Speaker abstracts
Day 1 - Tuesday 17 June
Using Systems Thinking to deliver safety in complex organisations
10:00 - 10:50 | Dame Judith Hackitt
Many organisations still regard Health and Safety as being about compliance with rules and their motivation is driven ( to some extent at least) by avoidance of enforcement by the regulator. Whilst regulatory frameworks are important they describe the very minimum we need to achieve. Regulation can often be very prescriptive which leads to the generation of checklists to demonstrate compliance but also encourages a “tick box” mentality rather than active management of risks which can change from day to day. Outcomes based regulation creates a better environment to encourage people to think specifically about the risks in their organisation and how to control them.
But if regulation only gets us to the minimum, what else do we need to do? Who should do it? Who is responsible? If we want to prevent harm we have to find ways of measuring whether we have the right processes in place to ensure things are safe, not wait to see if they go wrong. Those at the top of the organisation need to know the right questions to ask not only to assure themselves but to understand where the risks and vulnerabilities are. That means welcoming bad news as well as good.
As we all strive to manage multiple risks in increasingly complex and interdependent organisations, Dame Judith will share her thoughts on how her experience as an engineer has led to her passion for bringing systems thinking to play in tackling wicked challenges.
Risk based approach to managing occupant safety
10:50 – 11:05 | George McCracken
Combating AMR through the built environment in the NHS; ICD and CMO perspectives from Frimley Health
11:05 – 11:25 | Tim Ho and Manjula Meda
In a climate of intense financial pressures, and with NHS hospitals being many decades old and in need of improvements to face the requirements of modern medicine that has evolved at a considerable pace since the inception of the NHS, tackling the threat of antimicrobial resistance (AMR) through the healthcare built environment requires a systematic approach at an organisational level. Hospitals being responsible for the vast majority of AMR transmission, the pace at which new hospitals are being built / refurbished and AMR is spreading, requires lessons learnt within the NHS to be shared to future proof investments into NHS buildings This session explores the challenges faced and shares the lessons learnt by Infection prevention and Trust Board at Frimley Health NHS Foundation Trust in combating AMR through its built environment and bringing about organisational culture change in Infection prevention practices, and how a collaborative approach both within the organisation and in partnership with other NHS organisations and international collaborations a successful outcome is possible.
Interactive Session – Competence
11:50 – 12:10 | Mike Weinbren
View of Estates and engineers
12:10 - 12:30 | Nigel Keery
Healthcare buildings have always played a pivotal role in infection prevention and control. This presentation explores the evolution of the healthcare built environment—from the constraints of historical hospital design to the complex requirements of modern estates—and how these have impacted infection control strategies over time.
Particular focus is given to the integration of water safety and air quality measures within healthcare infrastructure, highlighting the risks posed by pathogens such as Legionella and Pseudomonas aeruginosa. As antimicrobial resistance (AMR) becomes a growing threat, we assess how the design, operation, and maintenance of building systems must adapt to support effective infection prevention.
Drawing on lessons from legacy estates, we consider the challenges of managing ageing infrastructure alongside the opportunities offered by new builds. The presentation identifies the need for future-ready environments that are resilient, sustainable, and engineered to control infection at every level—from wards and plant rooms to ventilation and water systems.
Through a blend of historical reflection, current practice, and future-focused strategies, this session will highlight the critical role of built environment professionals in safeguarding patients and staff, and in meeting the rising challenges of AMR infections in healthcare.
NHS Occupant safety - The opportunity to change
12:30 – 12:50 | Alpa Patel & Rahul Chodhari
"Occupant Safety" is a pioneering framework within the New Hospital Programme (NHP) that defines how safety is embedded across the entire lifecycle of hospital projects. With £15 billion government funding to build 18 hospitals in the first wave, this initiative represents a transformative opportunity to design out risks before they materialise.
