Care Home Evidence-based Interventions to Reduce Infection that are Sustainable and Holistic (CHERISH)

Research question: Can a care home research network and data platform enable implementation of effective interventions to reduce/prevent infection in care homes, and address evidence-gaps by facilitating the development and evaluation of new interventions?

Background: Our ageing population has led to a focus on prevention to reduce the need for adult social care and support.

Many infections could be prevented by implementing existing interventions e.g. vaccination and/or by generating new evidence where none currently exists.

Aim: To transform the current reactive model for managing infection in care homes to a proactive, evidence-based approach, which facilitates effective public health intervention and quality improvement; and to demonstrate my approach by delivering exemplar studies on two leading causes of infection: influenza and urinary tract infection (UTI).

Methods: The study builds on partnerships with providers and linked data infrastructure established through my VIVALDI (COVID-19 in care homes study) in >300 care homes.

Objective 1: Development of a set of 'social care infection indicators' to capture the impact of infection and outbreaks in care homes from multiple perspectives (residents, families, staff, NHS, providers, purchasers).

This will include a systematic review of care home surveillance approaches, qualitative interviews with stakeholders and coproduction.

Indicators will be used as the basis for infection dashboards for providers and for intervention evaluation in all subsequent studies.

Objective 2: Feasibility study to gain insight into whether a rapid diagnostic test for influenza can increase the proportion of influenza cases (residents) who receive antivirals within 48 hours (primary outcome). The intervention will be coproduced with stakeholders and the study will run in 10 care homes.

We will undertake a mixed methods process evaluation (focus groups, semi-structured interviews with staff, longitudinal survey). Objective 3: Development and evaluation of interventions to reduce (antibiotic-resistant) UTI.

I will link the VIVALDI dataset to national microbiology and prescribing datasets and use it to estimate rates of UTI and UTI-related (gram-negative) bloodstream infections in residents.

This will inform the design of my cluster randomised trial of a hydration intervention to prevent UTI in residents, in partnership with NHS England.

The primary outcome and evaluation design will be coproduced with stakeholders, informed by the social care infection indicators (Objective 1), and include a health economic analysis and mixed methods process evaluation. Timelines for delivery: Infection indicators in Years 1-2 and deployed the following year.

Influenza and UTI studies in Years 2-5.

By Year 5, I aim to have obtained further funding to evaluate the influenza intervention, and will partner with NHSE to implement the UTI intervention, if successful, nationally. Dissemination: Knowledge exchange events, conference presentations, journal articles, and infographics. Findings will be shared with policymakers e.g.

UKHSA and NHSE.

Impact: Infection indicators will support providers and policymakers to monitor infection, and enable targeted public health and quality improvement interventions, improving residents' health and wellbeing. The influenza study will support improved practice in relation to antivirals and influenza testing, reducing outbreaks.

Reductions in UTI will benefit residents (wellbeing and health) and the NHS (fewer avoidable admissions and consultations).