National Resource for Infection Control (NRIC) and edugames4all Evidence dissemination and engagement for professionals and public – a key area in tackling AMR Sue Wiseman and Patty Kostkova

AMR Projects National Resource for Infection Control (NRIC): Professionals Bugs and Drugs on the Web ( Public Edugames4all (edugames4all.org) Children

Methods and measurements of NRIC’s success Since its launch in May 2005, the ‘National Resource for Infection Control’ ( has provided a freely available website for quick and easy access to IP&C evidence-based guidelines, policy and research in the UKwww.nric.org.uk It has during that time also become an internationally recognised online resource It’s impact has been measured through research 1 using web analysis of traffic and impact evaluation 2

Evaluating users needs Clinical practice 48% Diseases 17% Policy 16% Settings 14% Transmission 5%

Measuring Impact – recent research (NRIC) 1. Kostkova P, Fowler D, Wiseman S, Weinberg JR. Major Infection Events Over 5 Years: How Is Media Coverage Influencing Online Information Needs Of Health Care professionals and the Public? J Med Internet Res 2013; 15(7):e107/ 2. P Kostkova, G Madle. “What Impact Do healthcare Digital Libraries Have? An Evaluation of National Resource of Infection Control at the Point of Care Using Impact-ED Framework” International Journal on digital Libraries, December 2012, DOI: /s

Public and professional interest, and media coverage 1 A comparison of Google searches for the terms "clostridium difficile", "MRSA", and "superbug“ The public and professional interest, and media coverage for: - Clostridium difficile and MRSA Tuberculosis. Meningitis Norovirus. Influenza

Some of the results Public needs in infection are much more static and do not relate to disease occurrence and media coverage as much as professionals whose needs inevitably increase with a public health event or a key policy change However, for events of major media interest, such as MRSA/C difficile, media coverage resulted in major public interest

Triangulated qualitative and quantitative data about the resource use and intended purpose of the information sought and its expected impact on target users’ work and clinical practice 2

Improvement issues and context 2012 – re-organisation of many of the key government, non governmental organisations, professional bodies and agencies websites in the UK Publications, guidance, policy and research in IP&C and AMR has become increasingly difficult to source (Archived) Many URL’s to knowledge that drives and informs IP&C no longer link to the evidence required at the point of care

Evidence of Improvement DH funding for NRIC ceased to exist NRIC was successfully transferred to the Department of Computer Science, University College London (UCL) in June 2013 Search for funding continues!

Updating NRIC continues to provide open access to knowledge and understanding of AMR and updated IP&C evidence base through re-development, keeping the best of NRIC’s well proven past but moving with the challenges of the present and future Facebook and Twitter

Future Steps Face to face interaction in information sharing is now rare; working together over wide geographical areas and in ‘real time’ by use of the internet is the ‘norm’ NRIC provides an internet digital library to keep pace with these changes plus real time data for research and analysis of information needs, a possible future platform for use of social computing and collaborative WIKI type policy and evidence development

Future influencing European Antibiotic Awareness Day UCL “A response to the Department of Health Antibiotic Resistance Strategy (20 November 2013)” Promoting NRIC at international level IPS EXCEL 2013 APIC IIPW 2013 Presentation at ICAN 2013

Future Research/Future Funding NRIC meets ICAN: Infection Control in Africa – enabling knowledge transfer of our research into models for Digital Library dissemination of IP&C evidence and user profiling/impact evaluation, piloted at NRIC to global users in low and middle income settings Working with Industry to secure NRIC’s future while maintaining independence

Patient safety/Sharing best practice on IP&C and AMR NRIC - Keeping patients safe through sharing evidence & best practice and evaluating need through an ever increasing user base : - Locally, Nationally and Globally

Global Reach – geographical distribution of top 20 searches

17 2. Bugs and Drugs Site for Public Evaluation of patient knowledge and attitudes before and after using the site –Users were free to browse the site between questionnaires –First study took place in the Science Museum London as part of ‘live science’ –227 visitors took part of which 177 completed both questionnaires –Study repeated at Nottingham City Hospital Open Day and also Oxford University Medical School

18 Summary of results - Science Museum

19 Google, msn searches that led to the AR site between 1 Sep & 31st Jan searches 7161 included the word alcohol antibiotic 6515 chest 3467 bacteria 2085 virus 1852 acne 1149 flu …. And 250 included "cat" Some users have an addiction problem: Quit antibiotics Quit working Many users are concerned about animal welfare: Antibiotics in disadvantaged animals information on cat colds Others have an international approach: swedish acne remedy mrsa chinese formula

edugames4all - Games of the moment! Bad Bacteria at BBQ Bugs Chefs Bugs Kingdom Detective Game Training GHD Game

Learning Objectives… Microbes are all shapes and sizes: (inside the body) (in the kitchen) (on the skin’s surface) Microbes exist in various locations:

Teaching by playing: Good and Bad Microbes Player transports lactobacillus to make yogurt

Antibiotics and Vaccine Use Player throws white blood cells Player delivers full course of antibiotics to infection

Game Evaluation: Statistically significant knowledge gain Level 3, Q1: “We use good microbes to make things like bread and yogurt” (p < 0.001, chi = 14.46) Level 1, Q1: “If you cannot see a microbe it is not there” (p = 0.02, chi =5.60) Level 2, Q2: “Soap can be used to wash away bad bugs” (p =0.02, chi=5.28)

Senior Detective Game The player explores a crime scene narrative, interviewing characters and finding evidence that illuminates their understanding of microbes, hygiene and antibiotics.

Microvision…

Evaluation integrated in the game flow Pre-test questions are asked at different stages of the game Seamless Evaluation

Number of games users per country: Junior GamesSenior Game

DH AMR Strategy Aim 1: To improve knowledge and understanding of AMR 1. Improving infection prevention and control practices in human and animal health, both through enhanced dissemination and implementation of best practice and better use of surveillance data and diagnostics 3. Improving professional education, training and public engagement to improve clinical practice and promote wider understanding of the need for more sustainable use of antibiotics