The NHP's Hospital 2.0 approach employs modern methods of construction and standardised designs to accelerate delivery while prioritising safety. By addressing critical & costly patient safety risks such as healthcare-acquired infections, antimicrobial resistance, and infrastructure failures, Occupant Safety ensures safer environments for patients, staff, visitors, and contractors.
NHP’s framework is world-leading in demonstrating sustained cultural change around safety throughout the capital build & run lifecycle. The workstream builds on current guidance, identifies risks through lived experience, and develops action plans to prevent harm through cultural and behavioural transformation.
Key outcomes include:
· Transformative cultural improvement in Occupant Safety from concept to occupation
· Enhanced patient outcomes through proactive safety measures with risks "designed out”.
· Financial efficiencies by mitigating risks early in design and operational phases.
· Improved transparency, accountability, and informed assurance
Through cross-functional collaboration between clinicians, engineers, and construction experts, we've established specialised sub-groups addressing water systems, ventilation, fire safety, and medical gases. This collaborative approach ensures that lessons learnt inform future designs, creating a virtuous cycle of continuous safety improvement.
The NHP represents a once-in-a-generation opportunity to revolutionise healthcare infrastructure while prioritising the safety of all who use these vital facilities.
Introduction to NETB 2024/3 Designing safe spaces for patients at high risk of infection from Nontuberculous Mycobacteria and other waterborne pathogens– more than NTMs, more than water (in association with RSPH)
14:20 - 15:00 | Susanne Surman Lee
This new Technical Bulletin NETB 2024/3 (TB), published in August 2024, is an enhancement to the existing Health Technical Memorandum 04-01: Safe water in healthcare premises. It was developed by a multidisciplinary expert team as a response to the Coroners' prevention of future deaths report following the inquest into the deaths of two patients from infections caused by Mycobacterium abscessus, a member of the nontuberculous mycobacteria (NTM) associated with exposure to water. Drawing on decades of experience in investigating waterborne outbreaks in healthcare settings and the factors leading to cases and deaths associated with unsafe water, for the first time, it takes into account not just the increasingly recognised risk of infections from any exposure to water for patients at high risk of infection but also the wide range of waterborne opportunistic pathogens, not just NTM, which pose a risk of harm.
This presentation highlights the challenges to what has previously been considered incontestable dogma regarding the provision of water and wastewater within healthcare, not just changes in procurement, construction, installation, system filling and commissioning practices but also the change in the culture needed within healthcare organisations to ensure all new capital and major refurbishment projects are safe at handover and beyond, for all intended uses and users. It takes into account the Hackitt report, requiring a HACCP risk-based approach using risk-assessed standards and guidance at every stage of the process, rather than simply complying with prescriptive requirements.
Practical tips for delivering real time change
15:00 - 15:20 | Jessica Martin and Trupti Patel
The NETB 2024/3 offers new recommendations to address risks from nontuberculous mycobacteria (NTM) as well as other waterborne pathogens in the healthcare environment. Although the recommendations are mainly directed to new builds and refurbishments, the document also states that the information provided will be helpful for use in existing buildings where the infrastructure allows.
Drs Martin and Patel will discuss key themes in the guidance, unpicking implementation considerations and additional factors that could stand as barriers and opportunities.
Areas covered will include: laboratory testing for NTMs and quantification, clinical surveillance, training requirements, governance arrangements, disinfection and gaps in knowledge and research.
Public Health Matters – What would Einstein say?
15:20 - 15:40 | Kevin Wellman
There are numerous water related problems across the world which will require global solutions to resolve. In the UK the skills shortage is becoming more of a skills crisis that requires maximum collaboration. Water related problems such as hot water scalds, burns from pipes and radiators, in addition to Legionnaires' disease and pseudomonas are fundamental problems that are not going away.
In addition to providing statistical information outlining the key issues the presentation includes observations on solutions that can help in the future. Whilst some improvements require radical change it is imperative to understand that doing nothing is not an option.
