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Work together to prevent infection

Nurse Tanya Kidson leads the team behind a set of assessment tools that are helping care homes in Shropshire to prevent infection outbreaks. The tools were developed with independent care sector nurses. Implemented in almost half of the county’s 300 care homes, the team was named runner-up in this year’s Nursing Standard Nurse Awards in the infection prevention category.

Tanya Kidson (left) and Jill Hassall

A set of assessment tools designed to be used in independent care sector homes is helping staff to prevent outbreaks of infection.

Check to Protect – bespoke assessments that enhance the skills and knowledge of staff in care homes – has been taken up by almost half of the 300 adult social care providers in Shropshire.

Tanya Kidson, infection prevention and control lead nurse for Shropshire Clinical Commissioning Group (CCG) and Telford and Wrekin CCG, led the initiative that created Check to Protect.

She says there is a clear need to support care home staff on infection prevention. ‘There are lots of supportive initiatives and tools around for NHS organisations to monitor practices and maintain consistency, but not so much for the independent care sector, which still has to meet Care Quality Commission (CQC) requirements.’

Shropshire has particular issues as a geographically large county with a higher than average population of older people. The wide variety of adult social and nursing care providers also makes standardising practice a challenge.

Ms Kidson and her colleague Jill Hassall looked at how the infection prevention and control team could work with the independent sector to ensure that residents and clients enjoyed the best care and that providers met commissioning and CQC requirements. Ms Kidson says: ‘We wanted to support staff learning and their understanding that if you link a number of care elements in a procedure and perform them consistently, residents and clients will have better and safer care.’

Bespoke tools

The resulting assessment tools has seen the Check to Protect team named runner-up in the 2015 Nursing Standard Nurse Awards infection prevention category. The judges praised the widespread impact Check to Protect has achieved and Ms Kidson’s leadership.

The assessment tools provide the independent sector with ‘a means to evidence that every resident/client is receiving the right care, at the right time in a safe environment,’ says Ms Kidson.

It was important to develop something that the sector was happy to implement, she explains, so infection prevention and control link nurses from across Shropshire and Telford were invited to join working groups to develop something ‘useful and used’.

Representatives from large and small providers shared ideas and existing resources, training programmes and pathways, and reviewed national tools available for NHS trusts.

The information coupled with the nurses’ specialist knowledge enabled the team to produce a set of assessment tools built around areas seen as priorities by the independent sector.

Nurses in the sector were so keen to improve care, they rushed to volunteer for the working group.

‘It was heartening and the ideas they had for the assessment tools were exciting, but it became evident that for the project to be manageable, the group needed to be divided into smaller subgroups,’ says Ms Kidson.

‘Doing so not only maintained their enthusiasm, it meant that with each sub-group focusing on developing different assessment tools, they could be developed over a shorter time period.’

The Check to Protect tools include:

Hand hygiene.

Personal protective equipment.

Waste disposal.

Sharps handling and disposal.

Aseptic technique.

Urinary catheterisation insertion.

Urinary catheterisation daily care.

Enteral feeding.

Oral hygiene.

Ms Kidson with Jo Edwards (centre) and Sue Grehan, (bottom), both from Alexander House care home in Ludlow

Picture credit: Neil O’Connor

It also meant the team could ensure the subgroups had representatives from different sizes and types of providers, from care homes to domiciliary care agencies, so that a diverse range of perspectives and ideas were fed in.

‘Big care providers with lots of staff could have dominated, with small ten-bed areas getting lost,’ says Ms Kidson. ‘They might have different needs and we needed to capture those.’

Volunteers from the working group piloted the tools for six to eight weeks in their work area. Feedback was also obtained from service managers, staff and service users. The results were taken on board and used to refine the tools.

Assessor prompts are provided for each tool to ensure assessments are consistent. Staff designated for the assessor role were given training in their care homes by Ms Kidson’s team. ‘This gave the assessors the opportunity to familiarise themselves with the tools in a supportive environment,’ she says.

