co-funded PhD 
Organisation Zoetis
Country United States 
Sector Private 
PI Contribution This is a PhD co-funded by Zoetis and by the University of Surrey School of Veterinary Medicine. The three supervisors for this are from the AMRSim study team (2 based at the University of Surrey and 1 at the University of Plymouth). A fourth individual from the AMRSim study team is an advisor.
Collaborator Contribution Financial support towards the fees and maintenance for the PhD.
Impact None as yet
Start Year 2022
 
Title VIPVis Infection Prevent and Control Training Tool 
Description We have developed a software training tool for veterinary practitioners, staff and students which, in its early stages of evaluation has demonstrated its ability to change perception of risk of infection and potentially changed intention to change behaviour. We initially developed this as an executable folder of exe files for running on PC on our earlier AMRSim study. In the VIPVis study we developed this as an APK file for android devices, and a WebGL folder for web browsers. These technical products are undergoing further development and evaluation and are not fully protected or in the public domain. 
Type Of Technology Webtool/Application 
Year Produced 2022 
Impact These products are currently undergoing fuller evaluation, for both android devices and web browser versions, through an academic/industry co-funded PhD. From this we will be able to determine if our innovative interactive training software has the ability to change, in veterinary practitioners, staff and students, perception of risk of infection and change behaviours, to reduce infections, in turn reduce the use of antibiotics, enabling better stewardship of antibiotic use. 
 
Description Antimicrobial resistance: a One Health issue 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact A talk for the International Veterinary Students Association.
Year(s) Of Engagement Activity 2022
 
Description Antimicrobial resistance: a global one medicine challenge 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Humanimal Trust symposium - Antimicrobial resistance: a global one medicine challenge.
Year(s) Of Engagement Activity 2021
 
Description Novel alternatives to antibiotics for use in the livestock industry 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A talk for the the RANK prize.
Year(s) Of Engagement Activity 2022
 
Description Understanding and controlling antimicrobial resistance (AMR) in the food chain 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact A talk for the Woking U3A - Understanding and controlling antimicrobial resistance (AMR) in the food chain
Year(s) Of Engagement Activity 2022
 
Description Veterinary approaches to antimicrobial stewardship 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Short talk at the Westminster Health Forum AMR meeting in 2021 - Veterinary approaches to antimicrobial stewardship
Year(s) Of Engagement Activity 2021
 
Description Veterinary approaches to antimicrobial use and stewardship 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A talk at the autumn 2021 British Society of Antimicrobial Resistance meeting - Veterinary approaches to antimicrobial use and stewardship.
Year(s) Of Engagement Activity 2021
 
Description Zoonoses - The original One Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Zoonoses - The original One Health - Talk at the Royal College of Physicians.
Year(s) Of Engagement Activity 2021