Day 2 - Wednesday 18 June
Water safety issues and why patient rooms are such a high risk in hospitals
09:30 – 09:50 | Jimmy Walker
Water safety issues in hospitals have been recurring themes for decades demonstrating that guidance, and conformance to guidance, has not delivered safe water or water services appropriate for patient use and care. Water should not be considered safe as there are predictable and unacceptable waterborne infection risks for vulnerable and high risk patients. Water delivered to and used in hospitals is not sterile. Due to the large size and complex nature of healthcare building's hot and cold water systems, pathogens and biofilms proliferate. The last two meters at the water system periphery, including outlets, drains and “splash zone”, heightens the exposure risk of patients to supply-water and drain-associated pathogens, including antibiotic resistant strains. Due to their illnesses and restricted mobility, many patients are unable to use water outlets associated with their single or even multi-bedded patient rooms. As a consequence, stagnancy supports biofilm development and amplification of microorganisms at outlets such as taps and showers as well drains and bottle traps or u-bends results in preventable healthcare-acquired infections.
This presentation will review novel technologies which the water industry has developed to reduce the exposure of patients to microbiologically contaminated water. Additionally, there will be discussion on designing healthcare spaces to minimise infection risks (as per NHS Estates Technical Bulletin (NETB) No. 2024/3) as well as the approach of “water-free patient care” to eliminate waterborne infections, to ensure that patient safety is the priority for the duration of their hospital stay.
IPC team's role in the hospital built environment – management and response to concerns
09:50 – 10:10 | Sara Mumford
Using surveillance systems to monitor impact of novel changes to the built environment
10:10 – 10:30 | Vicky Gentry
The ongoing, systematic collection, analysis, and interpretation of healthcare-associated infection (HCAI) data is crucial in providing Infection Prevention & Control (IPC) Teams, clinical teams, and Boards with assurance of actions taken to improve patient safety and quality of care, including novel changes to the healthcare built environment.
The roll-out of the ‘Bugsy’ Infection Control module of the Epic electronic patient record at Frimley Health NHS Foundation Trust in 2022, has enabled the IPC Team to manage a robust programme of HCAI surveillance, ranging from surgical site infection surveillance, trends in Gram-negative bacteria and antimicrobial resistance (including Carbapenemase- and ESBL-producing organisms), as well as day to day management of infection cases and assessment of the clinical significance of microbiology results.
The system has also enabled continuous surveillance for catheter-associated urinary tract infection, intravascular device-related infection, and ventilator-associated pneumonia, and provided invaluable assistance in outbreak management. Using real-time reports of antimicrobial prescribing patterns has helped target antimicrobial stewardship efforts where it is most needed, and automated reports built specifically for the National Point Prevalence Survey of HCAI and antimicrobial use, enabled the Trust to collect high quality data in a short space of time, that would not have been achievable prior to 2022.
Machine learning for the prediction of infection in hospitalised patients
11:20 – 11:40 | Timothy Rawson
In a climate of intense financial pressures, and with NHS hospitals being many decades old and in need of improvements to face the requirements of modern medicine that has evolved at a considerable pace since the inception of the NHS, tackling the threat of antimicrobial resistance (AMR) through the healthcare built environment requires a systematic approach at an organisational level. Hospitals being responsible for the vast majority of AMR transmission, the pace at which new hospitals are being built / refurbished and AMR is spreading, requires lessons learnt within the NHS to be shared to future proof investments into NHS buildings This session explores the challenges faced and shares the lessons learnt by Infection prevention and Trust Board at Frimley Health NHS Foundation Trust in combating AMR through its built environment and bringing about organisational culture change in Infection prevention practices, and how a collaborative approach both within the organisation and in partnership with other NHS organisations and international collaborations a successful outcome is possible.
