Profile: Professor Graham Ayliffe
Tina Bradley, Laboratory Manager, Hospital Infection Research Laboratory, Birmingham
Professor Graham Ayliffe is a well-known and highly respected figure in the field of infection prevention and control; I am very fortunate to have had the privilege of knowing him for over 40 years. He has been influential in developing the role of infection prevention and control nurses, education of all staff and the formation of professional bodies such as the Infection Prevention Society (IPS) (formerly the Infection Control Nurses Association (ICNA)). Now let me give you a potted history of his career.
After serving in the Royal Navy as a sick berth attendant/medical laboratory technician he studied medicine at Bristol University. His interest in the mode of spread and prevention of infection probably started when he was in the navy and continued when he worked with Professor William Gillespie in the Department of Pathology at Bristol Royal Infirmary. After 4 years in Bristol as a registrar he moved to the Hammersmith Hospital in London working as a research assistant/registrar with Mary Barber where his interest in hospital infections continued to grow. It was there that he met his wife, Janet, and in 1964 they moved to Birmingham where Dr, as he was then, Ayliffe worked with Professor Edward Lowbury and founded the Hospital Infection Research Laboratory (HIRL) at Dudley Road (now City) Hospital. The HIRL was then funded by the Medical Research Council and the Regional Health Authority.
I joined the team in 1975, straight from school with O levels, and was very fortunate to work with not only Prof but also Barry Collins and John Babb. Ayliffe, Babb and Collins were sometimes referred to as ‘the ABC of infection control’. The HIRL carried out one of the first large prevalence surveys of hospital infection, involving over 30 hospitals in the West Midlands. The prevalence rate was 10% which was similar to later national studies. Outbreaks of infection were studied and a detailed assessment of an isolation ward in the prevention of spread of staphylococcal infection was made. Other studies included the emergence of antibiotic resistance and the role of plasmids. The development of tests for chemical disinfectants (and subsequently standards), the decontamination of endoscopes and other items of medical equipment, and various types of steriliser were studied. My interest in endoscope decontamination started in the 1970s when we assessed different disinfectants for manual processing. The routine use of alcohol hand disinfection in hospital wards was introduced into the UK from other European countries and the technique described by the HIRL for hand washing/disinfection is now commonly used throughout the world. This work was carried out by Prof and Lynda Taylor where they looked at the technique for application of hand rub carried out by nursing staff and noted that areas were very often missed, e.g. tips of the fingers and thumbs. This led to the development of the ‘5 stroke’ or ‘Ayliffe’ technique which is recognised by the World Health Organization (WHO). Over 400 papers have been published on these and other topics by Prof and laboratory staff.
Prof replaced Edward Lowbury as Director of the laboratory in 1980 and the HIRL was designated a WHO Collaborating Centre for hospital infection in 1985. Prof also served on the WHO Expert Working Panel for Infectious Disease.
Prof was appointed Professor of Medical Microbiology at Birmingham University in 1981 and he developed a practical course for medical students which included prevention of hospital infection. The laboratory staff were involved with this and we used to turn up with culture plates and loads of props. His other teaching interests included courses in hospital infection for medical microbiologists, nurses, engineers and hospital administrators. He was external examiner for several medical schools and for the primary and final MRCPath examinations.
He was involved in many hospital, regional, national, international and university committees and working parties, often as Chairman, including laundry and kitchen hygiene, endoscope decontamination, biological safety and control of MRSA. He was a member with Dr Robert Blowers of the Council of Europe Committee on Hospital Infection in 1972 and a UK representative with JC Kelsey on the Committee on the Standardisation of Disinfectants in Europe during 1972–1978. He was a member and later Chairman of the DHSS Microbiological Advisory Committee and a member of the DHSS Working Group on the Management of Infection Control and Investigation of Outbreaks in 1985.
