Brett Mitchell on the price of patient safety (Australia)

Brett Mitchells_edit

Wed, 10/13 5:56AM • 35:36

SUMMARY KEYWORDS

infections, hospital, study, cleaning, clinicians, people, important, terms, infectious diseases, patients, intervention, point, evidence, infection prevention, guidelines, australia, prevalence, approach, healthcare, quality-adjusted life

SPEAKERS

Brett Mitchell, Dr. Marco Bo Hansen

Dr. Marco Bo Hansen  00:02

Hi, I'm Marco, and thanks for listening in. I'm a medical doctor and researcher. And my mission is to empower healthcare workers to prevent infectious diseases. Each episode is a short conversation with experts sharing their insights with us. excited to have you, Brett,

00:23

it's wonderful to be here, Marco, thanks for the opportunity to chat with you.

Dr. Marco Bo Hansen  00:26

So tell us how you got involved in infection prevention and control?

Brett Mitchell  00:30

Well, I think, probably started, but I worked on an infectious diseases board in the UK. And I really got a bit of an interest for preventing infections in that point that was a infectious diseases board that had multidrug resistant tuberculosis patients and a whole raft of other things, as well as outpatient clinics for infectious diseases. And so I got involved in clinical nurse and then ultimately, as an investment manager for that board for a period of time. But it was funny because when I actually was in high school, I did a placement buster, Vayner 14 1516 year old, and I went to my local hospital in Ipswich in Queensland, and actually ended up as a placement in a microbiology lab. And I had this fascination for bugs. And I didn't actually thinking more of it until years later, when I actually got into infection control for a second it was 16 years old, I remember doing a little work experience in a micro hospital. So took me a while to realise I think that that was the case. But yeah, infectious disease, and then from there into more infection control and, and then public health after that.

Dr. Marco Bo Hansen  01:39

What have been some of your most important learnings from your career so far,

01:43

I think probably one of the things I've learnt is just follow your passion, I think you've got to have a real passion to do something. And I've been lucky enough to mix a few worlds together of nursing, of patients. And that's fundamentally why I went into nursing in the first place, and, and research and I'm in a really privileged position at the moment where I've can mash all three together. So I think following your passion is really important, and do things that make a difference to patients. And I see lots of things that might be good pieces of research. But really, I wonder what difference that actually going to make to patients at the end of the day. So everything I do, I try and think about that. And I guess the other thing I've learned is the importance of networking with people from outside your discipline, but also within across the country and internationally. So therefore, with main things I'd say,

Dr. Marco Bo Hansen  02:37

I can definitely relate to that. And I'm sure some of our listeners can as well. My passion and your passion is infection prevention. And let's talk more about that. Most people expect hospital treatment to make them better. But for some stay in hospital can make them sicker. You published a study and American now it was actually antimicrobial resistance and infection control demonstrated and one in 10 patients in hospitals acquired infections during their stay. Can you tell us more about that study?

03:10

Yeah, thanks. maka Yes, this study was a point prevalence study that we did. Led by Phil Roscoe is a colleague of mine until research with Phil and many others actually, on that paper, Andrew shields and Alan Chang. And what we did was a point prevalence study across 19 hospitals in Australia. Now that doesn't sound that exciting, because probably a lot of listeners will be thinking point prevalence study that's, we do that a fair bit in Europe and people in America do that. But the reason why we want to do this is because Australia is probably unlike most other OECD countries, and that we don't have a good national surveillance programme for healthcare associated infection, so don't really have a great handle on what are the common infections that people are acquiring in hospital. So we did this through some philanthropic funding, we surveyed just under 3000 patients at 19 hospitals across Australia. And we use the same research assistant who travelled around Australia to do this point prevalence study. So we know that the application of the definitions we use which were ACDC point prevalence, political definitions that are applied equally across all those hospitals, that was one strong advantage of this and it wasn't people in the hospital doing the point prevalence study themselves. And what we found is essentially that one in 10 people in hospital, the point prevalence is 9.9% had an infection acquired in hospital and unsurprisingly, that those common infections are surgical site infections, domain urinary tract infections, and they're made up two thirds of all the infections. So I guess it was an important study here in Australia because it really started to shine a bit more light and a bit more data on what was going on. And the rate of 10% of point prevalence was probably a little bit higher than we thought as well.