Remote surgical wound monitoring and the role of artificial intelligence
11:40 - 12:00 | Melissa Rochon
Surgical site infection (SSI) is the most common healthcare-associated infection among surgical patients and a major source of post-operative harm. SSIs contribute to more than one-third of post-surgical deaths and are associated with significant complications, including prolonged hospital stays, extended antibiotic therapy, emergency readmissions, reoperations, and poorer long-term outcomes. Notably, most SSIs develop after hospital discharge, highlighting the need for improved post-operative wound monitoring. Emerging systems and technologies offer promising opportunities to enhance surgical wound care. However, remote wound monitoring introduces a new workload for already busy clinicians.
This session will share our experience at Guy’s and St Thomas’ NHS Foundation Trust, where we routinely use patient-owned smartphones to collect patient-reported wound healing outcomes and wound photographs. We will also discuss the development and clinical evaluation of artificial intelligence in this setting, focusing on issues of scalability and inclusivity.
Advancing Infection Prevention and Control through AI: A Scoping Review of Applications, Barriers, and a Decision-Support Checklist’
12:00 – 12:20 | Silvana Gastaldi
Introduction: Artificial Intelligence (AI) is transforming Infection Prevention and Control (IPC) through predictive analytics, surveillance, outbreak detection, decision support, and environmental monitoring. However, its adoption remains uneven due to persistent challenges. This scoping review synthesizes AI-driven IPC applications, identifying global trends, implementation barriers, and risk factors while proposing a structured decision support checklist for healthcare integration.
Methods: Following Joanna Briggs Institute and PRISMA-ScR guidelines, we systematically searched PubMed, Web of Science, and Scopus (2014–2024). Dual reviewer screening and data extraction were conducted using a standardized framework, categorizing studies by AI techniques, IPC applications, barriers, risks, and research distribution.
Results: From 1761 studies, we included 105. AI-driven IPC research is concentrated in high income countries, with the USA (33.3%) and China (16.2%) leading in predictive analytics, while Europe (17.1%) focuses on HAI detection and workflow integration. Machine Learning (63.8%) dominates AI applications, followed by Deep Learning (21.9%) and Generative AI (5.7%). Predictive analytics (50.5%) is the primary application, particularly for hand hygiene compliance (12.4%), HAI detection (12.4%), and surveillance (7.6%). Despite advancements, only 16.2% of applications are fully integrated into digital health systems. Barriers include technical (9%), interoperability (15%), and economic constraints (2%), with operational (35.2%) and technical risks (30%) prevalent.
Conclusion: AI enhances IPC but faces adoption challenges. Addressing interoperability, workforce upskilling, and regulatory gaps is critical. We propose a structured checklist to guide healthcare administrators in AI adoption, ensuring secure, scalable, and effective implementation
Practical use of WGS for IPC: visualising potential transmission events
13:50 - 14:10 | David Eyre
The talk will cover ways of visualising whole genome sequencing data alongside patient contact and ward overlap data from hospitals. It will also recap evidence that WGS can make a difference to infection prevention and control, including specific interventions that WGS results might prompt. Examples of available visual tools that could help IPC teams to identify transmission events and clusters using WGS data will be discussed.
The second part of the talk will cover a new study aiming to measure how much difference WGS makes to IPC decision making using a new tool for visualising sequencing data alongside patient contact information.
Real-time Genomic Surveillance for Healthcare Outbreaks: Current Evidence & Future Directions
14:10 – 14:30 | Alex Sundermann
Genomic analysis reveals persistence of three distinct ST80 VREfm clones over 39 months in a large Irish hospital
14:30 – 14:50 | Peter Kinnevey
Background:
Vancomycin-resistant Enterococcus faecium (VREfm) are significant nosocomial pathogens. Sequence type (ST) 80 vanA-encoding VREfm predominate in Irish hospitals, but their transmission is poorly understood.
Aims: To investigate transmission and persistence of predominant complex type (CT) VREfm in two wards of an Irish hospital (H1) using whole-genome sequencing, and their intra- and inter-hospital dissemination.
