Antimicrobial Resistance: Infection prevention through design

As the efficacy of Antibiotics wane, many types of surgery may be at risk

Antibiotics are at the heart of modern medicine. They make many types of surgery that would otherwise be life-threatening routine, and enable everyday infections to be treated easily at home, before becoming serious illnesses.

But the efficacy of these miracle drugs is waning. Increased bacterial resistance to our existing arsenal of antibiotics coupled with a lack of new drugs risks creating what England's Chief Medical Officer Professor Dame Sally Davies, recently described as a "post-antibiotic apocalypse".

Staving off this potential crisis will require a massive effort from scientists, medical researchers, doctors, nurses, big pharma and public policymakers. But non-scientific disciplines also have their part to play in helping apply lessons learned in the laboratory to the real world.

One Arts and Humanities Research Council-funded project is leading the way. As Professor Alastair Macdonald from The Glasgow School of Art (GSA), explains:

“Interdisciplinary working is fundamental to tackling complex global challenges.

“Design on its own, like any other discipline, can offer no effective single solution. But I think we can bring certain essential skills to the table to work alongside and integrate with other disciplines, in research and in practice.”

“Interdisciplinary working is fundamental to tackling complex global challenges."

In total, GSA has been awarded more than £600,000 by AHRC to find ways to stop bacteria becoming resistant to treatment. This grant has enabled Prof Macdonald to focus on how he can use design to better communicate scientific data on how bacteria spreads, and then use this knowledge to change behaviour in hospitals.

VisionOn is a multi-disciplinary project to look at how visualisations of key infection data might help with Infection Prevention and Control (IPC). It has produced a prototype training tool for hospital staff to prevent the spread of infections, developed over a 12-month period, involving a commercial partner, two NHS boards and 150 NHS nurses, doctors, cleaners, along with other staff and students.

“We regarded the hospital ward environment as a complex ecosystem, with different groups – including patients, nurses, doctors and cleaners – all interacting in a set of spaces and through sets of complex tasks,” says Prof Macdonald.

“Any one transgression in infection protection and control would have consequences within that ecosystem, for everyone.

Design research is helping to show how infections can be transmitted

“The challenge was to present evidence – from microbial data to covert observational data of who touched what – in ways that all the key players would understand. So that when they were in the ward, going about their various tasks, they would understand the consequences of their actions.”

The outcome of the project was a tablet-based training aid that highlighted three pathogens – MRSA, C diff and norovirus – and showed where these were located in the hospital; how they were transmitted; and how long they survived.

All of this was represented using dynamic visualisation on a virtual ward with the aim of improving awareness and understanding.

Apart from in-ward use, a number of further applications of the tool were also suggested, including inductions for new starts; education in schools/universities; and staff refresher courses.

Prof Macdonald believes a collaborative, inclusive approach was key to the project's success.

“The challenge was to present evidence – from microbial data to covert observational data of who touched what – in ways that all the key players would understand."

“In this scenario it’s important that each discipline is able to articulate clearly to the others its value,” he says. “Why science is important, why design is important, why the arts are important, why the humanities are important, why social sciences are important; in this particular context, for this particular global challenge.”

Prof Macdonald also believes that it's important to involve all key stakeholders as early as possible in the development of potential solutions or interventions as they will all have different world views, perceptions and experiences of what he calls an “essentially very messy world”.

“I think part of what we can do in design is provide the means, through co-design and co-development, and through iterative prototyping, to elicit different kinds of evidence and data and to use the innate creativity in everyone to propose solutions which reconcile these different experiences and world views,” he says.

For example, in the VisionOn project, although the scientists provided the 'hard' data, it was the designers who found a way to give that data meaning and translate it effectively into a real world setting.

Many types of bacteria have already become resistant to antibiotics

“We are good at designing the tools and creating the spaces and situations which enable different stakeholders and disciplines to work effectively and productively together,” says Prof Macdonald.

“We can help re-present data, which is often presented in a privileged way in scientific and academic journals. We can find ways which are contextualised and make sense to the people who may not have [scientific] training, but who would benefit – in our messy world – from [scientific] understanding.”

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