Dr. Marco Bo Hansen  04:57

Did the findings surprise you in any way

04:59

Yeah, so I think that point prevalence is 9.9% was a little higher than we anticipated. Point prevalence studies in Europe in the US have somewhere between four and 6% 7%. I think they sort of started hiring and has crept down over the years. So a few things crossed their mind is the true rate. Are we higher than other countries? Or was it something that we did in our approach and mythological approach that, you know, perhaps it inflated that. So I think two things might partly explain that one was that we did choose and select acute hospitals. And our stress studies are large tertiary type referral hospitals. So they're likely to see sicker and larger, sicker patients. And compare that to perhaps studies in Europe where there's a bit more dilution of just big acute hospitals, but also smaller base hospitals, community regional type hospitals as well. So that could be one reason. And the other reason could be that I mentioned earlier having the same people go around and undertake the point prevalence study, and not have hospital staff undertake it. And maybe that was another reason perhaps why some of those numbers are a little bit higher than we thought as well.

Dr. Marco Bo Hansen  06:14

briefly tell us what a point prevalence study is, and what it means when you say that you identify and a prevalence of nine to 10% of hospital acquired infection.

06:25

So important prevalence studies are really just a snapshot in time. So think of it like a survey, where on any given day, Does someone have an infection or not. And so they're not an incidents where you're measuring the number of cases over a period of time, we're really just looking at in hospital today, how many proportion of people have a healthcare associated infection? So we're actually working on a paper at the moment that that tries to recalculate or backwards calculate the incidence from that point prevalence data so we can actually come up with what are the incidence of if you go to hospital? What's the incidence of you acquiring an infection in a hospital in Australia. But really, what that means is, the problem is simply about today, how many people have an infection, because remember, people will have an infection for multiple days. So if you go in tomorrow, then same people might also have an infection. So they're useful, we think, in terms of a broad brush to say, what is the general burden of infections in your hospital or institution? And also, what are those infections, the contributing to that burden of healthcare associated infections. So in this case, it was euro attract infections, pneumonia, and surgical site infections. So you can get a grip, or get understanding about perhaps, where you want to prioritise your resources based on some of those findings. So they're faster do relative to ongoing surveillance, which you have to do every day or every week, they might take you a day or two to do that in your hospital. So they're a bit faster to do, but that is meaningful in terms of some of the incidents and cohort studies that you might want to do.

Dr. Marco Bo Hansen  07:53

And how many of these infections in health care settings Do you think we can prevent?

07:57

Oh, that's a great question. The honest answer is I don't know. But if you look at common infections, those were the largest common factors. And those are the largest burden on health services and patients, I'd say, you know, that'd be urinary tract infections, bloodstream infections, just as two examples. So bloodstream infections, although the incidence might be low, if you get a bloodstream infection, the consequences are quite high relative to other infections, both in terms of morbidity and mortality. Compare that to urinary tract infections, which perhaps don't have the same morbidity and mortality, but a much more frequent associated those two is an example both of those infections, much of the time they're associated with device use, whether that be intravascular device use or central on devices in the case of bizarre infections, or in the case of urinary tract infection, urinary catheters. So both of those are often associated with indwelling devices. And in the case of urinary tract infections, it's been estimated that up to 80%, of all UTI is associated with urinary catheters in hospitals and healthcare settings. So this really does mean that there's an opportunity to prevent some of these infections, because it's about how they're inserted, and how they're maintained, and how quickly they come out, they can make a difference to preventing those types of infections from occurring. Not all but many. So I think for those types of infections, we've got plenty of work to do to reduce them further, but I think it'd be very hard to put a real percentage on that. He said,

Dr. Marco Bo Hansen  09:25

some important insights and thank you for sharing that. Most people know that infection prevention is critical to the future of healthcare. What are some of the barriers to success that clinicians are faced with?