Methods:
Rectal screening (N = 330, September 2019 to December 2022) and environmental (N = 48, November 2022 to December 2022) E. faecium were investigated. Isolate relatedness was assessed by core-genome multi-locus sequence typing (cgMLST) and core-genome single nucleotide polymorphism (cgSNP) analysis. Likely transmission chains were identified using SeqTrack (https://graphsnp.fordelab.com/graphsnp) using cgSNP data and recovery location. Well-characterized E. faecium (N = 908) from seven Irish hospitals including H1 (June 2017 to July 2022) were also investigated.
Findings:
Conventional MLST assigned isolates to nine STs (ST80, 82%). cgMLST identified three predominant ST80 CTs (CT2933, CT2932 and CT1916) (55% of isolates) of related isolates (≤20 allelic differences). cgSNP analysis differentiated these CTs into multiple distinct closely related genomic clusters (≤10 cgSNPs). Parsimonious network construction identified 55 likely inter- and intra-ward transmissions with epidemiological support between patients ≤30 days involving 73 isolates (≤10 cgSNPs) from seven genomic clusters. Numerous other likely transmissions over longer time periods without evident epidemiological links were identified, suggesting persistence and unidentified reservoirs contribute to dissemination. The three CTs predominated among E. faecium (N = 1286) in seven hospitals, highlighting inter-hospital spread without known epidemiological links.
Prevalence and diversity of Non-Tuberculous Mycobacteria in UK hospital water systems
15:35 – 15:45 | Sam Watkin
The study objective was to investigate the presence, prevalence and diversity of Non-Tuberculous Mycobacteria (NTM) in UK hospital water systems.
11 hospitals located across the UK were visited between November 2023 and August 2024.Water samples were collected from the incoming/mains supply and from six showers across three different wards. Drain samples and swabs of shower heads and hoses were collected. Samples were cultivated for NTM by MGIT and/or on NTM Elite agar incubated at 30°C and 37°C for 6 weeks. Isolates were identified by MALDI-ToF mass spectrometry.
NTM prevalence was high with 100% of supply waters (n=14), 100% of shower waters (n=65), 95% of shower drain samples (n=65), 85% of shower hoses (n=65) and 58% of shower heads (n=65) yielding NTM by culture. NTM concentrations in shower water ranged from 970 to >3.0x10⁶ cfu/L. 27 different species of NTM were identified but only 5 were recovered from supply waters, NTM recovered from showers were more diverse. The most frequently recovered species from showers (all sample types; n=260) were Mycobacterium chelonae/salmoniphilum/stephanolepidis (51%), Mycobacterium mucogenicum/phocaicum (32%), Mycobacterium fortuitum (21%), Mycobacterium gordonae (15%) and Mycobacterium chimaera (13%). The NTM recovered from shower water, head and hose differed from that recovered from drains.
NTM, including clinically relevant species e.g. Mycobacterium chimaera and Mycobacterium fortuitum are common colonisers of UK hospital water and drainage systems. Other clinically important species e.g. Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium abscessus are less prevalent. The majority of NTM species recovered can be classified as pathogens according to published literature.
Are Clostridioides difficile ribotype 955 spores susceptible to sporicidal disinfectants used in hospitals?
15:45 – 15:55 | Sam Watkin
Introduction
Hypervirulent Clostridioides difficile ribotypes pose a significant risk to hospitalized patients. The emergent, metronidazole-resistant C. difficile ribotype 955 (RT955) has been associated with prolonged outbreaks in several care settings, with an incident management team (IMT) formed to investigate the impact of this pathogen. Clinical evidence has indicated that C. difficile RT955 may be associated with increased
transmissibility despite enhanced environmental disinfection interventions.
Objective
To determine if C. difficile RT955 exhibits reduced susceptibility to commonly used hospital disinfectants.
