INFECTION CONTROL


backing to address the issue, so the infection prevention team put forward a proposal to roll out a Trust-wide surveillance programme. As a result of the initiative, the team found that smoking was the biggest risk factor for wound infections in breast surgery patients. “We therefore changed our patient


information leaflet to encourage patients to stop smoking before surgery and set up a smoking cessation programme in GP surgeries,” said Prof. Tanner. “We also found that 40% of the women who had breast surgery developed seromas [i.e. fluid collection in the breast area]. “These women had an average of eight


visits to the seroma clinic to have a syringe inserted into the breast to draw out the fluid.We looked into this and realised we had no guidelines on when you should drain a seroma – there are no national guidelines either. As a result, nurses worked together to come up with some guidelines which have now reduced the number of visits that women have.” The team at Leicester also discovered


that for patients who incurred an SSI, discharge was delayed by one night, while they had a vacuum dressing applied, at a cost of £400. However, a quarter of patients who were discharged with vacuum dressings had their dressings removed within 24 hours because the primary care nurses did not know how the vacuum dressings worked. “As a result of this finding, we worked


closely with tissue viability nurses in the community to make it a more seamless service,” said Prof. Tanner. Reflecting on the project findings, she


commented: “We thought, at first, that the hospital would not allow us to publish our results, but to our surprise, it encouraged us to share our insights and to raise the profile of the work – to share the message with other hospitals that, if you undertake good surveillance, these are the realistic infection rates that you will find. This was really encouraging.” This work also provided the impetus


‘There were many inconsistencies and variations in the data collection methods and quality of surveillance being carried out across Trusts. It was impossible to benchmark this data.’


40 THE CLINICAL SERVICES JOURNAL


‘Patients who had no pre-op warming had a superficial SSI rate of 22%. For patients that were pre-op warmed, the superficial SSI rate was 0%.’


behind a number of follow-up projects, Prof. Tanner explained: “We knew we needed to build a case to support the investment in initiatives by demonstrating the cost-effectiveness of interventions. The infection prevention team came up with a plan to ‘blitz’ patients for six months to reduce infection rates and achieve 100% compliance with all the interventions.” Drawing on the expertise of David


Leaper and Martin Kiernan, nurse consultant, infection prevention Southport and Ormskirk Hospital NHS Trust, the team set to work – appointing a dedicated project nurse for a period of six months to help achieve a goal of 100% compliance. Although this was just an initial pilot study, the team were disappointed to find that the infection rates did not significantly decrease. Nevertheless, the work uncovered some interesting findings.


Staff engagement and feedback “What we did learn through this pilot study included some important insights into staff engagement and feedback,” said Prof. Tanner. “Before staff undertook the care bundle, we undertook quarterly


reporting and the document was several pages thick.We reduced this to just one page and performed reporting on a monthly basis. The results were displayed by the scrub room sink, on the doors of the anaesthetic rooms, on the coffee room doors, on the wards and in theatres – everywhere where people could see them.” After the first month of the study, a


notice was displayed stating: ‘this month there were six infections following colorectal surgery’. Despite changing the way the information was reported, to address initial feedback that the SSIs may have been ‘superficial’; ‘didn’t count’, or were ‘probably due to the care at the other hospital involved in the pathway of care’, this approach did not prove successful at delivering change. The strategy was therefore adapted to emphasise compliance. A report was displayed stating: ‘last month three elective patients did not get antibiotics before knife to skin’.


Inspiring change “This prompted the question: ‘who was it?’ This is when things started to change because people started to take individual responsibility,” said Prof. Tanner. “This


Student nurse training issues


Other highlights at Infetion Prevention 2012 included the results of a study entitled: Are they ready? A study of student nurses’ infection prevention skills, by Tingle et al, which was announced as the winner of the ‘Best Oral Paper Presentation’ category, awarded by IPS. The pilot study (undertaken by a team from the HCAI Research Network, University of West London and HCAI Service User Research Forum) evaluated student nurses’ competence in key infection prevention and control skills and knowledge, compared to their self-rated levels of confidence. A multiple choice questionnaire of


third year students indicated a limited grasp of key infection control concepts – yet self-rated confidence was high and did not correlate with scores. In simulated scenarios, some good practical skills were observed. However, poor knowledge and skills were also evident – for example, hand hygiene,


aseptic technique and glove and apron use. All students failed to challenge a consultant’s poor hand hygiene. The pilot study suggested that current


approaches to education may not equip students to practice infection prevention and control safely, while the scarcity of acute clinical experience may also be an issue. A survey of English universities further indicated variation in infection prevention and control teaching and assessment methods, with minimal use of simulated practice. The researchers are currently developing an educational approach aimed at improving competence, through the use of simulation.


Reference Tingle A, Whitfield A, Elliott S, Britt D, Loveday H. Are they ready? A study of student nurses’ infection prevention skills, Oral Paper Presentation, 2 October 2012, IPS 2012, ACC Liverpool.


NOVEMBER 2012


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