One of his main interests was in the dissemination of information on the prevention and control of hospital infection to professionals responsible for infection control both nationally and internationally and in the formation of professional organisations for the study of infection control. An early interest was the training, practice and the appointment of infection control nurses and in the setting up of the Infection Control Nurses Association in 1970. He was President of the Association in 1976 and an annual lecture was inaugurated in his name for services to hospital infection and to the Association in 1996 on his retirement. He was also a Trustee of the Brendan Moore Trust. The success of the ICNA (later the IPS) led to the formation of a similar organisation, the Hospital Infection Society (later the Healthcare Infection Society), mainly to meet the special needs of medical microbiologists and infection control officers. He was the first Chairman of the Society in 1980 and President in 1988, and was awarded the first medal of the Society for services to control of infection in 1996. The Graham Ayliffe Training Fellowship was established by the HIS in 2013. The Graham Ayliffe International Federation of Infection Control (IFIC) Annual Certificate in Excellence was inaugurated in Malta and I was privileged to be the first recipient of this award.
He was a member of the BSI Committee on Sterilisation, Chairman of the Central Sterilising Club in 1986 and President of the Institute of Sterile Services Management (later the Institute of Decontamination Science) in 1988.
The Hospital Infection Research Laboratory has developed an international reputation, mainly down to Prof, receiving visitors from all over the world for training and discussions and he visited most of these countries to lecture and give advice and received several awards for services to infection control. His visits included most European countries, the USA, Canada, Argentina, China, Japan, Australia, India and most countries in the Middle East. I imagine his passport makes for interesting reading. The WHO also became interested in improving infection control and with the support of an interested international group of infection control nurses and medical microbiologists formed the International Federation of Infection Control (IFIC) in 1987. He was elected Chairman of the IFIC in 1990.
Prof has published widely and was the first editor of the Journal of Hospital Infection which is now one of the world’s leading journals on this subject. My first publication was in the first edition of this journal in 1980. He also served on the editorial boards of a number of other journals. He was the co-author or co-editor of 10 books and wrote chapters for many others. The Control of Hospital Infection, a practical handbook, written with EJL Lowbury, AM Geddes and JD Williams in 1975 is well-known both nationally and internationally; the 5th edition (Ayliffe’s Control of Healthcare-Associated Infection, edited by AM Fraise and Christina Bradley) was published in 2009. In 2004 he was awarded, with his co-author Mary English, the medical history prize for the year, presented by The Society of Authors and the Royal Society of Medicine for the book Hospital Infection: From Miasmas to MRSA.
Something you may not know about Prof is that he is an experienced fencer and was selected for the English team in the annual quadrangular match in 1960 and was the winner of the Leamington (later Birmingham) International Easter Epee Tournament in 1967. He has been President of Birmingham Fencing club for over 20 years and continued to fence in his 80s. He was the author of a book on the history of Birmingham Fencing Club. He has a keen interest in the history of swords and archaeology and is a corresponding member of the Arms and Armour Society. He is also a keen fly fisherman and birdwatcher. I have a strong memory of him also being an expert rounders player for the HIRL team. Being a left-hander totally confused the opposition (the diagnostic microbiology laboratory) as the ball went in the opposite direction to what they were expecting.
I can honestly say that I would not be in the role that I am now without the support and knowledge that I have been given, particularly by Prof. His enthusiasm for infection prevention and control has not waned over all these years and even now he will contact me to get hold of a publication that he would like to read.
South West branch, IPS (SWIPS)
Janet De Witt, SWIPS Coordinator
The South West branch is a large, diverse rural and coastal region encompassing members from across the peninsula that stretches from Cornwall, through Devon, Somerset, Avon to South Gloucestershire & West Wiltshire; the branch currently has 150 members, including Judy Potter who was the last ICNA chair-person and the first IPS president. A number of branch members are or have also been involved in Special Interest Groups: the Education & Professional Development Committee has included Lauren Tew, and before her Maria Bennallick, who many IPS members will know. Penny Criddle is the mental health forum secretary and Gwen Walker is part of the Research & Development Group. In addition, two of the three short-listed applicants for the IPS Team of the Year Award at the 2015 Annual Conference were from the South West; which is great for the branch.
SWIPS is a friendly, welcoming branch who meet three times a year usually at NHS venues along the M5 corridor, in order to reduce the amount of travelling time for as many members to attend branch meeting as possible; although in the past year the branch has met at venues in the more northern and southern aspects of the region to reach members at the regions’ extremities.