Methods
Clinical isolates of C. difficile RT955 were obtained from the C. difficile reference network. Purified spore suspensions were prepared. Frequently used sporicidal disinfectants were identified through the IMT relating to C. difficile RT955. Susceptibility testing of spores to sporicidal disinfectants was performed using suspension tests based on the method detailed in EN 17126:2018. Spores were exposed to disinfectant agents in the presence of light organic soiling for the specified product contact times before neutralisation with a pre-validated neutraliser. Test suspension aliquots were plated on supplemented brain heart infusion agar with sodium taurocholate and incubated anaerobically for 48 hours. Reductions in CFU from the initial spore suspensions were determined.
Results
Findings indicate that in the presence of light organic soiling, C. difficile RT955 is
effectively eliminated by chlorine-based disinfectant agents, including sodium
dichloroisocyanurate at 1,000ppm free available chlorine, chlorine dioxide and
sodium hypochlorite, exhibiting a > 6 log10 reduction.
Conclusions
Findings suggest that C. difficile RT955 exhibit susceptibility to chlorine-based
sporicidal agents in the presence of light organic soil.
Urinary tract infections in care homes in England: a matched case-control analysis of infection burden, management, outcomes using linked data
15:55 – 16:05 | Nina J Zhu
Objectives: To assess the prevalence of urinary tract infection (UTI) in care homes, and compare outcomes with the cases outside.
Methods: linked records of 2.5 million London population between 2018 and 2023 were analysed. Patients aged above 64 with UTI in and outside care homes were identified and matched using propensity scores. Health outcomes were assessed using generalised estimating equation (GEE) model, adjusted for demographic, catheter use, co-morbidities, COVID-19 infection, and the year of infection onset.
Results: 91,501 UTI episodes were identified, including 6,648 from care homes. The incidence rate was significantly higher in care homes (229.2 per 1,000 person-years vs 64.8), and increased during COVID-19, while decreased outside. Urine culture was requested for 23.2% care home cases (39.2% outside, p < 0.05), and 73.5% had results within one week (83.8% outside, p < 0.05). Escherichia coli was the most common pathogen, with higher level of resistance in care homes (trimethoprim 46.4% vs 32.0%, p < 0.05; nitrofurantoin 7.5% vs 2.4%, p < 0.05). Each patient with UTI living in care home has had significantly worse outcomes than a comparable case outside, measured by the odds ratio of 60-day mortality (2.06, p < 0.05), complications present to GP (1.38, p < 0.05) or hospitals (1.15, p < 0.05), recurrent infection (1.21, p < 0.05), or prescription of alternative antibiotics (1.12, p < 0.05). Conclusions: This research provided robust population-level assessment of UTI in care homes using linked patient data. Targeted infection prevention measures are urgently needed to protect the vulnerable population in this setting.
Metagenomic next-generation sequencing in clinical virology: bioinformatic analysis and reporting
16:05 - 16:25 | Nathaniel Storey
There has been a significant increase in interest in metagenomics sequencing for diagnosis in the clinical setting in recent years. This is due to the untargeted nature of the technique, allowing for identification of pathogens without prior knowledge of the causative organism, whether it is viral, fungal, bacterial or other, as well as the reduction in sequencing costs.
However, challenges remain in the analysis, interpretation and reporting of results. With the unbiased nature of metagenomic sequencing increasing the likelihood of incidental findings and significant risks of contamination from both reagents and the laboratory environment, it is imperative that the bioinformatic analysis is robust and reproducible, with uncertainty in results addressed and clearly reported.
The use of metagenomics for the detections of emerging pathogens
16:25 – 16:55 | Meera Chand
Metagenomics has the potential to change the diagnostic and surveillance landscape, both by introducing a pathogen-agnostic view and by routinely providing genomic characterization data that has not previously been available. It can benefit individual patients, local outbreak control, and national surveillance – if we get it right.
As with any widescale adoption of new technology, we must set clinical and ethical frameworks, manage new risks, and embed rigorous evaluation. We must work out how to deploy it to benefit individuals and identify novel risks in a cost-effective way. An integrated clinical and public health approach could enable real change in the next five years.