How did you get into the infection prevention field?
My background was in critical care and I saw a number of patients die from infections whilst their underlying condition was being managed successfully: whilst not a direct correlation it sparked an interest, which I was able to pursue. What this insight gave me was an opportunity to think about germ pathways, their potential effect on people, and where weaknesses in the system may evolve. From that point, I knew I wanted to move into the relatively new discipline of infection prevention, and whilst I was in the Royal Air Force the opportunity arose which I was able to follow.
What do you think are the three biggest challenges for IPC (Infection Prevention & Control) teams in the UK now?
The first has to be workload pressures – all healthcare facilities are running at maximum capacity, and so the ability of clinical staff to adhere to infection-prevention protocols at all times is difficult. Generally, staff will know what they should do but under pressure, corners may be cut and there might be a problem of disengagement between the IPC teams and clinical staff.
The second issue I think would be financial – the cost constraints faced by the health service at the moment means the ability to make changes is significantly more difficult because the resources may not be available. This may impact on the ability to recruit and train specialists in IPC.
Finally, as with most other disciplines, the impact of an increasingly elderly, vulnerable population who may be subject to procedures that are more invasive than those performed on previous generations, multiple admissions, or longer stays within the healthcare system may render them more likely to get an infection if they are not properly managed.
Another challenge, which sits outside of your question, is antimicrobial resistance, which is an issue of continuing concern and increasingly so over the last 15 or so years. From an IPC team’s perspective, again, that is down to patient management. Workload and resources of course will influence the ability to properly manage a patient, so in a way, they are all connected.
How are IPC teams perceived in healthcare settings and hospitals based on your experience?
I have no doubt that they are seen as an important part of the patient safety team, as seen by the emphasis the CQC (Care Quality Commission) and Commissioners place on their existence. When infection prevention teams are valued, they add to the hospital’s throughput by helping to make more beds available; by intelligent use of resources in working with clinical staff, they can influence how quickly patients can be turned around, whilst also reducing the risk of infection for patients. The challenge may come in that whilst organisations value them the hospital’s priorities lie in the allocation of resources, e.g. will it be better having a nurse specialising in infection-prevention or another ward nurse.
What are IPC professionals looking for from industry, for example Vernacare?
Collaboration! Industry needs to be able to listen to what the clinical staff need rather than clinical staff being told what they need. At the same time, commercial organisations working in the field of infection-prevention need to make sure they are developing good solutions to clinical problems. Cost will always be an issue, especially in the NHS, but really for any healthcare provider. Whilst it has to be recognised that it is a commercial world and businesses have to make profit that profit has to be reasonable and justifiable. Also, I do not want to be told by 10 different companies that what they have is the best, what we need is the (preferably independent) evidence to support the claims being made for a product. Clinical and IPC teams generally do not have the resources or time to conduct trials and need industry to support them in undertaking any studies. It has to be recognised that when you make a change it is a complex process and you have to change the perspectives and attitudes of multiple people, so multiple changes can be quite damaging if you make the wrong choice. You want to be confident that you have made a safe choice which is acceptable to the clinical teams otherwise, the IPC team in a healthcare facility will lose credibility.
Who do you think is leading the way for IPC now?
The Infection Prevention Society is a well-founded organisation with good structures in terms of continuity and support for practitioners in conjunction with the Healthcare Infection Society. Between them and the other associated professional groups, there are great resources for education out there. There has been effective collaborative working between those groups. Ultimately, it comes down to individuals in teams as to how infection prevention measures work in practice. The most important thing at local level is getting Hospital/Trust Boards on side to improve patient outcomes; given the demands placed on Boards to meet high standards of infection management this will usually be one of a number of priorities. At a national level then as you might expect, the Department of Health or Government will intervene when they perceive a need to do so as we saw in addressing the challenges of MRSA and Clostridium difficile.
Why does the risk of cross-infection not get enough of a profile?
There are many issues in healthcare that are “headline grabbers”, with a constant stream of news worthy items coming to press. Accordingly, unless there is an outbreak or incident with severe outcomes, it does not make headline news. A patient could go into hospital and get an infection but that is not newsworthy. The Sepsis Campaign is a national campaign struggling to get coverage. Awareness around how to treat sepsis and this campaign in particular, has House of Lords backing and acute patient management is key to preventing death. The Sepsis Campaign is focussed on the need for all clinicians to be aware of the risks of Sepsis, recognise potential cases as early as possible and providing the urgency of acute care required to minimise harm. If you looked in a national newspaper for a week, you may struggle to find a story. Cross infection is a difficult thing to define to the public. Unless it affects you personally or directly, the individual will generally not think about the risks of healthcare associated infection. Cross infection is more insidious. It usually is not as dramatic as acute sepsis but the consequences can still be serious.
What do you do to raise the profile of cross-infection measures?
Good, well thought out communication programmes make all the difference. Whilst not perfect the need for good standards of hand hygiene has become ingrained in the public and professionals minds; this has been the result of continuing publicity over many years. One of the key issues is making people aware of the risks of incorrect disposal of body waste. Wash water has the potential to be a bigger problem than is recognised by clinical staff, because people dispose of it in the wrong place, e.g. in the nearest sink, rather than in the sluice because it is inconvenient to do otherwise, if thought is even given to the disposal process and the risks of contamination of a hand wash basin. There have been a number of outbreaks that have occurred because water had not been properly disposed of.
What has been a career highlight for you?
I think the development of the Infection Prevention Department at Guy’s and St Thomas’ was a career highlight for me. Getting the team established and accepted by clinicians, and then seeing the impact on patients and the reduction of rates of MRSA bacteraemia and C-diff was incredibly satisfying. I have always been an action-based person: I like the challenge of a problem, getting my hands dirty and being a part of the team that resolves it.
Where is the best place you have worked and why?
It has to be Guy’s and St Thomas’ Hospital. It is an organisation that generally had the committed engagement of staff who were so proactive and saw the highest standards of patient care. In particular, the leadership and support given by the Chief Nurse, Dame Eileen Sills and the Board provided an environment where those standards could be achieved.
What is the best part of your role now?
The freedom! I do not have to commute for 4 hours a day. Coming towards the end of my career and working in my current capacity has given me a fresh perspective. I was at Guys and St Thomas’ for 16 years and naturally went through several re-incarnations of my role and my team, but ultimately I realised that I needed a fresh perspective. Since I left 3 years ago, I have a completely new way of working. Now I work more closely with people from commercial organisations, and get different perspectives on issues that are so familiar to me and it is refreshing.
If you could have your career over again would you choose the same profession?
When I first left school, I wanted to be a pilot. Unfortunately, that did not work out, but I still carved out a worthwhile career for myself in the Royal Air Force for 25 years. With hindsight, I think I would definitely still do something in healthcare. Knowing what I now know I would like to think that I might have liked to go to medical school as the opportunities would have been different. I still would have gone into microbiology: it is an area that I have always had a genuine interest in. On reflection, I am pleased with what I have achieved as an IPN.
If you could live anywhere in the world, where would you live?
England. Maybe France, but more likely England.
What is the best place you have visited?
What advice you would give someone looking to enter the nursing profession today?
Recently I heard an interview with Martin Lewis (Money Expert) who recited a quotation that resonated with me: Do the best you can and be the best you can. Pay attention to the minor details and then look to the bigger picture.
You have to understand what your business or industry, whether it is healthcare or anything else, is trying to achieve. Periodically re-focus on what were your drivers for going into healthcare? It should always be about improving patient outcomes. It always was for me.