Hospital associated infections (HAIs) are a serious risk to patients, staff and visitors. In the UK, it is estimated that over 300,000 patients acquire HAIs every year, and at a cost of millions of pounds for hospital trusts.
The application of infection prevention and control (IPC) in hospitals is crucial to the effective management of patient care and reducing the incidence of HAIs. Effective IPC activities include hand hygiene, use of personal protective equipment (PPE) and environmental decontamination.
But how can hospitals ensure staff follow best practice at all times?
1. Continually educate staff
Effective infection control can only be achieved if all staff display the appropriate IPC skills and behaviours at all times.
In order to act responsibly, all staff must:
- Understand the impact of IPC practice
- Be aware of policies and procedures
- Attend mandatory training sessions
Staff should undertake training when they commence employment and on a continual basis. Training should cover the following:
- Hand hygiene
- The use of PPE
- The safe use and disposal of sharps
- Safe handling and disposal of clinical waste
- Spillage of blood and bodily fluids
- Decontamination of equipment and the environment
- Safe management of linen
2. Set clear processes and policies
The Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections and Related Guidance sets out the responsibilities of hospitals in England in relation to the prevention and control of HAIs. The standard states the need for systems to manage and monitor infection control and to provide secure isolation facilities, amongst many others. But each hospital or Trust will have their own policies and processes that staff must follow, and it’s important that these are widely understood by all staff.
3. Create a cleanliness culture
Leadership must champion cleanliness at every level to ensure all staff follow best practice at all times. This requires a ‘board-to-ward’ culture, where everyone understands their role in infection control. Take a proactive approach in setting personal HAI goals and cleanliness objectives, then carry out individual appraisals. Staff should also be encouraged to review, challenge and feedback on behaviours and practice.
4. Hold regular audits
The aim of a clinical audit is to ensure best practice is being implemented. The majority of audits can be undertaken using simple audit tools and can be carried out by anyone at any time.
Examples of infection control audits that may be undertaken on a weekly or monthly basis include:
- Hand hygiene observation audits – check for compliance with the 5 Moments for Hand Hygiene approach and hand decontamination at the point of care
- Observational audit of compliance – with a Bare Below the Elbows policy (no wristwatches, bracelets, long sleeves, white coats or ties)
- MRSA screening within 24 hours of admission to hospital
Examples of larger infection control audits that may be undertaken annually or more frequently include:
- Hospital-wide audit of compliance with the safe handling and disposal of sharps
- Compliance with MRSA screening – for example, admission and long-stay screens, including whether staff are obtaining the correct clinical specimens and screening within the correct timeframe
For audits to be effective, the results must be shared with staff promptly to ensure they are aware of – and can rectify – any issues.
Infection prevention and control is the responsibility of all staff working within the hospital, from doctors and nurses to administrative staff and cleaners. Ultimately, ensuring effective infection control comes down to four key areas:
- People – all staff must be trained in IPC best practice
- Processes – appropriate IPC processes and policies must be set in place and understood by all staff
- Culture – the hospital should maintain a cleanliness culture where everyone is compelled to work together to fight against HAIs
- Performance – regular audits ensure staff are exhibiting the appropriate behaviours at all times and allows for any issues to be rectified.