A Comprehensive Students-as-Teachers Program: Developing and Empowering Future Medical Educators.

We describe the development of two formats of a Students as Teachers (SaT) program that was designed to train fourth-year medical students as near-peer teachers in the pre-clinical classroom. This program has served 191 students since its inception in 2017 through a 2-week credit bearing elective or an evening workshop series. We describe key elements of the courses and positive outcomes of our program within a learning communities' framework. We present these data for other institutions interested in creating their own SaT program.

Hospital outbreak of carbapenem-resistant Enterobacterales associated with a blaOXA-48 plasmid carried mostly by Escherichia coli ST399.

A hospital outbreak of carbapenem-resistant Enterobacterales was detected by routine surveillance. Whole genome sequencing and subsequent analysis revealed a conserved promiscuous blaOXA-48 carrying plasmid as the defining factor within this outbreak. Four different species of Enterobacterales were involved in the outbreak. Escherichia coli ST399 accounted for 35 of all the 55 isolates. Comparative genomics analysis using publicly available E. coli ST399 genomes showed that the outbreak E. coli ST399 isolates formed a unique clade. We developed a mathematical model of pOXA-48-like plasmid transmission between host lineages and used it to estimate its conjugation rate, giving a lower bound of 0.23 conjugation events per lineage per year. Our analysis suggests that co-evolution between the pOXA-48-like plasmid and E. coli ST399 could have played a role in the outbreak. This is the first study to report carbapenem-resistant E. coli ST399 carrying blaOXA-48 as the main cause of a plasmid-borne outbreak within a hospital setting. Our findings suggest complementary roles for both plasmid conjugation and clonal expansion in the emergence of this outbreak.

Tackling C difficile with environmental cleaning.

BACKGROUND: Chlorine-based cleaning products are often used in acute settings for high-level disinfection of the environment to help control C difficile. However, these products must be used at high concentrations, making them irritant, toxic and corrosive. This means they are inappropriate for the near-patient environment, and can lead to user resistance and non-compliance. More recently, products using peracetic acid and hydrogen peroxide have become available, which are highly effective even under conditions of heavy soiling. AIM: To determine whether peracetic acid sporicidal wipes could help reduce rates of C difficile at an acute London trust. METHOD: An observational study of C difficile rates was carried out at an acute London trust between 2006 and 2010. All inpatients aged two years and over were monitored. Chlorine-based cleaning regimens and products were changed to peracetic acid sporicidal wipes in April 2008 and monitored for 18 months. Inpatient bed days were also monitored to ensure findings were not affected by changing patient numbers. RESULTS: The mean C difficile rate per 1000 patients fell from six to two following the 2008 introduction of the sporicidal wipes. In the first half of 2009, this rate dropped to below two. The overall rate of C difficile infection was reduced by 72% following the introduction of the wipes. CONCLUSION: The introduction of sporicidal wipes resulted in a significant reduction in C difficile rates. This supports the need to review and enhance traditional environmental cleaning regimens for preventing and controlling C difficile in acute settings

Developing satellite roles within infection prevention teams to fulfil responsibilities.

Changing demands on infection control services require managers to think about roles and responsibilities within the infection prevention team. Satellite roles focus on specific job functions to complement the role of the clinical nurse specialist and are related to one area or subject within the remit of the clinical nurse specialist. This article outlines the development of satellite roles in an infection control team, which resulted in reduced healthcare associated infections, improved clinical practice and patient satisfaction.

Understanding why healthcare workers refuse the flu vaccine.

BACKGROUND: Vaccination is one of the most effective interventions used to reduce infections. Nonetheless, concerns and misconceptions about vaccines have resulted in an increased rate of refusal of vaccination among healthcare workers (HCWs) and within the general population. AIM/ OBJECTIVE: To understand the factors that underlie vaccination-refusal. METHODS: A questionnaire was given to the HCWs in the inpatient area of an acute London hospital during May 2019. The sample was one of convenience, i.e. the wards where the principle investigator covered. All staff were approached: 306 in total completed the questionnaire. FINDINGS/RESULTS: In total, 212 (69.28%) healthcare professionals had the flu vaccine during the 2018-2019 campaign, 94 (30.62%) did not have the flu vaccine and 37 (39.36%) of the HCWs that did not receive the flu vaccine reported they had previously a bad reaction following administration of the vaccine. DISCUSSION: This report will provide the Trust and other healthcare settings with information integrating the disconnection between misconceptions and vaccination knowledge, which may inform practical interventions to address the challenges of vaccination in future campaigns. Increasing HCWs' knowledge of flu vaccine side effects could address this and may increase rates of vaccination compliance.

The Clinical Anatomy and Imaging Laboratory: Vertical Integration in the Preclerkship Curriculum.

Introduction: As medical schools implement integrated curricula, anatomy education especially has experienced increased pressure to make foundational content clinically relevant. We designed a novel type of integrative anatomy laboratory experience where students could use foundational anatomy concepts in concert with modern imaging/diagnostic techniques to enhance important clinical concepts. Methods: We selected a process called Lesson Study to develop the multidisciplinary Clinical Anatomy and Imaging Laboratory (CAIL) in the cardiovascular and gastrointestinal systems. We utilized soft-embalmed cadavers extensively for their highly realistic tissue appearance and texture, which allowed instructors and students to perform a wide array of procedures in case-based scenarios similar to practicing clinicians. We conducted field observations of participating students, focus-group discussions, and knowledge-based exams to examine efficacy of the CAIL. Results: Approximately 150 first- and second-year students participated in each of the CAIL activities on an annual basis. Most focus-group participants felt the CAIL was a great learning experience. They commented on how the lab provided relevance to anatomy knowledge and helped integrate prior classroom learning more deeply. Instructors noted that students asked more advanced, clinically relevant questions than in a typical anatomy lab. Knowledge improved significantly after the CAIL, although it is unclear if this translates to summative exams. Discussion: The CAIL creates a unique learning experience where students use prior foundational anatomy knowledge in conjunction with modern imaging and diagnostic techniques to reinforce important clinical concepts. We have continued to integrate CAIL experiences into more clinical systems in our medical school curriculum.