09:37

I think there's probably there's lots but perhaps, to spring to mind for me initially, and that's having good quality evidence to rely upon. And the second is having good systems and culture to support best practice. So on that first one, having good quality evidence to rely upon, I did a review which was published in the journal hospital and Last year, and what we did was we looked at the common guidelines infection control guidelines across the world, and the CDC guidelines from who, Europe, Australia, where the guidelines and recommendations and those guidelines are formulated or developed from a systematic review of the evidence or review of the evidence, at least. And yes, they use all different methodology. For example, great methodology is one methodology that might be used to formulate those recommendations. But what we want to look at is, let's look at all these recommendations, I think there was around 140 odd that we looked at across those different guidelines. And then we said, let's look at the evidence underpinning those recommendations and the quality of the evidence, the strength of the evidence to make those recommendations. And what we found was for many things, in infection prevention and control, particularly things around environmental cleaning, around transmission based precautions, that's contact precautions, droplet airborne, this sort of precautions, if you want to use that sort of terminology, the evidence is was really quite low. So we're relying on things like quasi experimental studies, cohort studies, which selected cohort studies and even just expert opinion for a lot of those recommendations. And so we really do have had to rely on infection control, generally a poor evidence base to make a lot of decisions on. And so I think that is a particular barrier for clinicians, because we can be challenged by the evidence that we have in making any kind of decision or recommendation you have. So I think that's one thing. And then the second I learned to was about the systems and culture to support best practice. And that can be from organisational culture, or could be just a very local culture on your ward or unit. And that includes things like leadership, as well as the system. So could you actually have the tools and the processes to support what you need to do as a clinician, you might be able to know what to do I know what the good quality evidence, but do you have the best systems in place to be able to make sure that you can do that efficiently and effectively every time you're delivering care? So I think there's some of the biggest challenges that clinicians face in terms of infection prevention and control.

Dr. Marco Bo Hansen  12:12

Your points got me to think about the fact that when I talked to decision, and policy makers, they often asked me, What is the impact on infections of a given intervention? So you recently published a very interesting study in Lancet infectious diseases called reach. Can you tell us about that study?

12:31

Yes. Look, this is one of the studies I'm very proud to have been involved with, with the study. Thanks, Marco. I'm very proud to be part of this study, because it was a big study. It was a study was undertaken for over a number of years. And really, there's a lot of lead up work to get to that point, too. And it was expertly ran by the project manager, Alison fountain give a big shout out to her because she managed a big project and a big team of academics, clinicians and hospitals. So in this study, we wanted to look at the impact of hospital cleaning. And if we were to improve routine, cleaning, routine and discharge cleaning, that sort of terminal cleaning, and when someone leaves hospital, if we were to improve that, does it make a difference to infections? And you might think it's a pretty simple question to answer and you think, because it does, because he wants to claim that in fact, this is the first randomised control study ever undertaken to look at the effect of improved routine cleaning in hospitals, and does it make a difference to infection rates. So this was a study we did a step bridge, randomised control study in, in 11 hospitals across Australia, our intervention was a bundle cleaning intervention. And we looked at the product that was used the technique of cleaning, staff training, audit, and feedback, and communication. There were the five sort of elements to the intervention. And what we're particularly interested in is did this make a difference to key infections such as stephanotis, bacteremia, and vancomycin resistant Enterococcus infection, not colonisation is hard outcome of infection. And we also looked at a whole range of secondary outcomes as well. So we looked at the thoroughness of cleaning. So did our intervention actually improve the quality of cleaning that was going on? We looked at things like to change knowledge and attitudes of environmental services and cleaning stuff. And we also looked at things like cost effectiveness of the intervention, as well. So it was a big study, we did it between 2016 and 2017. And this study involves some three and a half million occupied bed days in hospitals, and it was a really complex study to pull together.