Link nurses

The tools were also promoted by the infection prevention and control nurse link group, a strategy that has been ‘a tremendous success’, says Ms Kidson. ‘We can’t get to 300-plus providers so we rely on them to act as a role model in the area. We have an active link nurse group that meets regularly in various locations across the county.’

The team also worked closely with Shropshire Partners in Care, a not-for-profit member organisation for the independent care sector to promote and raise awareness of the initiative.

The input of the sector ‘has been invaluable in creating a sense of ownership which in turn has encouraged take up by providers’, says Ms Kidson. ‘Almost half of care homes have implemented it.’

Audit shows improved compliance with infection prevention and control standards among all providers who have implemented Check to Protect. The tools have also been credited with helping to reduce the rate and duration of diarrhoea and vomiting outbreaks as a result of norovirus.

A review of all diarrhoea and vomiting outbreaks reported to date in 2014/15 has found the majority of outbreaks were contained in eight days compared with 15 in previous years.

The assessment tools have also been credited with helping to reduce hospital admissions when norovirus has been circulating in the community. So far in 2014/15 no residents from care homes have been admitted to hospital because of diarrhoea and vomiting, dehydration or associated urinary tract infections. ‘We have seen reduced use of urinary catheters as staff are more competent and confident in managing incontinence in other ways,’ adds Ms Kidson.

And in a further boost to consistency of care across the county, Check to Protect has become a recognised standard in Shropshire.

‘It has been designed to support a workforce that often moves between homes. Certificates are given to staff, evidencing their professional development and competency.’

The tools have already attracted attention from other areas, with nurses in the Midlands hoping to adopt a similar scheme. And the Shropshire team has no intention of standing still.

Praise for Check to Protect

‘It is vital staff practise infection prevention and control procedures to the highest standard. Any shortfall can lead to hospital admission and impact on NHS services. Check to Protect has taken a partnership approach to clinical and care processes to improve cleanliness and safety for patients in the independent sector. Early signs are highly promising, and are a credit to Tanya and the team’s hard work and enthusiasm’ – Shropshire CCG chief nurse Linda Izquierdo

‘Tanya’s work is very important and I think it will go places’ – RCN nurse adviser for infection prevention and control Rose Gallagher

‘Tanya and her team had great ideas. When she brings it into primary care she will have rounded it perfectly’ – North Hampshire CCG chief nurse Jan Baptiste-Grant

‘Staff have become more vigilant’

Check to Protect has been used for the past three years at Alexander House in Ludlow, a 22-bed residential care home for people aged over 80. It cares for people with dementia, physical disabilities and sensory and visual impairment.

Picture credit: Neil O’Connor

The home has also been using a second set of tools, Check to Protect 2, since last year. These assess the cleaning of the care environment and equipment. Manager Sue Grehan (pictured far left with the Check to Protect team), and her colleague Jo Edwards helped to develop the tools.

‘All the Check to Protect tools are user-friendly and easy for employees to understand,’ says Sue. ‘Implementing them has certainly improved the standard of infection control in the home, including mandatory use of protective clothing, handwashing and management of any outbreaks. This has benefitted our residents. Staff are also more vigilant in spotting any infection issues.’

All staff have personalised files to make it easy for assessors and employees to use. There are further records covering the cleaning of rooms, communal areas and bathrooms, as well as laundry and protective equipment, specimen-handling equipment and environmental cleanliness.

It continues to promote the tools in the independent care sector and is now beginning to share them with primary care services, including GP and dental practices.

‘The tools are being updated in line with the clinical evidence base and new ones will be developed in response to requests from services and as more care is delivered in the community and by primary care services,’ says Ms Kidson.

New tools being developed include antibiotic prescribing, intravenous therapies, tracheostomy and stoma care.

The foundation laid by Check to Protect bodes well for the future. ‘Creating an environment in which independent sector nurses could have their voices heard has built trust and confidence,’ says Ms Kidson. ‘That trust has created something special in Shropshire and the sector’s enthusiasm for this has been truly inspirational.

‘Care home staff feel able to contact the team for support and guidance as and when they need to. And as well as excellent feedback, there is overwhelming support to champion other local infection prevention and control initiatives’.

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