Together, the branch officers Michelle Barnham (secretary), Carlton Kneil (treasurer) and Bridget Spooner (education lead) and myself hold regular teleconferences. These are used to keep in touch and work together to plan and provide members with a balanced and interesting programme, often inviting speakers from across the region and beyond, also with support from IPS Board members. Once a year, usually at our December meeting we invite our colleagues from Public Health England to a joint collaborative meeting, which goes down well with both sides. Our meetings include the business section where we review the branch activity, one or two educational sessions and time for IPS corporate members to share their expertise on various products and technologies. We have also introduced an ‘Innovative Ideas Corner’ at two of the meetings, where the idea is that members can share the work and ideas from their areas or teams and we all learn and grow together.
In June of each year we hold a very successful regional conference that is attended by 120 delegates, largely non-IPS members interested in infection prevention and control from across the acute trusts, community and independent sectors, nursing and residential homes, and dentistry. The value of this meeting is that it is free to everyone, with support from some excellent local and national speakers, and the conference promotes the aims and objectives of the IPS across the region and nationally.
One of our objectives in the next year is to become further involved in working on projects with other branches. SWIPS joined the other IPS branches last year in the calendar project which was a resounding success and we are keen to get involved with other projects both nationally and with other branches.
International engagement
Carole Hallam, Neil Wigglesworth, Debbie Xuereb, Gary Thirkell
Congress of the International Federation of Infection Control (IFIC) 2015
The Infection Prevention Society (IPS) has been a member society of the IFIC for a number of years. Each year the IPS provides funding to the IFIC for a scholarship which sponsors a delegate from a resource-limited country to enable them to attend the annual IFIC conference.
Two board members, Dr Neil Wigglesworth and Carole Hallam attended, on behalf of the IPS, the IFIC Conference 2015 in New Delhi, India. The conference was well attended by delegates from all over the world but the largest number were doctors and nurses from India. The topics were varied and interesting, many targeted specifically for delegates from India and other resource-limited countries. Neil was invited to speak on the management of blood-borne virus risks in haemodialysis units in the UK.
The board members had the opportunity to meet the infection prevention and control nurse, Prince Varghese, who had been awarded the scholarship provided by the IPS. Prince was keen to introduce his team and provided a brief overview of the project that he had submitted for the scholarship. He described how the surveillance programme and implementation of a bundle approach to the care of central venous access devices led to a significant reduction in central venous catheter blood stream infections in his hospital. The surveillance model used at his hospital was intriguing and the board members were also invited to visit the hospital the following day.
The AIIMS (All India Institute of Medical Sciences) trauma centre is situated in New Delhi, and although only a few miles away from the hotel where we were staying, it provided an interesting journey on the road between the hotel and the hospital; not for the faint-hearted! Neil and Carole together with Carole Fry received a warm welcome from the IPC nursing team. The trauma centre is a 250-bedded state-run hospital with a team of seven infection prevention and control nurses. They described an intense surveillance programme and monitoring of compliance of a number of bundles on a daily basis with evidence of improvement in all areas. We were impressed with their improvement work and have encouraged Prince and the team to write up their work for the Journal of Infection Prevention.
Although the trip to New Delhi was short, we were given the chance to network with other IPC specialists from different countries, grab a quick insight into a New Delhi hospital and see some of their successes and challenges, and also squeezed in a quick trip to the Taj Mahal! A definite work hard, play hard scenario.
Yorkshire branch supports a Romanian hospital
The IPS recognises that some of its members work outside the UK and/or support healthcare facilities in countries with limited resources. The Yorkshire branch has developed an interesting and unique opportunity to provide support to a nurse in Romania following Carole Hallam sharing her experiences of voluntary work in Zalau, Romania at a branch meeting. In 2009 they funded Ramona Marincas to attend the IPS Annual Conference in Harrogate. This inspired Ramona to organise a national conference in Romania. Ramona has been director of nursing at Zalau Emergency Hospital since 2010. Prior to this, she was the head nurse in the newly refurbished sterile services department at the same hospital. In 2010 she held the first National Sterile Services conference in Romania attracting around 150 delegates with the aim to share the excellent practice developed in their Sterile Service department. Since then the conference has been held yearly and has grown into a 2-day infection prevention and control conference. The Yorkshire branch also responded to a call for help to write an infection control book for Romanian healthcare staff. The 14-chapter book was written and translated in 2013 with 1500 copies provided free to the delegates at the annual conferences in Zalau.
