Emma Burnett

Healthcare-associated infection and the patient experience: a qualitative study using patient interviews

There is an increasing emphasis on the need for further patient involvement within healthcare to ensure that the voice of the patient is heard. This exploratory study utilised in-depth face-to-face interviews with patients to explore narratives from their experiences around healthcare-associated infection (HCAI). Interviews were undertaken with patients who had been diagnosed with a Staphylococcus aureus bloodstream infection and patients who had been in the same hospital but had not been diagnosed with a bloodstream infection. The lack of both verbal and written communications was a major concern for most patients regardless of their infection status. Some patients also stated that they were not comfortable about asking questions, and only a small number of patients and relatives stated that they would challenge staff about their practice. Although some patients retained confidence in the National Health Service (NHS), the majority had very little or no confidence in the NHS in relation to HCAI and would have serious concerns about this if they were to return to hospital. The results suggest that there are a number of issues that must be addressed in order to enhance the quality of care, safety of patients and the patient experience in relation to infection prevention and control. In addition, policy-makers, managers and all healthcare workers must ensure that patients are involved in the design and evaluation of systems change and information.

Outcome competences for practitioners in infection prevention and control Infection Prevention Society and Competency Steering Group

1. Foreword s Chair of the steering group overseeing this work it is my great pleasure on behalf of the four United Kingdom Chief Nursing Offi cers to commend this document to you. The work, which was funded by the Department of Health, led by the Infection Prevention Society, developed in conjunction with government leads for infection prevention and control, and supported by Skills for Health is a milestone in the evolution of infection prevention and control practice in the UK. This is a real example of what can be achieved through effective collaboration, cooperation and consultation between the professions, stakeholders and practitioners in the fi eld. A lthough infection prevention and control has been an established part of the NHS landscape for many years, for a number of those years it has been seen as the domain of a small group of designated specialists and has mainly focused on acute care. More recently, the determination of all four UK governments to address public concerns about healthcare associated infection and to drive improvements in patient safety throughout the health and social care system has placed infection prevention and control at the very top of the health and social care agenda and radically changed the expectations and requirements of practitioners working in this important area of practice. Todays infection prevention and control practitioners can come from a range of professional and occupational backgrounds and require a much broader range of competences than ever before. They know that a robust knowledge of infection prevention and control is not enough, they need to be looking ahead to future threats; developing the evidence base and working across the whole health and care system. They also need high-level leadership and team working skills if they are to effect strategic change at a national organisation level, and the interpersonal skills to use improvement science-based methods to sustain behavioural change in everyone involved in the care of patients and clients. We, in turn have to ensure that our expectations of practitioners in infection prevention and control are clear and consistent and that appropriate education, training and development is in place to ensure that the right people with the right capabilities are available today and in the future as we take infection prevention and control forward. This competency framework provides a solid foundation on which to do that and I look forward to seeing it used to meet expectations.

From theory to practice in learning about healthcare associated infections: Reliable assessment of final year medical students' ability to reflect

Background: Healthcare associated infection affects 9% of patients admitted to hospital. One of the greatest challenges in addressing this problem is transferring theory to practice in relation to hand hygiene. Developing the ability to reflect can promote this transfer. This study illustrates how an instrument to assess the reflective ability of final year medical students was applied to the context of hand hygiene within the infection control cleanliness champion programme (CCP) and demonstrated inter-rater reliability at all three levels of reflection. The results suggest behaviour change in relation to practice. Methods: One hundred and thirty two reflective accounts were used for this study, provided by 44 5th year medical students. Each student had written three reflective accounts for each part of the hand hygiene unit. Results show that the inter-rater agreement was consistently high for all three levels of reflection. However, the least consistent was at reflective level three. Conclusions: These results suggest that the students were able to link theory to practice following the completion of the CCP. It could also indicate that assessors might require more skills and knowledge to enable effective and consistent examination of all areas of reflection.

Hand hygiene knowledge and attitudes: comparisons between student nurses:

It is recognised that early intervention in healthcare workers’ education is important in terms of embedding effective infection prevention and control knowledge into practice. One of the most important aspects of this education is hand hygiene compliance and technique expectations. This small study was undertaken in collaboration with the University of Dundee, School of Nursing and Midwifery and NHS Tayside. It explored the differences in knowledge, attitudes and practice towards hand hygiene among second and third year student nurses with the aim of reviewing and informing the development of future educational material at undergraduate level in order to continually enhance knowledge and skills and bridge the theory–practice gap. This study concluded that third year student nurses did have a slightly better knowledge base than the second years and that although knowledge, attitudes and practice were reported to be of a good standard overall, there were still some important issues that must be addressed.

