Healthcare associated infections (HAIs) caused by pathogens (infectious agents) such as MRSA, Norovirus, and Clostridium Difficile are a substantial problem in developed and developing countries and within the NHS. In addition to the distress caused to patients who are infected, the cost of HAIs to acute services in NHS Scotland was estimated in the 2007 national prevalence survey at £183 million. The World Health Organisation (2014) global surveillance report on antimicrobial resistance shows that "a post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century". Within this ambit, work to prevent and control Healthcare Associated Infections can in no way rely solely on the production of new antibiotics. Rather, new thinking, new research and development, and new knowledge transfer activities are needed, drawing on knowledge from beyond traditional biomedical science. The applicants' prior AHRC funded 'Visualising the Invisible' (vis-invis) project is a good example of the contribution that the arts and humanities can begin to make through relevant multidisciplinary working. The vis-invis project investigated ways of making pathogens 'visible' in the context of the hospital ward in a multi-disciplinary collaboration involving a team from design, art, nursing and clinical microbiology. In the study, the team explored conceptions and perceptions of pathogens in relation to clinical settings, and produced prototype digital visualisations which aimed to make the pathogens 'visible' in the context of the hospital ward. From this project, through a series of workshops with key stakeholders including infection control leads, nurses and domestic staff, one of the key findings was that the adaptation of the visualisations for use in training software for healthcare staff would have significant value. This was not foreseen at the outset of the project but emerged through the development of the prototypes and in response to feedback from the workshops. It was clear from these discussions that using the visualisations as part of training would extend the potential of this earlier work to impact in a timely and valuable way - especially given the current scale of the HAI problem and the threat of increasing resistance of pathogens to antibiotics. Working with a leading UK commercial company in the area of infection control, which specialises in the manufacture of antimicrobial products and infection-control training, two NHS Trusts and a leading microbiology specialist, this follow-on project proposal will create a visual training application, running on a tablet device, which can innovatively exploit existing context-relevant data about the nature, location and prevalence of the pathogens associated with HAIs. The visualisations will make clear the direct relationship between the ward setting and the location, behaviour, causes of spread, and prevention of spread of pathogens. The NHS project partners will be closely involved in the specification, co-design, development and evaluation of the training tool to ensure it satisfies the requirements of current NHS training programmes and to maximise the opportunities for its adoption.

Hospital buildings are critical for supporting effective patient treatment. There is strong evidence that the design of patient environments influences well-being and comfort, recovery rates and can both cause and control transmission of infections, particularly those with an airborne component. Recent surveillance in England estimates 6% patients a year contract an infection while in hospital, which with hospital admissions of 15.9 million, totals almost 1 million people. Around 20% of infections are thought to be directly related to the environment. Hospital buildings have not progressed at the same rate as medical advances and many clinicians are treating patients in sub-optimal conditions. In addition recent scrutiny of healthcare buildings has been dominated by a focus on their energy usage, and there is increasing concern that decisions are made on energy and cost efficiency grounds without proper understanding of the risk to patients. This is counter-productive; efficiency savings in buildings leads to increased risks and hence costs in clinical delivery. With the NHS commitment to reduce recurrent revenue costs in supporting reduction of the national £22bn funding shortfall, it is essential that buildings are considered holistically and that the influence on patient outcomes is properly factored in. A major barrier to delivering good patient environments is having usable tools to assess risks and adapt the environment and operations in a responsive manner. Current tools for designing and operating healthcare buildings and selecting technology are good at modelling energy, but are very limited from a health and infection control perspective. Our previous research developed new methods for modelling hospital environments and their influence on infection risk. In this project we aim to build on these approaches to develop and test novel computational based tools to assess, monitor and control real patient environments in hospitals for infection control, comfort and well-being. We will develop and couple models of physical, environmental, microbial and human parameters together with environmental sensor data to build new tools to dynamically model hospital environments. These will focus on addressing challenges with existing wards which are often constrained by the current building design and in many cases are naturally ventilated via opening windows. We will build a system that links sensors with a real-time fluid dynamics simulation model to enable live monitoring of environmental conditions and allow predictions to be made for rapid adaption. This will inform and control aspects like window opening, heaters and additional cooling to optimise the patient environment for comfort and air quality parameters. Alongside this we will develop a quantitative pathogen exposure model that can enable comparison of the relative risk of air and surface transmission and likely effectiveness of different design and infection control strategies. This tool will support decision making and scenario testing, as well as provide a valuable interactive training tool to demonstrate the interactions between pathogens, people and the physical environment. The project has significant interaction with clinicians who manage complex ward environments and a wide range of patients, and expertise in industry in the design, specification and operation of hospitals. We will develop and test our approaches on real wards to understand their challenges, measure variability in conditions and evaluate how and where our models can best be used to inform practice. By working closely with industry partners we will understand how our pilot tools can be deployed in design and estates management and where they may inform guidance and governance. The project will deliver new risk based ways of assessing healthcare environments that support decisions, training, design and future guidance.

