VOL: 96, ISSUE: 46, PAGE NO: 40
Joan Lewis, RN, RSCN, RM, HV, MPH, is community infection control nurse adviser, Worcestershire Health AuthorityThe need for, and provision of, infection control training is established in the NHS and staff working in both acute and community care settings are well supported in this area. But for nurses working in the independent nursing homes sector, suitable courses are not always available and employers may be unwilling to commit time and money to staff training.
The need for, and provision of, infection control training is established in the NHS and staff working in both acute and community care settings are well supported in this area. But for nurses working in the independent nursing homes sector, suitable courses are not always available and employers may be unwilling to commit time and money to staff training.
Much of the routine care on offer in nursing homes is provided by unqualified staff who acquire most of their skills while doing their jobs. Nurses therefore have a vital role to play in education and setting standards.
From 1995, infection control practices in 100 nursing homes across Worcestershire were audited. The results indicated a need to raise infection control standards and educate staff on managing infection. The specific issues identified were:
- Homes refusing to take patients from hospital with methicillin-resistant Staphylococcus aureus (MRSA) or insisting on three sets of negative screening swabs before accepting residents when they return from hospital. This often resulted in a delay in patient discharge of several weeks;
- Outdated isolation practices. Residents with infection were being 'isolated' when this was unnecessary or inappropriate and likely to result in cross-infection;
- A lack of recognition and delays in reporting outbreaks;
- The national rise in the incidence of scabies infection and outbreaks were creating serious difficulties in controlling and managing the problem.
Infection control liaison nurses
The concept of training nursing home infection control liaison nurses (ICLNs) was introduced - at the time an innovative approach in the community - as it was decided that this would be the most effective and efficient way to improve infection control practices. The first course was run in October 1995. Since then, courses have continued to be run two to three times a year to meet demand.
Training is provided for a key member of the home's nursing staff. No charge is made, but staff must commit themselves to attend the entire three-day course (Box 1).
The aim of the training programme is to equip liaison nurses with the necessary knowledge and skills to enable them to take responsibility for infection control within their homes (Box 2).
Evaluation of the programme
The intended outcome was to achieve a sustainable and measurable improvement in infection control standards and a corresponding reduction in the infection risk to residents and staff.
Twelve courses have been completed to date and 180 nurses have completed the training. Participant feedback has been positive, and without exception they have reported that the course content has been of real benefit both to the home and to them personally. The only change to the original programme has been the introduction of a session on infection control relating to areas such as intravenous therapy, the management of percutaneous endoscopic gastrostomy devices and the care of a resident with a tracheostomy.
Evaluation of the results has shown:
- There has been a marked improvement in infection control in homes with an ICLN;
- The training has helped to develop the ICLNs professionally and has empowered them to make changes that improve the quality of care and safety of residents and patients;
- Residents with MRSA or any other infection are now accepted by the homes, relieving the pressure on hospital beds;
- The care of infected patients is more appropriate;
- The prompt reporting and improved management of outbreaks of infection is evident;
- The work generated as a result of the scabies epidemic has been reduced substantially;
- There has been a reduction in the number of calls to the public health department for basic advice and assistance as nursing homes now have local access to this knowledge;
- Homes are identifying potential risks, such as the use of spa baths and invasive procedures previously not performed in nursing homes, and seeking advice on them;
- The uptake of flu vaccinations has increased.
Development into social services
Following the success of the work undertaken with nursing homes, liaison training for infection control has been introduced for social services staff involved in residential and day care for elderly people and those with learning disabilities or mental health problems.