Is anyone else having trouble keeping up with all the initiatives, reports and announcements relating to infection prevention and control (IPC) released lately?
Last year alone we had numerous publications, revisions of existing strategies, launches of new initiatives and announcements of funding to combat healthcare-associated infections.
First, £50m for reducing HCAIs was announced last July and then, in November, chief nursing officer for England Chris Beasley launched an initiative to increase the number of modern matrons to 5,000, to enhance the role of nurses in cleaning and to deliver a major deep-clean to all trusts.
Responsibility for these moves was explicitly placed with directors of nursing services. It was made clear that money had to be spent – and proven to have been effective – by March 2008.
How is your trust coping with trying to instigate deep-cleaning of all wards before next month? How do you manage this if your bed occupancy is over 90%, as at Maidstone and Tunbridge Wells? Where do you put patients while the cleaning process is taking place?
And who do all these directors and new matrons obtain their specialist IPC advice from? The answer is that they are looking to their IPC specialists and, if they haven’t got any, they are trying to recruit them.
Last November, I spotted eight advertisements for IPC nurse posts, ranging from band 6 to 8C, in only two publications.
On the other hand, I do not see evidence of specialists seeking work; they are just not there. Many IPC teams have tried growing their own infection control nurse specialists but often these are snapped up by trusts with bigger spending power.
Some initiatives have money attached to them but this has been non-recurrent money, to be spent before March 2008. It buys capital objects – for example posters, sinks, furniture and mattresses – and maybe some training but it does not help recruit, train and retain IPC specialists.
Don’t get me wrong, I welcome the extra funding and initiatives. But what we really need is long-term investment with recurrent funding for the whole health economy.
The bulk of the initiatives, money and monitoring is aimed at acute trusts. These are showing results. But acute trusts cannot cut HCAIs in isolation – there must be the same investment of time, money and effort across the whole health economy.
The need for IPC specialists in acute settings has been recognised and indeed quantified (one per 250 beds, according to the National Audit Office), although many argue that this is not enough. However, no level has been set for community and primary care settings.
Mental health inpatient settings are challenging in terms of lPC but, to my knowledge, there has been no specific advice for them.
More patients are now being cared for at home. High-tech procedures are being used increasingly in the community, such as administration of intravenous antibiotics, vacuum-assisted wound care and care of ventilated patients, to name but a few.
Urinary catheter and wound care is now being performed by carers and social care staff.
Introducing training and audit of practice in community settings is challenging and time-consuming. People are in small teams or establishments, sometimes spread across a large geographical area.
Much as I am feeling swamped by initiatives and reports, I would welcome some for community settings, like one based on the cleanyourhands campaign.
But the government must realise that isolated efforts such as the deep-clean do not solve a crisis in infection control nor help in the long run.
Money for this, if ringfenced, must truly remain ringfenced. More importantly, it must be long-term recurrent money – otherwise, in 12 months’ time or more likely sooner, we’ll just be back to square one again.
Pauline MacDonald, nurse consultant communicable disease, Dudley PCT.
The opinions expressed here are the author’s own.
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