Infection control: an ongoing journey

Abstract

Good practice is infectious. The more we do it, the more it spreads, which is a huge benefit to patients and to ourselves. Nowhere is this more evident than in infection prevention and control (IPC). There was a time when health careassociated infections (HAIs) were our top concern and dominated all of our clinical conversations. However, of late I feel they have drifted down the agenda. This isn’t surprising given the 101 other clinical priorities staff often struggle to deal with on a day-to-day basis. However, IPC suddenly rushed back to the top of my agenda a couple of weeks ago when, after a further review of roles among my colleagues, I became our executive lead for HAIs. I have had the pleasure and pain of this role previously in another organisation and lots of memories of challenges and successes came flooding back to me. Although progress has been made, there is still a lot to do. As nurses it is essential that we know what to do to control infection and implement all care in a way that protects our patients. Delivering any clinical care such as line insertion, or wound or catheter management, requires us all to follow evidencebased guidelines and to make sure that as individuals and teams we practice consistently. Infection prevention and control is, as has been said many times before, ‘everyone’s responsibility’, as is providing clean and safe care to patients in environments that are fit for purpose. Preventing infection is much easier than curing it; its obviously much better for patients, it is easier for staff and it saves time and money. Robust clinical assessment of patients, including screening at pre-admission where possible or on admission is an essential first step to any hospital stay. Methicillin-resistant Staphylococcus aureus (MRSA) has reduced dramatically since government targets were introduced across the UK. Methicillin-sensitive Staphylococcus aureus (MSSA) and Clostridium difficile are proving harder to control and remain a challenge despite some sterling efforts by all concerned. Of course these are not our only troubles—we must not forget others such as Escherichia coli and Klebsiella. However, this winter it has been norovirus that has been our most prevalent and disruptive infection in hospitals across the UK. The norovirus ‘season’ seemed to start earlier this winter, last longer and have bigger spikes of activity. Norovirus and its consequences are unpleasant for anyone and can be devastating for those who are already in hospital and compromised by some other diagnosis. It also has a significant impact on staff as it increases workload while at the same time demanding more effort to ensure stringent infection prevention and control measures are in place and showing no mercy in terms of affecting staff. We have also seen Melanie Hornett Nurse Director NHS Lothian Health Board across a number of hospitals the need to restrict or stop visiting to try and limit the spread of the infection. As we all know, hand hygiene remains our first line of defence against the spread of HAIs and we have all got a lot better at compliance but we could still be better. Some staff still forget or ignore the requirements of hand hygiene and here, in NHS Lothian, like many other organisations, we have introduced an escalation policy to guide staff through the process to be followed when noncompliance is observed.