Dr. Marco Bo Hansen  14:45

Yeah, it sounds amazing. And what were they key findings in this study?

14:50

So what we found that was actually the secondary outcome about did it improve the quality of cleaning and I think that's an important point and often it's lost in randomised control studies. And studies infection control literature because you might look at the effect of the whole intervention itself and looking at to the intervention, whether the intervention danger does as you intended it to do, does it have the desired effect, that people actually do what they're meant to do? And so that's the key thing I'll start with, which was the secondary outcome, which was the thoroughness of cleaning, and did it actually improve. And so what we did was we used fluorescent marker gels embedded in the study, and we look to see whether those are these are gels that you can apply to a surface now applied before cleaning, and visible to the naked eye. And after cleaning, you can go back and see whether in fact, that gel was removed, and generally relatively easily to remove to the surfaces wiped appropriately cleaned appropriately. So what we found with that secondary outcome was the bundle of interventions work, we saw a really marked increase in the number of correct claims, if you like the percentage of frequent touch points that were claimed, and assessed using this marker gel approach, which was done at arm's length from paying staff, they were not aware of the actual sites that were being altered. So we know that the individual improved cleaning. So did that improve cleaning then lead to reduction infection. And the key findings of this study was that we found that it did reduce the incidence of vancomycin resistant Enterococcus infections. And the reason we thought that that was important is that vre is a really important surrogate for many other pathogens that survive an environment and are transmitted via that fomite route. So I'm thinking, perhaps on multi resistant gramme negatives as well, as well as perhaps other gramme positive bacteria. And that was one of the key findings from the study, and have been asked, why didn't we to have the resistant gramme negatives is one of the outcomes. I guess the short answer is this study was designed many years before we started, and then it took a little while to get funding for this study. So multidrug resistant gramme negatives weren't as big of an issue at that time, as they are, perhaps now met for many hospitals and healthcare services. But it was really interesting findings that we showed that yes, you can improve hospital cleaning, and that improvement in routine cleaning, discharge cleaning, does reduce the risk of a key infection like vre.

Dr. Marco Bo Hansen  17:17

And these results are so inspiring. Are you aware of, if any of the hospitals who took part have been able to maintain the improvements they shall,

17:27

yeah, we believe that some of the hospitals are continuing that and I know there's been lots of interest from many other hospitals to take elements of this or even try and translate that bundle of intervention to their own hospital. But we've noticed that this study has been cited in guidelines and informed various guidelines now. So I think we'll start to see the uptake of these findings. Much more. I think the other really important thing with this piece of work was the cost effectiveness side that was led by Nicole white and Nick graves. And that really, also helps decision makers about how am I going to invest in cleaning and this type of approach to cleaning.

Dr. Marco Bo Hansen  18:06

What are the results of this cost effectiveness study in published in clinical infectious diseases.

18:12

So what we want to look at was all the costs associated with this intervention. So that includes things like the product costs, that there was a change in production, the time for training time for undertaking the audits, and the feedback to staff. And then what were the savings from the intervention so that primarily the reduction we saw in infection, and the savings associated with a reduction infections, then are really about lower length of stay reduction in length of stay in hospital and putting a cost to that. And so in this particular study, we use two approaches, because it really that big saving comes from reduction in length of stay. And so how you value that freeing or bad days is particularly important. So in the interest of transparency in this paper, two approaches, we use one using that sort of traditional accounting method, we call this as the cost of the hospital and certain people you see, given fixed period, and so it's x amount per person per day. And that's quite often used in the literature. The second approach, which is less frequently used, was an approach where Nick grades in previous work with colleagues asked CEOs in hospitals, what were they willing to pay to free up beds in their hospital. And that was remarkably different to what the accounting model is. So t eyes weren't willing to pay anywhere near as much to free up beds in hospitals, compared to what the accounting model would suggest. So we use the cost effectiveness model, we use both those approaches in the interest of transparency to look at would this intervention be cost effective using both those types of assumptions? And the short answer is it was so 86% chance that this bundle is cost effective in terms of its approach. And really that the cost effectiveness ratio was about four and a half $1,000 per quality adjusted life year gained. So that's the cost of actually implementing the bundle relative to quality adjusted life year. And what we see in healthcare is willingness to pay the close to 2030 $40,000 per quality adjusted life year gained. So this was a study that you can then turn around say that it is cost effective to invest in improving the routine cleaning of your hospitals, because your investment is worth it in terms of reduction in friction seen, and reductions in things like length of stay for your hospitals, and even using a conservative approach like an accounting model to value a bad day. So equally the same with the CEO willingness to pay model. The other interesting thing that Nicole and Nick did in this paper was I presented a really interesting graph, which showed the willingness to pay per marginal quality adjusted life year. So if you were to say what my CEO is willing to pay $30,000 a year for quality adjusted life year gives you the percentage likelihood that this intervention is going to be effective at that rate. So even if you'd say, for example, are you willing to spend $10,000 a year for quality adjusted life year, it's still about 70 odd percent likely that this intervention is cost effective. So this particular paper is really useful? I think for hospitals, healthcare services, to have that debate and discussion with their own decision makers about investment in cleaning for their institution, I

