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Practice comment

The white paper offers infection control nurses new opportunities

  • 1 Comment

Infection control nurses have a key role in delivering improved patient outcomes, and the recent white paper challenges them to take this opportunity, says Gladys Xavier

Although major developments in healthcare effectiveness have improved the overall health and wellbeing of many people, healthcare also causes harm to patients, including healthcare associated infections (HCAIs). These cause 5,000 deaths every year, costing the NHS £1bn in additional bed stays alone (Davis, 2009). While the causes are complex, poor hand hygiene among healthcare professionals plays an important role.

The white paper Equity and Excellence: Liberating the NHS (Department of Health, 2010a) sets out the government’s strategy for the health service. The intention is to create an NHS which is much more responsive to patients, and achieves better outcomes. Effective delivery of the white paper’s objectives will crucially depend on expertise from different disciplines including nurses.  The different strands of public health aim to improve health through protection, service delivery and quality, and reflect some of the challenges posed by the white paper.

The consultation on transparency in outcomes (DH, 2010b) outlines changes to the current performance regime with separate frameworks for outcomes. The intention is that the NHS will deliver this by providing treatment and healthcare and will embrace effectiveness of care, patient experience and safety based on five outcome domains. These range from the first - preventing people from dying prematurely - to the fifth: treating and caring for people in a safe environment and protecting them from avoidable harm.

The challenge for infection control nurses relates to this fifth domain. Keeping patients safe means ensuring that the care environment - whether it is a hospital setting, GP practice, care home or other community setting – is safe and clean, and reducing rates of HCAI.

This is an area where nurses can improve clinical quality through good clinical practice and evaluation. Infection control nurses have extensive skills in change management that are fundamental to quality improvement; they are experienced in interpreting and implementing evidence based guidelines along with service evaluation and audits, and are involved in education and training of multidisciplinary teams.

One of the positive changes in the white paper for nurses is empowerment to be able to use their professional judgement about what is right for patients. Infection control nurses should embrace the existing Quality, Innovation, Productivity and Prevention (QUIPP) initiatives in delivering quality, increasing prevention and promoting innovation that will deliver better patient outcomes.

The key is to get patients and clinical staff to lead the process. This is an opportunity for infection control nurses to promote patients’ role in preventing HCAIs. Research suggests that most patients realise they can play a role in improving healthcare professionals’ hand hygiene and they should be encouraged to ask them  whether they have washed their hands.

The white paper’s central feature is to devolve commissioning responsibilities and budgets as far as possible to GP consortia. The role of the Care Quality Commission will be strengthened and commissioning organisations will need to ensure that all services commissioned incorporate infection prevention requirements in their commissioning intentions. This means organisations that provide care need to have:

  • Effectively operate systems to assess the risks of infection and to prevent, detect and control infection;
  • Maintain appropriate standards of design, cleanliness and hygiene for premises and equipment.

This provides infection control nurses with a great opportunity to influence GP consortia to commission services that will continue to reduce the risk of HCAIs through partnership working.  

Gladys Xavier, MSc,RN, FFPH, is deputy director of public health at NHS Redbridge


  • 1 Comment

Readers' comments (1)

  • Although I agree with what has been stated here, in practical terms the implementation of good infection control has its difficulties:

    1. Patients are reluctant to ask staff if they have washed their hands,especially prior to invasive procedures.

    2. Some patients and their relatives feel the rules of e.g. only 2 visitors to a bed, do not apply to them and staff are sometimes placed in a confrontational situation which they would definitely rather avoid.

    3. There are so many instances when items are 'touched' that the hand hygiene rule becomes quite a dilemma for front line staff. Clear guidance set out in Pittet's: Your Five Moments of Hand Hygiene, certainly helps to ensure that patients are kept as free from transmissible infection as possible.

    I do believe that "infection education" starts at an early stage and perhaps we should be reviewing how we get this message across to the young and wider public so that everyone is aware of the risks and will therefore be more compliant with prevention. How often have we noted people not washing their hands after visiting the toilet inspite of notices bringing this to their attention?

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