North Lanarkshire's (NL) ambitious aim for regeneration includes reshaping and repopulating its town centres as places of creativity and enterprise to support economic growth. This involves developing a sense of place by protecting or redeveloping vacant priority buildings, and providing 'Super Hubs' to support integrated delivery of public services including lifelong learning, housing, third sector & adult care facilities, police & community safety initiatives, business & employment. The high-level strategic plan for NL highlights shared priorities across sectors, focusing on aspects of the human condition to significantly improve the quality of life & wellbeing of people who want to live, learn, work, invest in and visit the locality. The arts and humanities, however, are absent from this vision. While Covid-19 has emphasised the need for accessible arts provision across NL, particularly for marginalised groups, there is no formal arts strategy. This is concerning as NL has the 4th largest population of Scotland's 32 authorities & the Scottish Index of Multiple Deprivation reports increases in deprivation. This collaboration builds on existing research - the Measuring Humanity research programme 'measuring' health and inequalities through creativity and connectivity - at the University of Edinburgh (UoE) - to: -co-produce a long-term, sustainable and 'measurable' Arts/Creative Communities strategic plan for NL with community members, including marginalised groups, and key stakeholders in health, education, business & employability, social justice & community safety that is integrated and aligned with other sectors' priorities -connect NL's departments, schools and grassroots organisations to ensure sustained access to the arts from early years through to healthy ageing -implement a social prescribing model to support the health & wellbeing of NL communities through the arts and humanities -identify assets (building, cultural, human resources, communities' knowledge & aspirations) that will contribute to a sustainable regeneration plan devised with constituents -implement a dignity and access fund for lower income households or those facing barriers in accessing the arts -develop a co-produced, multi-sectoral template for other local authorities' Arts/Creative Communities departments to apply/adapt/feed into national policies in Scotland & England The UoE will work with key national, regional and local partners (Scottish Communities Safety Network, Youth Theatre Arts Scotland; NL Enterprise & Communities; Community Learning & Development; NL Head of Education; NL Education & Families Social Work Service; NHS Lanarkshire and the Tron Theatre). We will apply the Measuring Humanity framework in various settings using participatory and arts-informed initiatives to connect with marginalised groups/other community members/partners across the lifespan: -early years education: Creative Consultation; Arts Pop Ups; Future Fridays & Primary Pathways in Schools -healthy aging: interactive 'Silent Disco' workshops with adults in care homes/living with dementia -community safety/social justice: musicBox to gather experiences of community safety and empower communities to capture stories using meaningful creative, community-based tools -creative consortiums: implement a mapping exercise of creative assets in NL to connect partners and create sustainable employment, education and improved quality of life opportunities linked to a social prescribing pathway Community members will create an interactive, non-digital map (treasure trail) to show people how to get to arts venues; showcase various art-forms; and identify local, cultural assets. We will also pilot an Immersive Taxi Theatre Experiment for marginalised groups, cut off from transport links. The trips will get them to/from arts activities, while capturing meaningful stories about life experiences and turn them into creative podcasts

The proposal aims to facilitate and encourage multidisciplinary research at Loughborough University (LU) into the healthcare environment (air, water and surfaces) and in community settings (e.g. nursing and care homes, low income countries with high population densities) as potential reservoirs for the transmission of antimicrobial resistant infectious agents. Hospital surfaces are a reservoir for transmission of antimicrobial resistant infectious agents, typically via contamination of the hands of healthcare workers. Staphylococci, C. difficile and Acinetobacter species have been shown to survive many months on high touch near-patient surfaces in healthcare environments. Recent epidemiological evidence suggests that patients admitted to rooms previously occupied by colonised patients have a higher probability of acquiring (i.e. is a risk factor for colonisation or infection) the same pathogen. Other studies have shown aerial dissemination of infectious agents, e.g. C. difficile spores, making it particularly difficult to eradicate infectious agents in hospitals. Despite a recent focus on performance management to improve the efficacy of cleaning and disinfection processes, published studies have demonstrated the presence of culturable indicator organisms (e.g. Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci) post conventional "terminal disinfection" (i.e. upon patient discharge). Bacterial endospores (e.g. Clostridium difficile) are particularly resilient to routine disinfection treatments due to a variety of factors including use of insufficient, low concentration disinfectant, inadequate contact times etc .The Chief Medical Officer's report highlights issues such as poor design that limits cleaning, poor ventilation and poor water-supply management (risk of Legionella species and Pseudomonas aeruginosa). One of the problems of AMR is the length of time taken to identify pathogens (1-3 days) resulting in (i) potential spread of infectious agents; (ii) antibiotics given to patients unnecessarily 'just in case'. Rapid diagnostics would aid early detection and isolation of patients that would otherwise spread contamination. Photocatalytic self-cleaning surfaces could inactivate infectious agents landing on surfaces thereby breaking the link between contaminated surfaces and transmission through contact. Barriers and levers could be identified to improve hand-hygiene compliance whilst monitoring compliance in real-time using teletracking technology. Novel surface, air and water disinfection systems could be developed e.g. using atmospheric plasma technology. Natural ventilation systems could be designed to improve air quality and reduce dispersal of infectious agents in multi-bed wards. The proposal aims to focus on the following three AMR research themes: (i) Accelerating therapeutic and diagnostics development - Alternative approaches to treat resistant bacteria; New technologies for identifying resistant bacteria to underpin diagnostics development; Scale-up and manufacture of biotherapeutics; The effective delivery of existing antimicrobial agents (ii) Understanding the real world interactions - Understanding the role of the environment as a reservoir for AMR microorganisms and the transmission of infections in community and healthcare environments; Ways to manipulate the environment to prevent transmission (iii) Behaviour within and beyond the healthcare setting - Elucidate underpinning motivations for human behaviours relating to the spread of AMR infectious microorganisms in the healthcare environment and the community; Evaluate interventions to control/prevent the spread of resistant bacteria.

REALITIES (Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems) is a collective of lived and felt experience community researchers already embedded within three localities in Scotland (Clackmannanshire; Easter Ross in the Highland; and North Lanarkshire); local council representatives; third sector organisations; artists; environmentalists; Scottish national dance, theatre and singing bodies; an executive non-departmental public body of the Scottish Government; and academics from diverse disciplines including health policy; health economics; mental health nursing; counselling, psychotherapy and applied social sciences; new public management; human geography; environmental sociology; design innovation and participatory design; and the arts. Our life experiences, work in communities and research has made us accept that we're part of a fragmented, traumatised system. Guided by Karen Treisman's thinking on organisational trauma, we're seeing the system as the 'client' or 'vulnerable participant' or 'deprived person' with 'lived experience'. Burnt out and suffering from compassion fatigue, the traumatised system polarises people, places and processes. It's crisis driven; avoidant or detached emotionally to cope with insurmountable global inequities. It's chaotic; dysregulated; disconnected. Our multi-site collaboration will co-design and test the scalable REALITIES model - to piece together the fragmented parts of the system to bring about integrated systemic change through conscious and co-ordinated engagement in hyper-local communities - using a multi-faceted approach that connects people, places, processes and power. We'll think differently and creatively about divergent perceptions of reality (ontology); different types of knowledge and evidence (epistemology) in the system (for example, how dance movement can sit alongside a statistical analysis); and we'll explore the ethics of vulnerability (who decides who is and isn't vulnerable and what does this label mean for the so-called vulnerable?). We're also uniting academics from multiple disciplines, who use diverse methodological approaches to analyse health disparities, and bringing them into deep, critical conversations about data, methods, theories and analysis. The REALITIES model will take us towards methodological convergence (or help us find ways to integrate methodological divergence) that situates participatory, arts-informed, creative-relational, (post)-qualitative approaches alongside positivist, scientific approaches in the evidence-base. In summary, our team will: i) facilitate cross-partner collaborations in three localities - Clackmannanshire; Easter Ross; and North Lanarkshire (NL) - to establish multiple, clearly defined asset hubs in these neighbourhoods. The hubs have focus on creatively connecting employability, health and social care (particularly mental health), transport accessibility, community learning and development, and the environment. ii) map and investigate how Integrated Joint Boards in these localities work with non-statutory community groups to connect cultural, natural, social and creative-relational assets to address health disparities; iii) explore how excluded communities in the system - 'The Outliers' - namely prisoners, ex-offenders, refugees and those experiencing homelessness are integrated within statutory and non-statutory services and partnerships in these localities; iv) co-design and explore the new scalable REALITIES model across emergent asset hubs in the three localities to understand how we can collaboratively create healthier communities across Scotland.