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Does Wales have enough nurses for infection control challenge?

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With two reports and a new strategy, infection control has topped the political agenda in Wales this month. Emma Vere-Jones reports

Earlier this month two watchdogs highlighted concerns that infection control nursing teams in Wales are too small (NT News, 13 November, p5). At the same time the Welsh Assembly announced plans to extend the battle against healthcare-associated infections (HCAIs) into the community, following a similar strategy in acute settings.

Plans to tackle HCAIs are obviously crucial but they cannot be successfully put into action without adequate nursing staff. And a large question mark remains as to whether there are enough nursing staff in Wales to ensure this success.

A Wales Audit Office report revealed this month that infection control nurses were responsible for an average of 332 beds each, with the most overstretched responsible for up to 475. That compares with US standards, which suggest there should be one infection control nurse per 100–250 acute beds.

Additionally, Healthcare Inspectorate Wales has called for a review of infection control nurse numbers after it found teams were being forced to carry out non-specialist tasks, because of a lack of adequate administrative support.

Furthermore the new community strategy, announced by the assembly last week, will certainly need further nursing support.

It is a wide-ranging and ambitious plan, which includes such measures as mandatory surveillance of post-discharge surgical site infections, the appointment of infection control leads in all primary care providers and the monitoring of infection prevention measures in all organisations – including care homes and learning disability groups.

The document seemingly acknowledges the need for adequate nurse numbers. ‘Infection control processes must be supported by adequately resourced specialist infection control staff, with a sufficient skill mix to meet the needs of their infection control plan,’ it says.

But at this stage there is not enough detail in the document to know whether in fact such support will be made available.

‘For the strategy to be successful you do, of course, need the staff to support it,’ said Dafydd Williams, infection control nurse and Welsh representative of the Infection Prevention Society.

However, he pointed out that it would not just be the role of infection control nurses to ensure the strategy’s success. ‘The people doing a lot of this work will be district nurses
and practice nurses, so it’s important that we get them engaged,’ he added.

Staff engagement, both clinical and managerial, has been one of the successes of the assembly’s 2004 hospital infection control strategy that included mandatory surveillance and the setting of local priorities. Indeed, despite the low number of infection control nurses in Wales, the strategy has resulted in a statistically significant reduction in HCAIs over the last two years.

Now there is hope that the new community strategy will have a similar effect. And nurse leaders believe a ministerial working group, set up in October to look at HCAIs, will also benefit infection control nurses.

RCN Wales director Tina Donnelly is generally positive about the situation. ‘Obviously if the US is recommending one nurse for every 100–250 beds then that realistically means we are underfunded and the audit office clearly denotes that. But there are measures being taken to address this,’ she said.

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