With antimicrobial resistance posing a serious threat amongst an ageing and increasingly complex patient population, infection control and prevention remains a key priority for the NHS. Although significant steps have been made to reduce the incidence of MRSA and C. difficile infection over the past decade, the number of infections caused by Gram-negative bacteria is continuing to rise.
Annette Jeanes, Director of Infection Prevention and Control at UCLH, supports and advises the UCLH NHS Foundation Trust to meet this challenge. With antibiotic use being the main driver of antimicrobial resistance, Annette’s role in preventing infection is fundamental to the safety and quality of patient care now and in the future. “My role is very broad,” she explains. “We concentrate on a number of different areas, from hand hygiene and isolation of infectious patients, to environmental issues such as decontamination and biological safety. My priority is not just patient care but also the safety of our staff.”
A fresh pair of eyes
Annette works closely with the Trust Board, managers and healthcare workers to minimise infection risk. “I spend about half my time in meetings, and the rest of the time on the ground, listening to frontline staff,” she says. “You can’t really understand the issues and explain them to a member of the Board unless you’ve seen them yourself.”
Providing a fresh pair of eyes and ears can help highlight areas where a small change can make a big difference to patient care. Attending a meeting about delayed discharge, Annette pointed out that sending the laboratory a prompt when a patient’s test results would affect their discharge could make the process much more efficient. “Those very small delays can have a huge impact on patient outcomes,” Annette explains. “But when you’re working on the same ward every day, it can become difficult to spot those small opportunities for improvement.”
Involving people is crucial
Since starting her role at UCLH, Annette’s aim has been to actively engage staff in infection prevention and control, moving away from a top-down, target-driven culture to a more pragmatic approach to quality improvement.
For the past five years she has been working on an infection control quality improvement tool, which has now been rolled out across all areas of the Trust. The new tool, which replaces the hand hygiene compliance monitoring system, seeks specific areas for improvement and allows for more flexibility in terms of what is measured.
“With hand hygiene compliance, we were regularly achieving 100% targets,” she says. “But this wasn’t consistent with what our patients, staff and visitors were telling us. We found that, in reality, hand hygiene compliance was much lower – staff were only reaching 100% targets when they knew they were being watched.”
This prompted Annette to create a new quality improvement tool – one which engages staff and more accurately reflects the practical realities of infection control: “In theatre, for example, we found that anaesthetists needed to do more than 70 procedures requiring hand hygiene during any two hour period. By talking with the anaesthetists themselves, we found that not all these opportunities for hand hygiene were completely necessary or, indeed, beneficial to the patient.”
“Together we developed more realistic hand hygiene guidance, which has improved compliance and given staff ownership of their role in infection control. We’re no longer just standing there with a clipboard telling them they’re not cleaning their hands when they should be – we’re involving them in the whole process.”
Moving away from a target-driven culture
The shift away from a one-size-fits-all, target-driven culture has been a welcome one. “It’s fascinating to see the how much has changed since we introduced this new quality improvement tool,” Annette explains. “In the past we found it really difficult to get staff to produce the hand hygiene data – they would often just copy the previous month’s results. But now people are engaged in the process, much more data is coming in and significant improvements are being made.”
Critical to the success of this tool is the fact that it recognises other activities impacting infection prevention and control aside from hand hygiene, such as isolation practices and IV line care. Hand hygiene is still there, “like the words going through a stick of rock”, according to Annette, but each department can now identify specific areas they need to work on.
Central to this is the understanding that achieving anything less than 100% compliance is not a failure. “The problem with achieving 100% compliance is that doesn’t give you any room to improve,” explains Annette. “We’re starting to see a shift in attitude – people are beginning to understand that our role is to improve patient safety, and that targets may not be as important as we once thought.”
“It’s taken a while to get this point, but I’m proud of how far we’ve come,” Annette says. “Infection control and prevention is more important than ever before, and we need to ensure we’re doing the best we can to improve the quality of care to our patients and the safety of our staff.”