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The enigmatic virus of the great pandemic 1916


John Oxford.

Virology, Queen Mary

s School of Medicine and Dentistry

The Influenza virus arising from Europe as early as 1916, spread widely

in 1918 as soldiers and airmen, including my father, returned to the

four corners of the world on the ships of the British Navy. Global case

fatality figures of around 7% are widely accepted although there are

serious gaps in our knowledge especially in China and India. But

unexpectedly regions of two continents experienced the extremes

namely zero deaths in American Samoa, and a death rate of greater

than 79% in Okak, Labrador. Major factors here are social including

colonisation and religion which impinged on the societies. We have

exhumed Phyllis Burns and Richard Sykes to obtain clinical samples

from 1916

1924 and have also searched pathology museums for lung

blocks as has J.Taubenberger. But to date no single gene of the virus

has been shown to correlate with virulence leading to conclusions

about the importance of co-infection with pneumococcus and to the

importance of social behaviour. The emergence of influenza from

initial clusters in the British Army at Aldershot Barracks and at Etaple-

sur-mer in 1916 could have occurred via short term contract doctors

and nurses from Harvard Medical School USA who criss-crossed the

Atlantic and worked at Etaples.

Methods to evaluate quality indicators

Pierre Parneix.

French Society for Hospital Hygiene (SF2H)

Since ten years, quality indicators (QI) are mandatorily measured in all

French hospitals. They are used for hospital quality improvement,

public disclosure and regulation goals. After a decade of use, the

Ministry of Health and the French National Authority for Health set up

a task force to evaluate these QI. The goal was to provide a decision tool

to help the authorities in terms of withdrawing, revising or continuing

their use. From a literature review and a review of national initia-

tives, we identified potential criteria for assessment. The taskforce

extracted a list of criteria for each goal using a modified Rand/UCLA

Appropriateness Method. Each criterion was assessed using a

quantitative approach or a qualitative approach: This integrated tool

was tested on four national process QIs related to healthcare-

associated infections (HAI) management. Three major international

experiences were studied. Among the fourteen retrieved potential

criteria, 12 were selected as appropriate for the evaluation of QIs for

regulation use including: benefit; side effects, feasibility, barriers to

Implementation and current metrological performances. Among

these, 11 were selected for hospital improvement and 7 for public

disclosure. Applied to the four HAI QIs, the task force proposed to

withdraw the indicator related to multidrug-resistant bacteria

management and to undertake major revision on the three others.


s new in vaccines?

Andrew Pollard.

Paediatric Infection and Immunity, University of Oxford

Immunisation is the cornerstone of public health policy globally

and vaccine programmes in developed countries have provided a

remarkable range of protection against serious infections that were

once themajor causes of early childhoodmorbidity andmortality. New

vaccines have been introduced in the past 15 years which have had

profound impact on child health. New candidates for high burden

difficult infections such as malaria and dengue are now available

and funding for control of outbreak pathogens (e.g. Ebola, plague) has

been released to improve future preparedness. There has been little

attention to understanding strategies for boosting the immune system

of the growing population of elderly adults, and the prevention of

nosocomial infection through vaccination has become a major focus of

attention for developers. Despite the many successes, there remain

some important gaps in the protection of children against infectious

diseases which cause serious morbidity and have a massive burden

on the health system (e.g. respiratory syncytial virus), or are

rare but responsible for high morbidity and mortality (neonatal

Group B streptococcal infection and adolescent capsular group B

meningococcal vaccination). However, international efforts are

expected to lead to new comprehensive programmes in the next


Quality indicators: healthcare organizations and Insurances

Walter Popp.

German Society for Hospital Hygiene

Quality indicators: healthcare organizations and insurances in the last

years, there are a lot of new law and other regulations regarding

Hospital Hygiene in Germany. The actual situation will be presented,

especially regarding benchmarking of hospitals and discussion about

future regulations. Also the role of healthcare organizations and

insurances will be included.

Does education really change IPC behaviour?

Jacqui Reilly.

Health Protection Scotland

It is often assumed that providing information on a topic will lead to

knowledge gain and practice improvement. This assumption is flawed.

A review of the evidence from IPC published literature on using

education and training to change behaviour indicates variation in

applied definitions of education and inconsistent reporting of

educational interventions. Nonetheless there is evidence that educa-

tion is an important component of a multimodal strategy for

behaviour change in IPC. However the evidence indicates that single

education sessions are unlikely to be successful and any positive

change identified in the short term might not be reported long term

pointing to the complexity of attitudes and behaviour. There is a need

for the theory of andragogy to be considered by IPC professionals

developing IPC training and education interventions as optimising the

learning experience is key to maximising the potential for education

and training to impact on behaviour.

Reducing sepsis mortality at scale

Kevin Rooney.

Anaesthesia and Intensive Care Medicine, Royal Alexandra


Sepsis is an indiscriminate killer of people of any age, background and

social status. Survivors of sepsis are also at increased risk of cognitive

decline and account for a significant proportion of healthcare

expenditure. In this presentation, Professor Rooney will share the

National Strategy to fight Sepsis in Scotland which resulted in a 21%

reduction in Sepsis Mortality. Hewill explain the

What, HowandWhy

of the campaign, paying particular emphasis on the key attributes of

reducing mortality at scale as well as any unanticipated consequences.

The role of intersectional innovations in preventing infection

Sanjay Saint.

Department of Internal Medicine, University of Michigan;

VA Ann Arbor Healthcare System University of Michigan

Professor Sanjay Saint, the George Dock Professor of Internal Medicine

at the University of Michigan Medical School, Chief of Medicine at the

VA Ann Arbor Healthcare System, and a Special Correspondent to the

New England Journal of Medicine, will give the Lowbury Lecture


The Role of Intersectional Innovations in Preventing


He will make the following key points during this lecture.

First, hewill discuss the importance of infection prevention, in general,

and catheter-associated urinary tract infection (CAUTI), in particular.

Second, he will provide an overview of how to prevent CAUTI with a

focus on recent data, and describe both technical and socio-adaptive

aspects to reducing healthcare-associated infection. Third, he will


intersectional innovations

and distinguish intersectional

innovations from

directional innovations

. Fourth, he will provide an

overview of the intersectional innovations that could impact infection

prevention efforts such as human factors engineering, cognitive

psychology, sociology, and management science. Finally, he will

discuss future directions in infection prevention, including the

possible role of mindfulness.

Abstracts of FIS/HIS 2016

Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1