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Making a difference in infection control.

This issue of Kai Tiaki Nursing New Zealand provides an overview of the different facets of infection prevention across health care environments. It is also a good opportunity to showcase our achievements and reinforce the fact infection prevention is fundamental to everything health professionals do. This premise is what those of us who work in infection prevention have argued for many years, so are we finally getting it right and making a difference?

New Zealand's pioneer infection control nurses, including Berry Bird, Alison Carter and Marie Fergus, worked hard to establish a firm foundation for our specialty. They struggled without the support systems we take for granted: education, peer networks, journal articles, internet access and forums.

From very small beginnings, the first infection control course was held in Palmerston North in 1980 with a mixture of doctors, principal nurses and a handful of nurses. We now have established undergraduate education--the Waiariki Institute of Technology certificate/ diploma course, which is recognised on the New Zealand Qualifications Authority framework, and, more recently, the Griffiths University master's programme.

The infection control special interest group had only a handful of members when it began in the 1980s. Today, the National Division of Infection Control Nurses (NDICN) has more than 500 members. Over the years, committee members have consistently fought for the voice of infection prevention and control (IPC), and represented all members.

The first national infection seminar was held in Auckland in 1982 over two days, with mainly local speakers. In 2012, more than 200 delegates attended our annual conference over three days, with recognised international and national speakers, and solid support from our trade sponsors (see report p32).

Since the emergence of new infectious diseases such as methicillin resistant staphylococus aureus (MRSA), extended-spectrum beta-lactamase (ESBL), severe acute respiratory syndrome (SARS) and more recently pandemic influenza, our IPC expertise has been widely acknowledged. In 2004, New Zealand was commended internationally for its "stamp it out" approach.

This recognition of our leaders, and the strong influence and involvement IPC has in all health care activities, has led to NDICN members being sought for consultation, committees, forums and initiatives, both nationally and internationally. As a relatively small workforce, our resources are limited, so the IPC workload has increased.

Networks are strong, with the NDICN having established its own website, forum, education links and resources. However, as we move to college status, it is essential we develop a competency framework to guide professional development and ensure we meet the needs of our wide and varied workplaces. We are looking to the example set by our international colleagues in Australia, Canada, the United States and the United Kingdom in working to build professional capacity, accountability and credibility.

International approach to hand hygiene

Engaging health care workers (HCWs) in IPC strategies has long been an issue and is well documented in the literature. Nationally coordinated IPC initiatives were lacking until 2008 when the Ministry of Health quality improvement committee led a number of national programmes to be implemented in district health boards (DHBs). These included the World Health Organisation's Five Moments for Hand Hygiene (see p32).

This is an internationally recognised approach to hand hygiene and should ensure HCWs across the globe practise to the same standard. After an initial flurry of activity, the project fell into a lull, with less than half of the then 21 DHBs participating. In 2011, it was reinvigorated by the Health Quality & Safety Commission (HQSC) and is now being driven by Hand Hygiene New Zealand (HHNZ), with all 20 DHBs contributing to the audit programme. HHNZ reports audit results directly to chief executive officers, so more attention is being focused on improving compliance in individual DHBs.

Hand hygiene has been well documented as the "most effective infection prevention strategy" and should be fundamental to every HCW's practice. However, national audit results show that improving compliance with this simple but effective strategy is still a challenge. There have been improvements since the initial audit but why are we not making a bigger difference? What are we missing?

Everybody's business

Hand hygiene, like other aspects of IPC practice, is "everybody's business". It is essential the new generation of HCWs have the "five moments" embedded into practice in colleges of medicine and nursing, followed by reinforcement in the clinical arena. If a consultant on a ward round consistently cleans his/her hands between every patient consultation, then junior staff will do the same. Similarly, if an experienced nurse mentoring a new staff member practises IPC safely, then they will reinforce its relevance. We must not underestimate the importance of role modelling across all disciplines. We can be good or bad role models--which are you?

Is your practice good enough? Would you be happy to receive care from someone who had just come from the person in the next bed, without cleaning their hands, and then touching your wound or intravenous line? We have all witnessed poor practice without speaking up. Vulnerable patients feel unable to challenge poor practice. HCWs are not encouraged to speak up when they witness poor practice. How can we empower everyone to challenge poor compliance?

Standardisation of practice, behaviour change, measurement and accountability are all key components of the HQSC projects. Once measured and recorded, the results can be compared and evaluated. We can then use a collaborative approach to address any systems or practice barriers to compliance.

IPC is moving forward and is recognised as an essential component of patient safety. We are beginning to get it right and make a difference.

Barbara McPherson, RN, BN, GradCert Clinical Teaching, is the National Division of Infection Control Nurses' communications officer. She is an infection control adviser for Hawke's Bay District Health Board's quality and risk service.
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Author:McPherson, Barbara
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Editorial
Geographic Code:8NEWZ
Date:Nov 1, 2012
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