Developing satellite roles in infection prevention teams to fulfil responsibilities
A number of new satellite role in the infection prevention team support clinical specialist nurses, improve practice and increase patients’ confidence in their care
Deborah Barry,BSc, RGN, is clinical lead nurse for infection prevention and control; Yvonne Carter,BSc, RGN, is service lead nurse for infection prevention and control; both at Royal Free Hampstead Trust and Nursing Times Awards infection control category winners 2009.
Barry D, Carter Y (2010) The benefits of developing satellite roles in an infection prevention team. Nursing Times; 106: 36, early online publication.
Changing demands on infection control services require managers to think about roles and responsibilities within the infection prevention team. This article outlines the development of satellite roles in such a team, which resulted in reduced healthcare associated infections, improved clinical practice and patient satisfaction. Satellite roles focus on specific job functions to complement the role of the clinical nurse specialist (CNS) and are related to one area or subject within the remit of the CNS.
Keywords: Infection control, Satellite roles, Team working
- This article has been double-blind peer reviewed
- Satellite roles enable increasing numbers of infection control staff to be visible in clinical areas to reinforce good clinical practice and ensure sustainable changes.
- Investment in satellite roles improves patient experience and outcomes and contributes to year on year improvements in reductions in healthcare associated infections.
- Practice educators can transfer lessons learnt from one clinical area to the next they work in.
Driving forces for satellite roles
The workload of the infection prevention team (IPT) in acute care has expanded considerably since 2000 in response to government initiatives and infection control targets and, as a result, new roles are needed.
Many of the changes in the structure of IPTs are not planned but have emerged as a result of external factors such as policy initiatives and must be incorporated without adversely affecting the existing service.
The time of infection control nurses (ICNs) at the Royal Free Hampstead Trust is stretched, with the introduction of infection control competencies based on the Department of Health’s (2005) Saving Lives programme of high impact interventions.
O’Boyle et al (2002) looked at staffing requirements for infection control programmes and although this study was based on US requirements, the data is relevant to UK hospitals. The time breakdown of major infection control functions is shown in Fig 1.
In light of mandatory surveillance requirements, detailed in the latest report on healthcare associated infections (HCAIs) in England (Health Protection Agency, 2009), the percentage of ICN time needed to perform surveillance is now much greater than O’Boyle’s estimate of 27%.
The estimate of time spent on surveillance provides evidence to support the development of a role for a specific nurse to carry out mandatory surveillance and additional local surveillance. Huotari et al (2007) identified that valid data is essential for a national surveillance system. This implies that staff need training to use surveillance systems to be able to collect and analyse appropriate data. Ward nurses can do this in areas where there is a relatively static workforce, although if turnover is high staff need continual training.
HCAIs have a high profile in the media, creating greater awareness and increased concern from the public, patients and relatives. This leads to increased demands for ICNs to provide information to alleviate fears surrounding MRSA, C difficile and other HCAIs.
Barrett (2002) identified HCAIs as a major problem needing greater investment, as general hospital staff lack resources and underpinning knowledge to achieve best practice. Poor staff compliance and underpinning theoretical knowledge about infection control procedures in clinical practice drives the need for targeted education by clinical educators.
Implementing satellite roles
The Royal Free Hampstead Trust IPT decided to develop dedicated posts to support the ICNs in their role, focusing on surveillance, practice education and assigning responsibility to individual team members. This includes:
- An audit and surveillance nurse;
- Two infection control patient liaison nurses;
- Four infection control education practitioners.
These satellite roles are part of the IPT and are managed by the lead infection control nurse.
It was important that the roles were clearly defined and boundaries drawn between the ICN role and others, to avoid confusion about responsibilities. Weekly meetings were needed to discuss how the team viewed these roles and how they would fit into the current team.
Audit and surveillance nurse
The audit and surveillance nurse is responsible for mandatory surveillance reporting and also for additional individual surveillance projects. Audit staff must be clinically experienced to recognise signs of infection but also efficient and meticulous in data collection and analysis.
Infection control patient liaison nurses
These nurses are responsible for visiting all new patients colonised or infected with MRSA and patients who are identified with other bacteria and viruses such as C. difficile and norovirus. They liaise with GPs and practice nurses to facilitate patient follow up and decolonisation of patients with MRSA.
Infection control practice educators
These practitioners are responsible for working with staff on a one to one basis at ward level. They work alongside clinical staff to role model and assess infection control clinical skill competencies. This role is preferable to a link nurse system within the trust as turnover of ward staff nurses can be rapid and it can be difficult for link nurses to find time to attend study sessions. Providing practice educators to work alongside staff enables them to identify issues within clinical areas and give feedback to matrons and the IPT so local action plans can be established.
The addition of satellite roles to the IPT results in a significantly different team and six monthly review is necessary in a continuously adapting team, along with regular updates and communication to ensure all team members are aware of planned staffing and role changes.
The strategy to develop the satellite roles within the IPT is supported by O’Boyle et al (2002), who suggested that the challenge for the field of infection control will be for practitioners to participate creatively in role expansion. Team members must not only be aware of their own role and its boundaries but also of fellow team members’ roles. These satellite roles draw on the team’s creativity.
The development of satellite roles enables the ICNs to focus on other aspects of their role including trust wide education, policy planning and also supporting staff in these satellite roles. In addition to other infection control initiatives, the implementation of these roles has occurred at a time when the trust’s MRSA bacteraemia rates have reduced by 58% and continue to fall.
The audit and surveillance nurse provides data that is fed back weekly to the IPT and informs the focus of much of the team’s work.
The patient liaison nurses have a large cross over with the day to day ICN role in terms of working together and collaborating on patient care.
Excellent communication between these staff members is vital , as well as regular review and updates of the boundaries. Patient and staff surveys have provided positive feedback on this role and the post provides excellent role modelling, enabling clinical staff to observe how patients’ fears and concerns can be alleviated when they are given relevant information from a confident practitioner.
The infection control practice educators working in the clinical areas have focused on competencies such as aseptic technique and invasive device care. Working side by side with clinical staff enables them to act as role models and also to train local infection control champions, who sustain the changes in practice in clinical areas when the educators move on. The impact of these roles can be seen by the numbers of staff completing assessment in infection control competencies and by feedback surveys from clinical areas.
Improvement measures are needed to continue to ensure that patients receive the care they need and deserve. The practice educators have already identified a theory practice gap in nurses’ practice in some clinical areas related to infection control issues. Some staff have poor knowledge or do not think they have the time or resources to practise in the way they are required to do so. These issues can be addressed through education and additional training and support as they arise in clinical practice.
The satellite roles within the IPT support the ICNs’ function in any clinical setting. These roles have specific responsibilities and may appear on the surface to be very task orientated but are fully integrated into the ethos of infection prevention and control practice. Changes in team dynamics are needed to support the continuation and development of these roles within the IPT.
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Barrett S (2002) Infection control in Britain. Journal of Hospital Infection; 50: 106-109.
Department of Health (2005) Saving Lives: Reducing Infection, Delivering Clean and Safe Care. London: DH.
Health Protection Agency (2009) Healthcare-Associated Infections in England 2008-2009 report. London: HPA.
Huotari K et al (2007) Validation of surgical site infection surveillance in orthopaedic procedures. AmericanJournal of Infection; 35: 4, 216-221.
O’Boyle C et al (2002) Staffing requirements for infection control programs in US health care facilities: Delphi project. American Journal of Infection Control; 30: 6, 321-333.