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Taking control of hygiene standards

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When Carmel Edwards became an infection control nurse over a decade ago - before most people had even heard of MRSA - it was still seen as a low-status job.

When Carmel Edwards became an infection control nurse over a decade ago - before most people had even heard of MRSA - it was still seen as a low-status job. ‘We had two infection control nurses for a 300-bed hospital and we were spread so thinly you could not have an impact,’ she recalls. ‘We were not high profile and not high in the hierarchy. ‘We had been pushing basic hygiene standards but our voice wasn’t really heard that much.’ But as the media and the public began to hear of antibiotic-resistant microbes and health care-associated infections, the government took more notice. ‘Now everything has changed,’ says Ms Edwards, who works at Wirral Hospitals NHS Trust. ‘Our focus used to be on wards all the time, but we present to the hospital board now. ‘We are listened to and improvements are made. We got two extra staff, but we could still have more.’ Ms Edwards began her career as a surgical nurse, but a six-month secondment in infection control showed her the breadth of the role. ‘Ward staff think that all we do all day is do audits, or go around giving them information. But we also get involved in the design of any new building, making sure it is fit for purpose - they haven’t forgotten to put in a handwash basin, for instance. You’d be surprised what happens,’ she points out. ‘Our role is to constantly remind staff about hand hygiene, see that we are giving antibiotics appropriately and ensure patients feel they have the confidence to say if things are not right.’ Now a senior infection control nurse, Ms Edwards needs all her persuasive powers and negotiating skills to ensure staff adopt new policies and protocols. In April, the National Patient Safety Agency (NPSA) called for alcohol handrubs to be available at every bedside as part of its cleanyourhands campaign. ‘It was a massive change; people said we don’t want them at the beds, we like them at the sinks,’ she recalls. ‘We found that we could not afford every member of staff having individual bottles [handrub dispensers]. ‘We also recognised that it would be dangerous to have them at every bedside in some wards, so staff carried them in those wards. We then had to persuade the finance department that this was the right way to go. ‘People said ‘I can’t possibly use gel that many times, my hands will be sore.’ You have to tell them that these products have been well tested.’ When assessing cleaning, she found that standards had slipped since she was a junior nurse, due to changes in the way nurses worked. ‘We used to have a weekend cleaning list of all the things to be cleaned. ‘Then when primary nursing came in, the view was that nursing teams would look after equipment. In reality that doesn’t happen, so we went back to the checklist.’ These days, other pressures impinge on the time needed to clean equipment. ‘Because of the maximum four-hour wait for A&E, patients are getting discharged and they are not getting time to clean the beds,’ she admits. ‘We are trying to address it at a corporate level, because if that bed space is not cleaned, the next patient might be susceptible.’ Ms Edwards is most proud of establishing a decontamination unit for equipment shared between wards. ‘Ward staff didn’t always have the facilities or the time to clean these items before they go back to the library.’ However, it is important not to blame staff when pathogens do gain the upper hand, she says. ‘If there’s an outbreak of infection, staff feel bad enough that something’s gone wrong on their ward. You have to support them and not make them feel worse about the situation. ‘Sometimes it’s something they might not have control over. If you have norovirus rip-roaring down the ward, it’s very difficult to control, no matter how good your standards are. A few years ago we had a particularly dreadful experience with it - wards closed, reopened and had be closed again a couple of days later.’ To ensure that standards are kept high on the wards, a 15-week course was developed to train infection control link nurses. ‘There’s no point having link staff without underpinning knowledge - they have to be role models,’ she says. ‘It’s fantastic when a link nurse says I have changed this or that. Or sometimes after a ward audit hasn’t been good, we get a link nurse and then can visibly see the improvement.’ Training link staff also opens a career pathway for those nurses who may be interested in infection control. ‘We have never had difficulty recruiting,’ says Ms Edwards. ‘Link staff are also important because we need to make sure that staff aren’t being influenced by what they read in the Daily Mail.’ ‘Sometimes patients can be very frightened if they have an infection, because the media has put the fear of God into them. ‘You want to make sure the information they receive is realistic - to allay their fears.’

How do I become an infection control nurse specialist?

THIS COULD BE FOR YOU IF you have a broad nursing background and can demonstrate that infection control has been high on your agenda. You may be a link nurse.

YOU NEED TO BE GOOD AT being organised, have a real interest in the subject and be constantly updating your knowledge. Negotiating skills - being sensitive but persistent. Commitment, drive and energy are vital.

YOU NEED TO HAVE a first-level degree or be working towards one. ENB 329 was the recognised infection control course, but many universities now offer a master’s route.

YOU DON’T NEED microbiology and laboratory skills, or expertise in epidemiology.

OTHER SIMILAR JOBS YOU COULD CONSIDER infection control surveillance nurse, audit-specific aspects of care; community infection control nurse; promotion to nurse consultant in infection control.

WHERE TO FIND MORE INFORMATION The Infection Control Nurses Association at www.icna.co.uk.

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