Jennie Wilson, Vice President of the Infection Prevention Society, speaks to HEQ about the key challenges facing infection prevention and control teams.
Jennie Wilson, interview by Rosemary Lobley
UK-wide member-based charity organisation the Infection Prevention Society (IPS) actively works to inform, promote and sustain evidence-based, expert-led policy and practice around the crucial field of infection prevention and control (IPC).
What is the role of the IPS within the UK’s healthcare landscape?
We are a UK-based charity which aims to inspire, promote and sustain evidence-based infection prevention and control practice by providing education and resources to support the work of our 2,000 members and the wider healthcare community. Our members deliver expert IPC advice, education and training across a wide range of healthcare settings, including acute NHS trusts and health boards, private healthcare providers, primary and social care and public health departments. Infection prevention and control services play a central role in assuring patient and healthcare worker safety and are focused on applying scientific, behavioural, environmental and organisational strategies to prevent hospital-associated infections (HAIs) and limit the spread of infectious diseases.
What are the key challenges facing the healthcare sector in preventing the spread of infection?
There are so many! The NHS has been run as a ‘high efficiency’ model for the last decade meaning that there are not spare beds or staff to cope when demand soars to the levels that we are seeing with this pandemic. Staff are being asked to work in unfamiliar areas and use unfamiliar IPC procedures – this makes it difficult for them and puts huge pressure on IPC teams in trying to support them. The bed capacity is inadequate to manage large surges in infected patients; and this makes separating those with and without the infection difficult. Add to this the problem of staff acquiring COVID-19 themselves (through contact both in and out of work) and then needing time off work, thus putting even more pressure on staffing.
However, perhaps the biggest challenge for healthcare staff is the emotional toll of caring for severely sick and dying patients (including some of their own colleagues) and their families who can’t be with them. No-one should underestimate how difficult this is and what a damaging effect it has on the morale of overworked staff. We must also not forget the ancillary staff in this – their personal circumstances often put them at increased risk of COVID-19 and they too have seen their friends and colleagues succumb to this awful disease.
Certainly, some ingrained practice related to the use of personal protective equipment (PPE) such as putting gloves on too early and taking them off too late (facilitating the spread of contamination), touching masks and not wearing them correctly so that they hang around the neck or under the chin, a reluctance to wear eye protection (and paucity of supplies), and using the same PPE with more than one patient have contributed to increased risks of transmission.
How could hospital infrastructures be improved to better support infection prevention and control?
Many hospitals have limited single-room facilities, but wards which can easily be converted into safe cohort areas are also hugely important. Improving the general ventilation systems would be beneficial: even enabling ward areas to open windows can help to improve air circulation and reduce transmission of respiratory viruses. Another major issue is the lack of good facilities for staff to take their breaks, obtain access to food and drinks without being in large crowds or queues. Social distancing in many areas of hospitals such as offices is also difficult because they are cramped and poorly designed. This has probably contributed to transmission of COVID-19 among staff.
What lessons should we take from the COVID-19 pandemic? How could the UK’s initial response to the virus have been improved?
Specialists familiar with the frontline delivery of IPC guidance in healthcare settings need to be better represented on the national committees advising government on the pandemic. Given that IPC is fundamental to managing the pandemic this is a significant oversight. It is not sufficient to assume that relevant expert advice can be provided by a generalist with a background in nursing or microbiology. IPC is a highly scientific and technical area of practice that requires a detailed understanding of the delivery of care across all professional groups and healthcare settings.
The development and provision of IPC advice requires staff with specific training and experience of delivering IPC services. The inclusion of IPC specialists on national committees would have highlighted the major risks of transferring patients out of hospital into care homes at a far earlier stage, a greater focus on social distancing among staff and its contribution to transmission in hospitals, along with other IPC issues, is critical to protecting patients and staff.
The demands on IPC services during the pandemic have been huge; and their workload has increased exponentially from early in 2020, with the need for IPC to provide a seven-day-per-week service for many months placing severe pressure on their staff. In many organisations they were required to pick up wide-ranging responsibilities that would be outside their usual remit, including setting up swabbing clinics and fit testing facilities. Improved resources for IPC teams, including staff that can support data collection and analysis, and forward planning in relation to critical services that need to be in place to support IPC is required.
The wholesale prevention of relatives visiting their sick or dying loved ones on the basis of ‘infection prevention and control’ is unacceptable. Whilst sensible controls on visiting need to be in place, essential visiting, for instance to patients who are dying, with appropriate IPC precautions in place, could and should be managed.
There are scant resources to support IPC in the highly disparate care home sector and their workforce did not have access to training appropriate to their needs. Clinical commissioning groups have a very small IPC practitioner workforce; and although they try to support education and training, they have inadequate capacity to achieve this. Systems for supporting education and advice on IPC in the care home sector are urgently required. The regulation of IPC in care homes is not perceived as an integral part of quality and it has therefore not been appropriately monitored and although many nursing homes did their best to control the virus it was inevitably hugely challenging for them with low-paid staff without the relevant training.
National guidance on IPC was often conflicting and issued in a piecemeal manner. It needs to be developed through greater partnership with IPS, the only UK-wide member organisation that represents this critical expertise, so that it takes account of the experience of applying IPC in practice and is not subject to undue influence by professional groups without specialist expertise in IPC.
Some of the equipment procured by the government was not fit for purpose and suggests that the appropriate expertise was not involved in securing these supplies and quality control systems were inadequate. This resulted not only in a significant waste of public money, but also a waste of IPC professionals’ time in assessing if PPE was fit for purpose – for example, ‘Turkish coveralls’ which were of poor quality and not designed for use in clinical settings; poor quality respirators which did not meet EN standards and were therefore worthless; surgical type IIR masks with straps incorrectly attached and readily pulled apart; poor quality aprons; alcohol gel and wipes which did not meet required standards and were not labelled in English.
Infection Prevention Society