Tracey Cooper

Infection Control Link Nurses A different educational approach

to a familiar concept.

Tracey Cooper

Consultant Nurse Infection ControlSouthampton University Hospitals NHS

Trust

Tracey Cooper

Background

• ‘Inherited’ link nurse group• Some staff ‘told’ to be ICLN• Short meetings monthly• Role not defined• Objectives not defined• Difficult to identify positive impact of

role

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Current Evidence?

• Little published objective evidence

• Subjective benefits identified– Improved awareness– Higher profile for infection control

• Measurable objectives described by 1 study

• (Ching & Seto 1990)

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Traditional ICLN Model

• No input to programme by ICLN’s

• ICN sets content• Little networking• Follows traditional

educational model• ..a bit of a dinosaur!

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Educational Theory…….

• Traditional model– Students passive recipients of information– No control over content, method– Based upon knowledge of how children learn

• Adult Learning– Adults learn differently– Need control over content, methods– Must be relevant

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…....Into Practice

• Role description, application process

• Quarterly, half-day meetings

• Facilitation of change-management skills

• Group selection of primary topic for action

• Agreement on plan for the year

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The Plan

• Baseline audit• Analysis & feedback • Practice interventions• Re-audit• Analysis & feedback

• Supported by ICNS

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Research Studies

• 3 inter-related studies

– Link Nurses knowledge and attitudes– Measurable practice improvement– Link nurses experience

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Study 1: Knowledge & Attitudes

• Pre & post questionnaires administered

• Attitudes: very positive throughout

• Knowledge– Significantly improved at end of study– Lowest scores at start improved the most

BUT: Small sample size (n=10)

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Study 2: Practice Improvement

• Handwashing facilities chosen

• Audit tool developed using Delphi method

• Self-administered

• Analysis by ICT & feedback to ICLN

• Practice interventions by ICLN

• Audit intervention re-audit

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Study 2: Measurable Outcomes

• Comparative data: 222 sinks in 14 areas

• 10 of the 11 standards showed:– Significant improvement – Improvements were associated with the study

period (p 0.05)

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Study 3: Experiences

• ICLN need to challenge poor practice– Confidence – Skills– Empowerment– Traditional model did not facilitate this

Focus group used to gather dataPhenomenology: The Lived Experience

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Study 3: Themes

1. Experience of application process

2. Effect of the educational programme

3. Authority, influence & empowerment

4. Support & facilitation of the role

5. Barriers to effectiveness

6. Quality & practice improvement

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Empowered Practice?

• ‘I always looked around to see what was going on but I wouldn’t have challenged them quite the same. Now you say – this is my role, this is what I’m trying to do.’

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Conclusions

• There appears to have been knowledge improvement

• Practice improvement has been demonstrated• This approach has had a positive impact on the

ability of ICLN’s to deliver practice improvement

• Further studies are required, building upon this

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Can This Be Used Elsewhere?

• Repeat in other organisations?

• ‘Pick n Mix’

• Utilise structure for practice improvement

• Involve ICLN’s in planning programme

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And Finally…………….

• Link Nurses can make a difference to practice

• It is possible to demonstrate this objectively

AND

• A link nurse programme can make a positive difference to the Link Nurses

Tracey Cooper

Work Supported By:

Isle of Wight

Healthcare NHS Trust