A fresh take on prevention
Just four months into her first job as a staff nurse in a nursing home, Shauna Rooney began developing an ambitious infection prevention programme. The programme eliminated preventable infection outbreaks and won her the Infection Prevention award at this year’s Nursing Standard Nurse Awards.
The programme she introduced to Rush Hall Care Home in Limavady, County Londonderry, led to a 100% reduction in outbreaks of infection – an achievement that earned her national recognition as winner of the Infection Prevention category in the 2015 Nursing Standard Nurse Awards.
Rush Hall, part of the Four Seasons Health Care group, is a 66-bed nursing home for people with dementia. It had previously relied on hospital staff for infection prevention and control training, but this changed when Ms Rooney arrived, recently qualified and full of the latest ideas. She became the home’s infection prevention and control link nurse.
‘Our residents were often unaware of potential risks because of their dementia,’ says Ms Rooney. ‘We have a duty to protect them from preventable infections and maintain a homely environment.
‘There was no point me having knowledge and not sharing it. I wanted to use it to reduce infections by raising awareness and encouraging staff to improve their practice.’
She adds that the work to develop the approach to infection control was a learning experience for her as well as her colleagues, and an opportunity to develop her leadership skills. ‘The programme allowed me to develop my knowledge of healthcare-acquired infections and to see that prevention, rather than control, was key.’
Before Ms Rooney could move forward she had to understand what was happening at the home. With this in mind she began a programme of audits, starting with standard precautions and clinical supervision, to find any gaps in staff members’ knowledge.
Shauna Rooney’s programme of change focused on preventing infection
She relayed her results to the home’s nurse manager, Jane Bell, who helped her develop an action plan that was implemented in supervision sessions with small groups of staff.
Ms Rooney worked alongside the staff to support their training. ‘This meant I could address the practicalities and answer questions as they came up,’ she says. ‘I could never have done this without being given supernumerary time by the home manager.’
At first she found it difficult to challenge long-established practices. ‘I thought I would look like a newly qualified know-it-all,’ she says. ‘And it was difficult getting staff to attend training on days off. But as my skills increased, so did my confidence and soon I was able to take on resistant staff who preferred “the way they were shown”.’
She says Four Seasons and her manager provided support. ‘I got it from the top. I also had the head housekeeper as my wing woman, so it was not just me pointing the finger.’
Initially, the biggest problem was communication between care and domestic staff. ‘It was important to get everyone together – everyone had to collaborate,’ she says.
By providing continuous feedback to the manager and staff and showing how things were improving through monthly audits, the focus of practice at the home moved from infection control to infection prevention.
‘I wanted to show staff there were results after they did the training and that it was not just about telling them off,’ says Ms Rooney.
The Nursing Standard Nurse Awards judges praised Shauna Rooney’s bravery in launching an ambitious programme in a challenging environment, just months after she had qualified.
North Hampshire Clinical Commissioning Group chief nurse Jan Baptiste Grant said: ‘I am overwhelmed by Shauna’s courage just four months into her career, and her ability to use her leadership skills to get nurses and domestic staff to follow her to such great effect.’
Staff reported increased confidence and satisfaction as they saw consistent improvements. ‘The most important thing was the positive effect on the residents’ wellbeing,’ says Ms Rooney. ‘Reduced rates of infection meant fewer hospital admissions. Also, infections often led to residents being isolated in their bedrooms.’
The significance of infection prevention measures, especially handwashing, was also raised at meetings with relatives and carers. ‘They often take people to the toilet, so it was important to help them understand how infections transmit and to think of the other residents as well.’
The use of catheters and antibiotic prescribing at the home also came under scrutiny in Ms Rooney’s programme of change.
‘Before working at the home I had worked on a urology ward on placement. At the home I saw a lot of urinary tract and catheter infections, gloves not being washed and a lack of aseptic technique.
‘When a new resident arrives from hospital catheterised, I ring the doctor to find out why. Often it is because of urinary retention and there has been no trial removal. Catheters are often the root cause of infection so we challenge their use when we suspect it is unnecessary.’
The use of prophylactic antibiotics was a concern for Ms Rooney. ‘Four or five of our residents were taking them for 18 months and no one was reviewing this, so I have been challenging their GPs,’ she says. ‘I’m not very popular with them.’
Home manager Ms Bell says the team is proud that Ms Rooney’s work has been recognised in the Nurse Awards. ‘Her work has had a tremendous impact on our residents as it continues to ensure no one experiences an infection that can be prevented,’ she says.
‘By imparting knowledge to her colleagues on a daily basis Shauna continues to help enhance the quality of vulnerable people’s lives.
‘She has also proved that the care home sector provides quality, life-enhancing care.’
Gary Cousins, Four Seasons infection control and clinical development nurse for Northern Ireland, Wales and the Isle of Man, plans to implement the infection prevention programme more widely. ‘I don’t think there are many nurses who could achieve what Shauna has at such an early stage of her career,’ he says.
As well as helping maintain the high standards at Rush Hall, Ms Rooney wants to be part of this programme and visit other homes to showcase her work.
‘I also want to pursue further education in infection prevention and control. It is lacking in care homes and there is work to do,’ she says.
‘People forget that older people are vulnerable, especially those with dementia, and infection has such a negative effect on them. Making their lives better is my motivation’.