Constructing identities in the media: newspaper coverage analysis of a major UK Clostridium difficile outbreak

AIM To examine how a major Clostridium difficile outbreak in the UK was represented in the media. BACKGROUND Clostridium difficile is a serious health care-associated infection with significant global prevalence. As major outbreaks have continued to occur worldwide over the last few decades, it has also resulted in increasing media coverage. Newspaper journalists are, however, frequently criticized for sensationalized and inaccurate reporting and alarming the public. Despite such criticisms, nothing is known about how the media frame Clostridium difficile related coverage. DESIGN Qualitative interpretive descriptive study. METHOD An interpretive analysis of newspaper articles from the national press that reported about the outbreak from the first day of coverage over 3 weeks (12 June-3 July 2008). FINDINGS Twenty-eight newspaper articles were included in the study from tabloids, broadsheets, a regional and a Sunday newspaper. Monster and war metaphors were frequently adopted to portray the severity of Clostridium difficile and the impact it can have on patient safety. In addition, the positioning of the affected patients, their families, healthcare professionals and the Government produced representations of victims, villains and heroes. This subsequently evoked notions of vulnerability, blame and conflict. CONCLUSION The media are and will remain critical convectors of public information and, as such, are hugely influential in risk perceptions and responses. Rather than simply dismissing media coverage, further understanding around how such stories in specific contexts are constructed and represented is needed so that it can help inform future communication and management strategies.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences.

Innovative infection prevention and control teaching for nursing students: a personal reflection.

A crucial part of our role as Infection Prevention and Control Practitioners is to develop, facilitate and evaluate the teaching and learning of students and healthcare workers. However, creating an environment for participation, interaction and socialisation whilst effectively stimulating reflective and critical thinking in order to promote good practice can be challenging. This paper is a critical reflection, based on Gibb’s model of reflection to demonstrate the development, facilitation, support and evaluation of learning using an innovative, interactive method.

Effective infection prevention and control: the nurse’s role

Healthcare-associated infections and antimicrobial resistance are significant threats to public health. As resistant organisms continue to emerge and evolve, and antimicrobial agents become less effective, infection prevention and control remains a vital aspect of maintaining public health, particularly among vulnerable patient groups such as older people and young children. Because of the increasing complexity of healthcare treatments and interventions, patients are becoming increasingly susceptible to healthcare-associated infections and resistant organisms. This article outlines some of the challenges that nurses may experience in ensuring effective infection prevention and control, and how these can be addressed.

Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation

Background: Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select the best vascular access device to meet the individual patient’s needs and to preserve veins for future use. Methods: Using the Outcome Logic Model, we conducted an evaluation of the short- and medium-term outcomes with regards to the impact and success of the VHP Framework. Results: This evaluation found that many respondents were aware of the framework and were using it in a range of different ways. Participants saw the framework as being most beneficial to help decisions on device choice and peripheral vein assessment. However, the framework has not fully reached its intended audience. Discussion: Many positive outcomes were reported as a result of using the VHP Framework including improving clinical practice as it relates to the VHP elements. However, further work is required to find the tools to extend the reach of the framework and assist healthcare teams to be able to fully implement it within their clinical settings.

Antimicrobial stewardship and pre-registration student nurses: Evaluation of teaching

Background: Antimicrobial resistance (AMR) is a global health concern. It is therefore imperative that healthcare professionals receive ongoing and relevant education and training to ensure they are competent in contributing to antimicrobial stewardship (AMS). At present, few undergraduate nursing programmes include AMS within their curriculum. Objective: The aim of the evaluation was to determine the relevancy of AMS within the undergraduate nursing programme through the perceptions of student nurses. Methods: A survey questionnaire was used to obtain undergraduate perceptions of AMS and the relevance to them and their clinical practice. Results: Our evaluation of this educational programme demonstrated that providing AMS education to undergraduate student nurses raises awareness of current challenges around AMR and reinforces the vital role nurses play in enhancing AMS and infection prevention and control. Discussion: This evaluation and current literature demonstrate a necessity for AMS to be embedded throughout undergraduate nursing education. Additionally, there is also a requirement to develop clear educational pathways in AMS to ensure continued professional development and contribute towards the advancement of the nursing role in AMS. By doing so, we will continue to build capacity and capability for the future delivery of healthcare.