The need to reduce the harm caused by infection is indisputable on every level. At one level are professionals. Every nurse, midwife and specialist community public health nurse operates under a code of professional conduct. The standards that comprise these make it clear that we have a professional duty to protect patients from the harm caused by infection and we have a clear obligation to ensure our practice does not contribute to this.
Our overriding duty is to protect and care. If we undertake an intervention that causes an avoidable infection, we breach our code of conduct. The NMC Code of Professional Conduct requires that, as a registered nurse, midwife or specialist community public health nurse, you must: ‘Protect and support the health of individual patients and clients; and you have a duty of care to your patients and clients, who are entitled to receive safe and competent care.’
There is a plethora of guidance, tools and advice available to ensure practitioners know what to do. Our code of conduct makes it clear we have a duty to seek this out: ‘You have a responsibility to deliver care based on current evidence and best practice; you must keep your knowledge and skills up to date; and to practice competently you must possess the knowledge, skills and abilities required for lawful, safe and effective practice.’
On our many visits to trusts, we have learnt that, because much of what is advocated to reduce infection is considered ‘basic care’, staff are often embarrassed to ask whether they are practising correctly or to ask others to check their practice. Compliance with codes of guidance therefore remains varied. Ward sisters, matrons and directors of nursing need to recognise that this anxiety exists and take steps to make it ‘OK to ask’.
Pre-registration training over recent years has not placed sufficient focus on assessing competence to undertake procedures such as aseptic technique, wound care and catheter care. As individual practitioners, we have a duty to reflect on practice, review guidelines for procedures and take action if required. As leaders, we must ensure that team members are competent to perform clinical procedures. Skills workshops and assessment processes have been set up in a number of trusts where infection rates are falling.
There is ongoing media scrutiny around infection and it remains a major concern to patients and the public. The environment, cleanliness and infection are inextricably linked in public and media discussions. While our individual clinical practice will help to reduce infection, we must also look at other aspects of our practice if we are to increase confidence that hospitals are clean and safe. Our code dictates that we: ‘Act in such a way that justifies the trust and confidence the public has in us; take personal responsible for ensuring we promote and protect the interests and dignity of patients; and work with other members of the team to promote healthcare environments that are conducive to safe practice.’
This means we need to check our environment and everyone has to play their part to ensure that wards and departments are clean and tidy. Clear accountability for cleaning equipment, particularly commodes and beds, needs to be agreed and leaders need to be sure this happens. Practitioners have a duty to raise concerns about the infection risks that they themselves cannot remedy and be prepared to offer ideas on rectifying these.
Hospitals are very busy and many patients with complex care needs pass through our doors. This supplement outlines what is needed in trusts to achieve sustainable reductions in HCAIs. It is based on the four main themes of policy, practice, people and performance. The articles also go beyond the acute setting and articulate the role and contribution that can be made from other healthcare providers and commissioners.
Janice Stevens, MA, RGN
MRSA/Cleaner Hospitals Team
Department of Health