Dr. Marco Bo Hansen  21:37

think these results are so interesting and important. They clearly shows that investing in environmental cleaning and in hygiene in general is cost effective. But I guess the obvious next question is how frequently should we be cleaning in the patient rooms? How often should that be performed?

21:56

Yeah, that's a great question, Marco, and it's another one that really does need to be set up as an individual. So to answer that question, specifically, I think so, in our study, rooms are cleaned at least daily. And importantly, the rooms upon discharge, will terminal claim really had a detailed claim in the use of a disinfectant. So I think that the two things really that I would take home from that is at least needs to be cleaned out or needs to be at least daily. And there also needs to be really important focus on the terminal claim. And the reason that terminal thing is critically important is that other studies and I did a systematic review a number of years ago, which show, if you're a patient and you're admitted to a room, with a prior occupant of that room had something like MRSA is a much higher risk of you acquiring that same organism, just because you're admitted to the room with a prior occupant had that organism. So that systematic review was part of the justification for getting some funding for this study. But it really just shows that the environment does play an important role and risk in terms of patient safety for subsequent occupants of room. So that really then enforces the importance of discharge slash terminal room cleaning, and getting that right. So those are the two things I'd say daily cleaning and really focus on that terminal room cleaning getting it right.

Dr. Marco Bo Hansen  23:16

What are the factors, then environmental cleaning are important when dealing with hospital acquired infections. So

23:22

I think there's always a few for this, I don't want to list a whole raft of things, perhaps focus on three things that I'd say the big ticket items. So environmental cleaning, and hygiene, I think ventilation is something that we don't know a lot about yet, in terms of what COVID has taught us in terms of implications for other healthcare associated infections. And so I think we've got a long way to understand about the role of the air in healthcare associated infections more generally, in healthcare settings in aged care settings. Clearly, it's an issue in terms of COVID. But what about other things that we've assumed in the past had been primarily droplet to use that paradigm or even contact by fomites, perhaps there has been an neglect of the air. And so I think ventilation is something that perhaps we need to be looking at a bit more. So cleaning hand hygiene ventilation, I think the fourth thing would be appropriate use of devices, whether they be urinary catheters, central lines, intravascular devices, they're really key in terms of getting in session technique, correct, how you prep skin, and all those types of things, the maintenance of those, and the removal of those, I think they're really important because they can affect a whole range of different infections that we see whether they be from bloodstream infections, urinary tract infections, or even things like ventilator associated pneumonia. So I think there's some of the big ticket items that are really important when thinking about prevention of hospital acquired infections,

Dr. Marco Bo Hansen  24:57

points and also by sharing all this information, it really makes us realise how important the hygiene part is. So can you tell us why should hospital leaders and policymakers invest even more, perhaps in preventing hospital acquired infections,

