Preventing healthcare-associated infections is a key priority for the Department of Health and, since the introduction of the Health Act code of practice (DH, 2006), infection prevention has become everybody’s business.
The use of medical devices can cause HCAIs as they breach the body’s normal defence mechanisms. Indwelling urinary catheters are some of the most commonly used devices and it is imperative that they are managed appropriately.
The publication of the national evidence-based guidelines for healthcare-associated infections (Prattet al, 2007; Pellowe et al, 2003) established best practice that indwelling urethral catheters should only be used after considering alternatives. Yet the latest prevalence survey (Hospital Infection Society, 2007) found that almost one-third of inpatients had a urinary catheter in situ or had one within the last seven days and nearly 20% of all patients had a urinary tract infection. Clearly, the use and management of urinary catheters needs attention.
Guidance alone will not reduce HCAI and a cycle of activities is required. Guidelines need to be disseminated to inform staff of best practice and encourage implementation. The effects of implementation should be audited and the results used to inform policy. This is an ongoing process and the high-impact interventions described inSaving Lives(DH, 2007) enable practitioners to auditkey elements of practice. Practitioners need to be engaged in the process and educational activities are critical in enabling them to understand the significance of HCAIs and their role in prevention.
The NHS core learning unit (CLU) has developed infection prevention modules for all healthcare staff.The initial programme, Infection Prevention and You, was developed as a review of the Epic guidelines for clinical staff and is intended to be used as an induction programme for new staff and/or an annual update for existing staff. A programmeis also available for non-clinical staff such as cleaners.
The advantage of e-learningis that it can be undertaken at any time, via a computer with an internet connection. The modules are bookmarked so that learners can access them when they have time. The trust can also monitor completion rates.
An evaluation of the programme highlighted that additional clinical modules were required and, following the issue of two vascular device modules last year, two urinary catheter modules have been released. The first covers preventing HCAIs associated with the use of short-term urinary catheters and the second concentrates on long-term catheters. The short-term urinary catheter module focuses on acute care and the long-term catheter module on the community.
These modules have been developed by staff at the Richard Wells Research Centre with intuition publishing and specialist practitioners in continence and infection control. There has been rigorous quality assurance at each stage of the development process. In addition, the CLU’s expert reference group of stakeholders commented on each stage of development. The module style is similar to that in the original programmes and access is via the same website.
Each module is divided into four topics (Box 1): HCAI; selecting a catheter; inserting and managing a catheter; and documentation, care bundles and compliance. Each module links the evidence base for best practice with tools for auditing practice.
Box 1. Topics included in the module
The learning experience is highly interactive. There are learning checkpoints throughout and, at the end of the module, there is a summary of the main points, a formal assessment and a certificate for those who successfully complete it.
These CLU modules are free of charge for all NHS practitioners in England and can be accessed by logging on to infectioncontrol.nhs.uk
Carol Pellowe, EdD, MA Ed, BA, RN, RNT,is deputy director, Richard Wells Research Centre, Joanna Briggs Institute Collaborating Centre, Faculty of Health & Human Sciences, Thames Valley University, Brentford.
Department of Health (2007)Saving Lives: Reducing Infection, Delivering Clean and Safe Care.London: DH.
Department of Health (2006)The Health Act 2006. Code of Practice for the Prevention and Control of Health Care Associated Infections.London: DH.
Hospital Infection Society (2007)Third Prevalence Survey of Healthcare-associated Infection in Acute Hospitals in England 2006: a Report for the Department of Health. London: DH.
Pellowe, C.M. et al (2003)Evidence-based guidelines for preventing healthcare-associated Infections in primary and community care in England.Journal of Hospital Infection;55 (supplement 2): S1–S127.
Pratt, R.J. et al (2007)Epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.Journal of Hospital Infection;65 (supplement 1): S1–S69