1. This resource has been developed by the Association for Science Education for their RCUK-funded series ‘Research focused teaching resources to inspire students in STEM Careers’ Visualising the Invisible

2. The global research context Antibiotic resistance The increasing resistance of bacteria to antibiotics presents a potentially catastrophic effect. Even patients undergoing routine operations are at high risk due to the potential of infection. Scientists across the world are urgently researching into alternative antibiotics. Ensuring good hygiene and effective cleaning in a healthcare environment is essential for infection control.

3. Your BIG Research Question How can hand touch data help to reduce healthcare associated infections?

4. Research summary 1 ‘Healthcare associated infections remain a problem for all hospitals. It is assumed that most infections arise from contaminated staff hands, which has led to the current focus on hand-hygiene initiatives. Whereas there has been some success in persuading staff to clean their hands, compliance rates frequently decrease when an intervention ceases. In addition, staff often forget hand hygiene when they are busy. Recent work has highlighted the role of the clinical environment in the transmission of ward-based infection. Any hand-touch site that escapes cleaning offers a potential reservoir for hospital microbes. Even good hand hygiene is rendered obsolete if staff then touch these sites after cleaning their hands’. Pathogens can survive on surfaces for days, weeks or even months. Questions… 1. How could pathogens for an additional illness be passed to a patient in hospital? 2. Look at the picture of the hospital ward (SS1b). Use a coloured pen to mark dots on areas that you think are at risk of having pathogens. Explain your reasons for marking these areas. 3. Now look at the picture showing the perceptions of hospital staff (SS1c). How do they agree with your picture? How do they disagree? 4. How do hospitals ensure that as few pathogens as possible are present in the ward? 5. As part of this research data was gathered about where staff and visitors touched whilst visiting the ward. Why is this data important in helping to reduce infections? 6. Explain why pathogens can still be spread even if hand-washing procedures have been followed. 7. Sometimes a patient can catch an additional illness whilst in hospital. What is this type of infection called? Now investigate your Big Research Question... How can touch-pattern data help to reduce healthcare associated infections? 1 Smith SJ, Young V, Robertson C, Dancer SJ. (2012) ‘ Where do hands go? An audit of sequential hand-touch data in a hospital ward.’ J Hosp Infect 80: 206-11.

5. Use a coloured pen to mark on dots to show areas you think are at high risk of contamination by pathogens. Pathogen survey

6. This image shows the areas that staff thought of as being at risk (green) or high risk (red) of being contaminated by pathogens. Hospital staff survey results

7. Going deeper… The research in this project has worked on the assumption that a higher hand-touch frequency correlates to higher levels of microbes. In other words, scientists worked on the basis that, if the number of hand touches goes up, so does contamination with microbes. Scientists designed an experiment to test this. The graph is shown on SS2b. The experiment Five sites in the intensive care unit (ICU) were tested for microbial contamination on nine separate occasions. Scientists measured the density of microbial growth (colony forming units per square centimetre of surface) and categorised growth as no growth, scanty growth, light growth, moderate growth and heavy growth. Sites with moderate or heavy growth were classed as being ‘heavily contaminated’ and the data plotted on the graph. Hand touches were monitored secretly for 1 hour. Visitors and staff did not know that they were being watched. The average number of hand touches was then calculated for each item. This was then repeated on two other occasions. The overall average was then plotted on the graph. Questions… 1.Why was it important that the hand-touch monitoring was carried out secretly? 2.Does the data for the monitor, IV pump, right and left bed rails show a correlation between hand touch and areas with high levels of contamination? Describe what you can read from the graph. 3.What is unexpected about the results for the bed table? 4.Scientists noticed that the bed table always had a container of hand gel placed on it. Can you suggest an explanation for the anomalous data?

8. Research graph The graph below shows the overall average (mean) hand-touch frequency of five different sites in an intensive care unit (blue) and the number of times each site was classed as heavily contaminated with microbes (orange). The areas tested were: the monitor screen, pump for the intravenous drip, right bedrail, left bedrail and bed table.

9. For more information on science and STEM careers see www.futuremorph.org.www.futuremorph.org Where can science research take you? She balances her clinical duties in hospital with her research into the role of the healthcare environment in healthcare associated infections. Dr Stephanie Dancer is a Consultant Medical Microbiologist and Professor of Microbiology. Photo Credit: Margaret McCartney

10. Useful links Further information 3D Microscopy 3D Microscopy A video about a BBSRC project showing the benefits of using 3D models of microbes both for those with visual impairments and to all students. Biomedical Picture of the DayBiomedical Picture of the Day Follow this site for stunning images including many from the microscopic world such as Salmonella typhi bacteria. Other resources from AHRC… Animals and Archaeology A resource exploring what the isotope analysis of animal bones can tell us about the past. This includes more in depth information about how isotopes are measured and analysed that would be suitable for post-16 students. Fossil Finders An opportunity for students to take part in real research by using their observational skills to contribute to this citizen science project.

11. Research project The Visualising the Invisible research project has a project website for the public, visinvis.org. A short video has also been produced by AHRC summarising the project.visinvis.orgshort video Thank you to Dr Colin Macduff, Principal Investigator, Institute for Health and Welfare Research/School of Nursing and Midwifery, Robert Gordon University, Aberdeen and Dr Stephanie Dancer, Consultant Microbiologist, NHS Lanarkshire and Professor of Microbiology at Edinburgh Napier University for their support in the development of this activity. Photographs on slides 1, 3, 4, 5, 6 and 9 are from the project team. Research Paper Data for the Going Deeper activity was kindly shared from a study currently in progress: Dancer SJ, Adams C & Smith J. ‘Examining the relationship between surface bioburden and frequently touched sites in the healthcare environment’. Organisations The Visualising the Invisible project was funded by the joint AHRC / Scottish Funding ‘A Healthier Scotland initiative‘. Collaborating organisations were:AHRCScottish Funding Institute for Health and Welfare Research, Robert Gordon University Institute for Innovation, Design and Sustainability, Robert Gordon University Glasgow School of Art Duncan of Jordanstone College of Art and Design, University of Dundee NHS Lanarkshire NHS Grampian NHS Education for Scotland (NES) Health Protection Scotland/Scottish Infection Research Network Acknowledgements