25:13

I think we always need to challenge that premise to start with so often continual investment, because ultimately, in most countries, there's a finite health budget. And so if we continually invest in one area, it's to the detriment of another. And so I think we need to be careful that we invest in the right things to prevent in this case, prevention of healthcare associated hospital acquired infections. But we don't want to just invest in things that aren't going to be useful either, because that's effectively unethical, because we could be investing that money in other areas and get better value for that money and get better outcomes. So I think that when we do broadly, when we do any type of research related to patient safety, healthcare associated infections, interventional based research in healthcare, must be looking at things like cost effectiveness, so that we can allow decision makers to make reasonable decisions and are always going to make reasonable decisions, but give them the evidence, as much as possible about make reasonable decisions about where that value for money should be placed. I think in genuinely in health care associated infections, because the incidence is still reasonable, it's still one of the most common adverse events that people have when they go into hospital, the effect of those infections for health service is quite substantial in terms of length of stay in hospitals, there's an opportunity cost for the community more broadly, who can't get access to health services, because they're blocked with people with infections, diagnostic and treatment costs, and just on their treatment costs in the era of antimicrobial resistance, we want to prevent infections from occurring in the first place to prevent the use of anti microbials and contribute to antimicrobial resistance. And of course, there's the patient side to this just as more importantly, in terms of morbidity and mortality that some of these infections have. So I think when you use the argument of all those things coupled together, it's a pretty compelling and strong argument, in most cases about investment in prevention of healthcare associated victims, but not always. And so I think we always need to look at whether when we do something, what's the cost of actually doing it in rozeta, a worthwhile investment,

Dr. Marco Bo Hansen  27:24

I often when talking to the hospital leaders, at least in some places in Europe, they literally don't know what the cost of infections are, and how to gather the information and the data. So I also see that this is a huge problem that we lack the information, we need transparency in terms of what the costs are in terms of making good cost effectiveness studies, or what is your opinion about that.

27:49

I couldn't agree more Marco. And going back when we started this chat right at the beginning, I talked about prevalence study that we got involved with in Australia. And I mentioned that one of the reasons we did is because we don't have really good data, nationally, transparent data about healthcare associated infections. And so without good data, how can we possibly convince community members that this is a problem, and that as a patient, I should be concerned or interested in preventing infections as a consumer, as a voter? And on top of that, then, of course, leaders in healthcare, how can we just get ready to go with them with some reasonable evidence to say, this is the impact this is the burden that they have. And so we do need to have much better data on the impact of health care associated infections, and not just data spewing lots of data out there. Because that's really unhelpful to and we're seeing a lot of that trying to shock people with massive numbers of infections. I think we need to take that approach of doing it doing it well. Extra methods are a sound and taking that 360 degree view, what's the impact for patients morbidity, mortality, but what's the humorous side of that too, as well, as was the impact for health services for some of these patients? So I think if we're trying to get a holistic approach, when we try and evaluate the impact of some of these infections, and the impact they have, then I think that will help with some of the arguments that we have down the track.

Dr. Marco Bo Hansen  29:13

Exactly. And I couldn't agree more. And perhaps also collaboration is the way forward to make good, big robust studies. And you also have a strong history of working with local health networks, hospitals, industry partners to find solutions to clinical problems. What are some of examples?