Three IPS members, Gary Thirkell, Carole Hallam and Tina Bradley, visited Zalau in Romania in May 2015. It was Gary and Tina’s first visit to the country and Carole’s ninth. Part of the visit was attendance at the national conference where Tina provided an excellent presentation on decontamination of endoscopes. The conference was a huge success attended by around 400 delegates and local television. The warmth of welcome towards their international guests was resounding and a fantastic experience.
Carole and Gary also had the pleasure of being part of the hand hygiene relay at Zalau Emergency Hospital. The idea came following the focus on WHO hand hygiene campaigns worldwide and involved the use of sanitising gel, use of the correct hand hygiene technique and passing on of the gel to the next person. An amazing 268 people participated in the hand hygiene relay that cascaded down the eight floors of the main hospital staircase; they included the local Director of Public Health, senior medical staff, off-duty nurses and other hospital personnel. Again, it was attended by local television with Carole giving an interview to the station on why clean hands can save lives. There was a tangible buzz felt around the hospital in the days after the event.
Carole and Gary visited an infectious disease and tuberculosis hospital within the region and were again delighted with the response from the local staff. They were welcoming and open to suggestions made by Carole and Gary. Romania, although a member of the European community, is a developing country and what the country lacks in monetary resources the people make up for it in terms of energy, industriousness, ingenuity and ability to make things happen. Romania is an amazing country and all of the visitors from the UK found the visit enlightening and in many ways life-changing. It is hoped that more IPS branches follow the lead of the Yorkshire branch and support infection prevention efforts in other countries outside the UK. Further information on ideas of how to get involved by contacting IEPG@ips.uk.net.
International Engagement Project Group (IEPG)
The IPS aims to broaden its membership and attract international members, particularly from countries without a similar support network to the IPS. As part of the IPS Annual Plan for 2015 an International Engagement Project Group was set up. The project group is led by board members Debbie Xuereb and Carole Hallam. A call in August 2015 for interested IPS members to join this project group saw eight members coming forward in the first week.
The purpose of the IEPG is two-fold: to increase international membership and also to provide support/resources to infection prevention practitioners collaborating/working in resource-limited countries (RLC).
The objectives of the IEPG are to:
Consider the best options to increase international membership
Identify and promote benefits for international members who join the IPS
Consider ways to communicate with current international members via the weekly bulletin, JIP, social media, International Virtual Community of Interest forum
Consider the best methods to support IPS members who are working with or in RLC
Explore available resources that could be made available and would be useful to both members supporting colleagues in RLC and individuals from RLC
Develop a resources section on the IPS website for members who are supporting RLC
Promote the use of the International Virtual Community of Interest as a communication platform for international members and IPS members working with RLC
Consider virtual membership and/or international membership as new categories and what could they expect as members (e.g. online access to the JIP)
Consider Branches to offer a buddy system for international members and/or sponsor a member from a RLC
Encourage attendance of international members to branch and national conferences
At IP2015 in Liverpool, 41 international delegates attended the conference and for the first time a welcome breakfast was held. This gave the IPS board members an opportunity to meet these delegates and provide a friendly face and also allowed the delegates to get to know each other at the beginning of the 3-day event. It was felt to be a great success with lots of exchanges of email addresses, Twitter handles and an increase in our Facebook friends.
The IPS currently has 33 international members. The use of the IPS’ social networking platforms, Facebook and Twitter have provided a way to engage with ‘friends across the globe’. To date, the IPS has followers on these platforms from Canada, Portugal, Malta, New Zealand, Taiwan, Brazil, Saudi Arabia and South Africa among other countries.
The IPS invites members, especially international members and members working abroad, to join the International Virtual Community of Interest discussion forum on the IPS website. We aim for this to be a forum of support and learning similar to the Members’ Forum pages. Members can get in touch by emailing IEPG@ips.uk.net.