NHS nurses’ fight against infection


n the NHS and across all four UK countries, nurses at all levels working with the multidisciplinary team contribute positively to the control and prevention of infection. In addition to the recent publication of the epic3 Guidelines, there are numerous other guidelines and policies in place emphasising the importance of the nurse’s role in the context of prevention and control of infection. In Scotland in particular, the NHS Scotland Health Department Letter, NHS HDL (2005) 7, emphasises the need to restore public confidence by achieving tangible improvements in infection control and standards of cleaning. In order to assist this process, senior charge nurses (SCNs) receive infection control safe patient environment audits based on the Infection Prevention Society’s template, which are carried out in every ward and department at least once a year. Across the UK, nurses along with colleagues in estates and facilities are also required to populate and complete action/improvement plans to address any issues identified. The results of the infection control (IC) audits are included in the performance management review for all wards/departments across the NHS. In addition, SCNs in Scotland are required to participate in and sign off the results of audits conducted to comply with the 2010 Monitoring Framework for NHS Scotland National Cleaning Services Specification and Estates HAI Issues. Standard infection control precautions (SICPs) must be applied to prevent cross transmission from both recognised and unrecognised sources of infection (and transmission-based precautions (TBPs) should be applied in cases such as when a patient has an infectious disease, e.g. influenza, MRSA, etc). SICPs are basic infection prevention and control measures of which there are ten elements as follows: ■■ Patient placement ■■ Hand hygiene ■■ Respiratory hygiene and cough etiquette ■■ Management of care equipment ■■ Control of the environment ■■ Safe management of linen ■■ Management of blood and body fluids ■■ Safe disposal of waste ■■ Occupational exposure management (e.g. sharps) ■■ Personal protective equipment.

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Education The Cleanliness Champions Programme is part of the Scottish Government’s action plan to combat healthcare associated infections (HAIs) within NHS Scotland and all SCNs are required to complete it. All staff are also required to complete HAI induction as per the NHS Education for Scotland (NES) HAI Mandatory Induction Training Framework. The HAI Standards issued by Quality Improvement Scotland

British Journal of Nursing, 2014, Vol 23, No 2

in 2008 set as a standard that all staff should attend routine IC update training, however, the standards did not specify a frequency. In NHS Greater Glasgow and Clyde, this frequency is set at every 3 years.

Hand hygiene HDL 2005 (07) also reminded SCNs that effective implementation of hand hygiene relied on the integration of best practice into routine activities and reminded sisters and charge nurses of the importance of self-audit activity of compliance with good hand hygiene within their clinical areas.This was supported with the issue of Chief Executive Letter (CEL) 5 (2009), which set out expectations with regards to monitoring of compliance with hand-hygiene policies.

HEAT and mandatory surveillance of HAIs Health Improvement, Efficiency, Access to Services and Treatment (HEAT) is an internal NHS performance management system includes targets to support national outcomes. SCNs with the local infection prevention and control teams in the NHS complete a trigger tool if there are two or more linked HAI cases of Clostridium difficile infection (CDI) in any clinical area in a 2-week period. Nursing staff also ensure that TBPs are in place to prevent onward transmission. In the case of Staphylococcus aureus bacteraemias, nursing staff are responsible for ensuring that peripheral vascular catheters and central venous catheter care bundles are in place for patients with invasive devices and that best practice with regards to their management is compliant with local policies and procedures. This is an important part of the board strategy to reduce harm caused to patients by invasive devices and contributes to the overall HEAT target.

Surgical site infection surveillance The NHS in Scotland are required to carry out mandatory surveillance on the following procedures as per HDL (2006) 38: ■■ Caesarean section ■■ Hip arthroplasty ■■ Knee arthroplasty ■■ Reduction of long bone fracture ■■ Repair of neck of femur. Nurses across the NHS have a key role in delivering the control and prevention of infection in collaboration with team members in medical, facilities, allied health and infection control. The majority of NHS organisations across the UK are achieving CDI targets. This is a credit to nurses who continue to learn from each other about how to put patients and their families first in the control and prevention of infection.  BJN

Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division

The views expressed in this column are those of the author


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