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A day in the life of … an infection control practitioner

Angela Billings
RN RM Dip Nursing Studies Dip Midwifery Studies BSc(Hons)
Infection Prevention and Control Practitioner
NHS Sheffield

The prevention, investigation and control of infection is being addressed at national, regional and local levels. Angela Billings provides an insight into the challenges she faces as a community infection prevention and control practitioner and explains how her work is pivotal to the health community's agenda.

The prevention and control of healthcare-associated infections (HCAI) is a high priority for all NHS organisations; with equal importance for healthcare providers in the independent and voluntary sectors.1

Throughout the UK, primary care trust (PCT) infection prevention and control (IPC) teams vary greatly in size, skill mix and specific areas of responsibility. The structure of the organisation in which the IPC practitioner (IPCP) works greatly influences their main roles and responsibilities. In light of the current PCT restructuring, a community IPCP may be employed within a provider services or commissioning PCT organisation; within a public health directorate; within an external organisation, such as a health protection unit; or even in an independent organisation.

In addition, within this structure there may be colleagues who sit under the umbrella of the IPC team with very different remits, such as waste management, decontamination, environmental cleaning or surveillance.

Jack of all trades
The phrase "Jack of all trades, master of none" is one that all nurses working in community settings have heard. However, I would describe the world of IPC as "Jack of all trades, master of most"! Unlike many nurse specialist roles in the community, IPCPs are somewhat unique. For the most part, they are office based and, as such, do not directly deliver "hands-on" patient care.

[[Box 1 infect]]

It is an autonomous role, working at both strategic and operational levels. The focus of other community nurse specialist roles is dealing with patients with a specific disease, such as chronic obstructive pulmonary disease (COPD) or an aspect of care such as wound management or tissue viability. However, the IPCP is required to have a sound knowledge base and provide expertise on an abundance of subjects in day-to-day situations. These include:

  • Education and training on all aspects of IPC and the ability to apply the principles to a broad range of healthcare settings in community.
  • The isolation, safe management or transfer of a patient with a notifiable disease, such as MRSA or Clostridium difficile and the complexities of each individual case. For example, advising healthcare professionals such as GPs and community nurses on appropriate management, providing a management plan; communicating with other healthcare professionals including an environmental health officer or the consultant in communicable disease control (CCDC) or dealing with a patient's relative in elevating any anxieties surrounding the diagnosis or management of care.
  • Provide recommendations to all stakeholders involved in a new PCT build or refurbishment project on infection control in the build environment, including areas such as flooring, wall coverings, fixtures and fittings, hand washing facilities and ventilation.
  • Advise on the decontamination of medical devices, reusable instruments and single use instruments used across all service providers.
  • Environmental cleaning recommendations, including colour coding of equipment and cleaning schedules to reflect the activities undertaken in all premises.

The community setting
While the principles of IPC are universal, in many ways the work of the community IPCP differs from that of IPC colleagues working in an acute setting. Different challenges are faced due to the geographical diversity and location of healthcare settings.

The responsibility of patients, staff and visitors in a broad variety of healthcare facilities depends on the geographical demographics of the locality; these can range from care homes to community hospitals, from prisons to health centres, from GP practices to intermediate care facilities, and from podiatry to dental services.

IPC work is frequently unpredictable and requires flexibility. For example, the notification of a patient diagnosed with a community associated MRSA bacteraemia, requiring the IPCP to carry out a root cause analysis process; or a gastrointestinal outbreak is confirmed in an intermediate care facility requiring outbreak management.

Ultimately, the aim is to provide a clean environment and maintain patient and staff safety. While striving for the highest IPC standards in community settings, at times the IPCP applies the principle of what is reasonably practicable, without compromise on safety.

References
1. Department of Health (DH). The Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance. London: DH; 2009.
2. Health and Social Care Act 2008. London: Stationery Office; 2008.
3. Department of Health (DH). Standards for Better Health. London: DH; 2004.
4. Department of Health (DH). High Quality Care for All: NHS Next Stage Review Final Report. London:
DH; 2008.

Resources
Care Quality Commission
W: www.cqc.org.uk

Clean Safe Care
W: www.clean-safe-care.nhs.uk

National Resource for Infection Control
W: www.nric.org.uk

Infection Prevention Society
W: www.ips.uk.net

Health Protection Agency
W: www.hpa.org.uk

Department of Health
W: www.dh.gov.uk

Healthcare A2Z
W: www.healthcarea2z.org/index.aspx