29:33

Yeah, thanks, maka. Actually, before I get that this touches on your point about collaboration, I can put you agree, you know, we need to get better at collaboration within our country. But between countries around infection prevention control research, we see some great clinical trials in the drug worlds. They pull it off, we need to put our resources together and stop reinventing the wheel all the time. And we have all these bodies kind of guidelines that say different things to confuse people across the world and it is gonna take forever to develop Another day to go to or perhaps future podcast is a consortium in Australia called the National COVID evidence taskforce. And it was about living guidelines and ongoing updating systematic reviews to provide live evidence to things like treatment of COVID-19. And perhaps that's the kind of model that when you're thinking about infection control, but perhaps that's a discussion for another day. But you know, in terms of local health networks, and working with industry, our really work hard to try and do that over many years, and have probably done studies in last few years with 20 3040 different hospitals, here in Australia, and I've worked with different industry partners as well. Some spring things bring to mind one, we had a study in a randomised control study in three hospitals where we want to look at the effect of convexity in 0.1%, on the actual cleaning prior to urinary catheterization, and see whether they actually reduced the incidence of catheter associated UTI is a very simple intervention. And we found really significant reductions in counties RCT had that published in The Lancet last year as well and subsequently cost effective analysis that shows it cost saving for you to invest in this type of approach. But that was working with clinicians because they didn't know what to do the guidelines are all saying something different. Do we use klaxoon? d. So why do we use it? And it was quite, technically difficult study to do. But it was a simple question that needs enhancing. So I think starting with simple questions, and working with clinicians about what's the problem we want to solve here is a good way to go. And in terms of industry, I've had some great collaborations with the industry. One, I was actually introduced to a gentleman at a nursing graduation ceremony. So one of the nursing students graduated, and she introduced me to a brother in law, who had an idea well, it's actually his wife, who worked in an accident emergency department in Brisbane in Queensland. And she could see that people are coming in with flu and diarrhoea and vomiting. And there's no way to isolate them and nama, staff are getting exposed to be a better way. And she spoke to her husband about it, they got this idea of of perhaps a portable isolation room. So at this graduation ceremony, I got introduced to her husband, he said, I've got this idea of a portable isolation, and it's a good idea. And he developed it all up and I just sort of provided some input I on infection control aspects and clinical aspects Could you do what you need to do as clinicians in this room, I researched the prototype and had that published. And then subsequently that particular room called the ready room has gone commercial. And it's available in countries across the world. And in the NHS in the UK, during COVID. It was deployed, I think, at one point every 40 minutes to protect both patients and staff from acquiring COVID. So you could reel this room into an existing four bed area and create a single isolation room. So that was a really, really fascinating thing to be involved with. I've been involved in another company, again, a small company here in Australia, who had an idea about electronic point of care reminders to help clinicians take out things like peripheral vascular devices and urinary catheters. And long story short, that device is now starting to be solved worldwide as well called a Time Attack. And so it was just really working with people who have ideas and thinking would this work in the real life, making sure it was the clinical problem that needed to be solved. And then doing some research that joins up the industry, the entrepreneurs, and the clinicians, and trying to find a solution that might work to everyone's benefit. So that's where I get really excited and love getting involved. Because as a clinician, still I can see the problems faced and as a researcher, I see these opportunities. And then you know, I'm lucky enough to have interests come along and have a chat with me from time to time. And that's just a really rewarding place to be.

Dr. Marco Bo Hansen  33:44

This also leads me to my final question for you. So what would be the single most important advice you would give to our listeners, if they want to improve patient safety in their department or organisation?

33:58

One thing that's I've done is I've worked in you know, I've worked in public health of large hospital trusts, big outbreaks, hotel quarantine, all kinds of different things. The one thing that I would say stick true is follow the data, follow the evidence, and that's probably the most important thing I would say. Follow your data, follow the evidence. And I guess the third thing in terms of you know, what I see in myself in health services and, and still see now and I'm on the research side of it, too is this constant need to want to reinvent. And if there's a good randomised control study that's providing the best quality evidence to do something, then perhaps look at doing it and a local project to confirm findings, an RCT is probably not necessarily the way to go. It's probably not a great use of resources. Trust the evidence when the evidence is there because you save yourself a lot of time trying to reinvent local projects, which really I'll never be answered because you're doing a local project mechanics Same question has been done in an RCT in the same methodological rigour. So I think for me, it's about filling it out and fill in the evidence wherever possible and try not to read things wherever possible as well.

Dr. Marco Bo Hansen  35:12

I couldn't agree more. Thank you, Brett, for taking your time to join us today.

35:16

My pleasure, Mark, and thanks so much for inviting me on.

Dr. Marco Bo Hansen  35:19

And thank you to all listeners. Please be safe and remember to clean your hands