Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review

Objective: To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.Design: Scoping review. Methods: A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.Results: From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing on the professional–patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional’s power).Conclusions: There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs

The role of badgers in the epidemiology of Mycobacterium bovis infection (tuberculosis) in cattle in the United Kingdom and the Republic of Ireland: current perspectives on control strategies

Bovine tuberculosis (TB) caused by infection with Mycobacterium bovis, is a persistent problem in cattle herds in Ireland and the United Kingdom, resulting in hardship for affected farmers and substantial ongoing national exchequer expenditure. There is irrefutable scientific evidence that badgers are a reservoir of M. bovis infection and are implicated in the transmission of infection to cattle. A range of options for the control of TB in badgers is currently available or under development including culling of badgers, vaccination of badgers and cattle, and improved biosecurity to limit contact between the two species. It is unlikely that the eradication of TB from cattle will be achieved without the reservoir of M. bovis infection in badgers being controlled. The chances of success will, however, improve with greater knowledge of the disease in both species and an understanding of the epidemiological drivers of the transmission of infection between badgers and cattle.Department of Agriculture, Food and the MarineAuthor has checked copyrigh

Oral Vaccination of Free-Living Badgers (<i>Meles meles</i>) with Bacille Calmette Guérin (BCG) Vaccine Confers Protection against Tuberculosis

<div><p>A field trial was conducted to investigate the impact of oral vaccination of free-living badgers against natural-transmitted <i>Mycobacterium bovis</i> infection. For a period of three years badgers were captured over seven sweeps in three zones and assigned for oral vaccination with a lipid-encapsulated BCG vaccine (Liporale-BCG) or with placebo. Badgers enrolled in Zone A were administered placebo while all badgers enrolled in Zone C were vaccinated with BCG. Badgers enrolled in the middle area, Zone B, were randomly assigned 50:50 for treatment with vaccine or placebo. Treatment in each zone remained blinded until the end of the study period. The outcome of interest was incident cases of tuberculosis measured as time to seroconversion events using the BrockTB Stat-Pak lateral flow serology test, supplemented with post-mortem examination. Among the vaccinated badgers that seroconverted, the median time to seroconversion (413 days) was significantly longer (p = 0.04) when compared with non-vaccinated animals (230 days). Survival analysis (modelling time to seroconversion) revealed that there was a significant difference in the rate of seroconversion between vaccinated and non-vaccinated badgers in Zones A and C throughout the trial period (p = 0.015). For badgers enrolled during sweeps 1–2 the Vaccine Efficacy (VE) determined from hazard rate ratios was 36% (95% CI: -62%– 75%). For badgers enrolled in these zones during sweeps 3–6, the VE was 84% (95% CI: 29%– 97%). This indicated that VE increased with the level of vaccine coverage. Post-mortem examination of badgers at the end of the trial also revealed a significant difference in the proportion of animals presenting with <i>M</i>. <i>bovis</i> culture confirmed lesions in vaccinated Zone C (9%) compared with non-vaccinated Zone A (26%). These results demonstrate that oral BCG vaccination confers protection to badgers and could be used to reduce incident rates in tuberculosis-infected populations of badgers.</p></div

Kaplan-Meier survival curves (time to seroconversion) for non-vaccinated and vaccinated badgers during the whole period of study.

<p>Kaplan-Meier survival curves (time to seroconversion) for non-vaccinated and vaccinated badgers during the whole period of study.</p

Kaplan-Meier survival curves (time to seroconversion) for non-vaccinated and vaccinated badgers enrolled in sweeps 1–2 (A) and in sweeps 3–6 (B).

<p>Kaplan-Meier survival curves (time to seroconversion) for non-vaccinated and vaccinated badgers enrolled in sweeps 1–2 (A) and in sweeps 3–6 (B).</p

Distribution of badgers enrolled in vaccine field trial by age, sex and zone of capture.

<p>Distribution of badgers enrolled in vaccine field trial by age, sex and zone of capture.</p

Time (days) to seroconversion for all badgers that seroconverted during the trial: non-vaccinated (N = 30), vaccinated (N = 21).

<p>Time (days) to seroconversion for all badgers that seroconverted during the trial: non-vaccinated (N = 30), vaccinated (N = 21).</p