Tuesday, 22 August 2017

AHRC Grant 'Exising Infection in the Surgical Environment' [ExISE]

Prof. Alan Short leads Cambridge/Kings College London team of researchers to win the Arts and Humanities Research Council AHRC Antimicrobial Resistance AMR Call with the project 'Exising Infection in the Surgical Environment' [ExISE]. He writes:
ExISE addresses the AHRC Antimicrobial Resistance Call, 'Creative, Collaborative and Disruptive Innovation, Experiments and Design in Indoor/Built Environments'. Its overarching Aim is to eliminate airborne acquired Surgical Site Infections (SSI) in operating theatres OTs, traditionally countered with antibiotics. Our microbiologist colleagues emphasise that any antibiotic use, suboptimal or optimal, creates AMR and so avoidance of antibiotic use, in this case post-operative, is paramount. ExISE proposes to achieve this aim through the evidence-based reinvention of the actual physical environment in which surgery is practised, the Operating Theatre OT. Eliminating airborne SSI will reduce the number of infections and the reactive use of antibiotoics in recovery and recuperation and in some cases repeat surgery and renewed risk. Airborne transmission of infection has long been feared, the post war custom and practice position on its mechanisms has dominated OT design. SSI is not eliminated in contemporary OTs. The position is not wholly substantiated. Surgeons do not question OT design. Is there another way?
ExISE will search for alternative approaches: its historians of science, art and architecture will research a history of Operating Theatre design, of making 'safe', appropriate environments for surgery within their designers' and patrons' theories and beliefs over some 150 years. The search will extend to exhuming still and moving images of surgery in action within its set environments. The Royal College of Surgeons believes this is an as yet unwritten history. The team will be searching for accompanying evidence for environmental intent to enable meaningful reconstructions of their theatres and environments against the original criteria for success. What did they think a healthy environment with healthy air looked like? ExISE scientists will assemble laboratory models and environments from the historical reconstructions of OTs alongside a contemporary 'Ultraclean' OT, the familiar 'cooker hood' issuing truly prodigious flows of cool air through the OT over all the occupants and contents, up to 40 air changes/hr, making a bizarre and not wholly welcome working environment for surgical teams. In parallel, Exise will achieve greater understanding of of the physical and psychological experience of being in/working in a contemporary OT for surgical teams and support staff by visiting teams and interviewing them in situ and at the Royal College. We hope to translate these insights into a meaningful critique from which design and redesign leads can be drawn, leading to a radical step change in fundamental approaches to the design of OTs. Approaches which appeal to our stakeholders and partners will be interrogated and tested physically with both analogue and theoretical models to enable wide dissemination of research outputs with real confidence and thence make significant impacts on the aspirations for and expectations of environments for surgery. Pursuing the international success of our earlier Robust Hospitals project film, we will make a 4-5minute animation out of our drawn reconstructions of OTs, our ideas for redesigning the OT superimposing the fluid flow modelling and calculated environmental performance. Our partners will post the film for their constituencies as will Cambridge University on its streaming media site and YouTube
Much detailed and painstaking work will be required subsequently to implement such radically new OTs in practice but ExISE should achieve the 'great leap forward' that breaks more than 60 years of standard practice.