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Tricia Hart: 'Infection prevention needs the attention of staff at all levels'


Protecting patients from an invisible microbial enemy is complex and often far from common sense, says Tricia Hart

When I was asked this year to become patron of the Infection Prevention Society of the UK and Ireland, I accepted almost without thinking. Infection prevention and control is synonymous with healthcare so becoming the figurehead of a charitable organisation with a vision that no person is harmed as a result of a preventable infection seemed logical. The IPS vision is realistic and achievable, but not without its challenges.

Infection prevention and control relies on evidence-based and evidence-informed practice, plugging the knowledge-practice gap, political commitment and an organisational culture that supports it as a cornerstone of patient safety.

The issue is no longer the responsibility of a few technical specialists. Its success, as has been repeatedly demonstrated, depends on executive support and leadership. As the chief executive of a large, complex foundation trust providing acute and community services, I have seen major reductions in some of the infections that blight the life of patients and wreak havoc on families affected. But more can be done.

“We must remain vigilant at every level and engage all staff, not only clinical teams but also the boardroom”

The NHS constitution reminds us that the NHS is all about protecting health and wellbeing and that it touches people’s lives at times when care and compassion matter most. Protecting patients from an invisible microbial enemy is complex and often far from common sense. For this and other reasons, infection prevention and control still poses phenomenal challenges.

The challenges could be paradoxical in that they are constant and found easily in textbooks from the last few decades. They are also evolving, particularly when we consider future threats posed, for example, by antibiotic resistance. Infection prevention is a major part of the action needed to prevent a future catastrophe. This is why we must remain vigilant at every level and engage all staff, not only clinical teams but also the boardroom. We are faced with five broad challenges:

  • We need to continue to build a competent workforce, which involves investing in training at undergraduate and postgraduate levels as well as training for our non-registered workforce;
  • We need active, meaningful monitoring, including surveillance, that drives action;
  • We need a strong collaborative approach that goes beyond hospitals and reaches out to the public, with patients at the centre. In the words of Nigel Crisp, patients can be empowered, certainly not disempowered. If the level of trust is right between patients and staff, patients can play a role in facilitating true empowerment of professionals;
  • We need meaningful regulation and an informed inspectorate that scrutinises what matters most in terms of keeping patients safe. I will be supporting IPS in its efforts to seize a key opportunity to make sure we get regulation for infection prevention right in England and beyond;
  • We must capitalise on quality improvement methods that improve safety, such as bundles and checklists. Where they take account of local context, they have a tremendous opportunity to make a difference.

Much progress has been made but we must continue to strive to get the balance right between risk, human rights and human wrongs. This calls for a continued policy focus. A high proportion of healthcare-associated infections are preventable. Collectively we have prevented hundreds of thousands of infections from occurring and ruining the lives of patients and their families in the past 10 years. The patients and families of the future deserve nothing less.

Professor Tricia Hart is patron of the Infection Prevention Society of the UK and Ireland and chief executive officer, South Tees Foundation Trust



Readers' comments (3)

  • Just one simple question ?

    Do you "prof" Hart have sufficient nurses or do you have acute wards where one registered nurse is expected to care for 8 or more patients.

    Tell the truth !

    We are not interested in managerial "porky pies" !

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  • Trisha, I'm sorry, but what we really need on our wards and departments are cleaners that clean, enough sinks in which to wash our hands, enough side-rooms in which to isolate our infective patients and enough time to care.

    I work on a 25 bedded ward, none of our bays have doors on them and there are only 5 toilets for 25 patients so, when there is an outbreak of something nasty and the infection control mafia start kicking off, maybe they need to look at the environment before the start finger-pointing at nurses' poor hand hygiene etc.

    We don't need 'bundles and checklists' we need the right equipment to do the job!

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  • I've worked for Tricia for several years in different trusts elsewhere in the country. I don't now. She is a nurse. Even as CEO she does shifts on wards to keep in touch with reality. She's a honorary prof, not an academic boffin. They have a 21% establishment headroom that's regularly reviewed. Staffing levels on acute wards is regularly reviewed and acted on (lower than 1 in 8). Ward budgets have changed to reflect this. They have a critical care outreach team for deteriorating and complex patients. They proactively fill vacancies, especially band 5, they don't wait. Ward managers are supernumary and supervisory. There's a volunteer programme on care of the elderly wards to help patients with eating and drinking.
    I also understand the comments about equipment, but the article is about a national strategy not an individual trust plan. But you're right, it's a key thing that's missing in the above piece. Process and people are part of it, but facilities are even more so.

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