APPENDIX 2
Memorandum by the Infection Control Nurses
Association (PH 4)
CONTENTS
1. Introduction
2. The Role of PCGs/PCTs
3. Surveillance
4. Organisational Development
5. Conclusion
6. References.
1. INTRODUCTION
1.1 The Infection Control Nurses Association
is a professional organisation for nurses working in infection
control. These nurses may be employed in acute hospitals, community
healthcare trusts, mental health trusts, the private sector and
public health departments of health authorities.
1.2 Regardless of employment settings infection
control nurses work both at a strategic level and an operational
level.
1.3 At a strategic level they are actively
involved in decision-making processes, the development of risk
management strategies and the development of evidence based policies
and guidelines.
1.4 At an operational level they are involved
in the implementation of services such as:
— education of staff, patients and
the public;
— quality assurance activities;
— surveillance of infection;
— management of outbreaks of infection;
— advising on new products and medical
devices;
— advising on site and facilities developments;
and
— formulation and promulgation of policies,
guidelines and public information materials.
1.5 For infection control nurses employed
by healthcare trusts the boundaries of the trust usually defines
their area of practice.
1.6 Infection control nurses employed in
health authorities work with the Consultant in Communicable Disease
Control and contribute to the prevention and control of communicable
disease and in some cases control of environmental hazards.
1.7 Within a trust infection control nurses
work with all professions and departments.
1.8 Those nurses employed by health authorities
are familiar with multi-agency working in the community at both
strategic and operational levels. The development of good multi-agency
working relationships is fundamental to control of infection and
communicable disease control in the community.
2. THE ROLE
OF PCGS
/PCTS
2.1 When considering the role of PCGs/PCTs
in the delivery of a social model of health it is important to
remember the key professional issue for doctors and nurses is
the relationship between the professional and the patient and
the individual context within which care is delivered. At the
moment the rhetoric around delivering the public health agenda
is failing to recognise this context of care and the value of
the public health messages which can be articulated at this level.
2.2 Immunisation is a key public health
activity carried out by PCG/PCT staff. The delivery of these immunisation
programmes is essential if morbidity and mortality rates due to
infectious diseases are to be controlled. However, the resources
for delivering the ever more complex programmes as new vaccines
are licensed need to be examined.
The contribution nurses working in primary care
are to make to the promotion and delivery of public health is
well documented. However, it is not possible for nurses to both
deliver (in the form of immunisation programmes) and promote (in
the form of population based initiatives such as those to reduce
teenage pregnancies) at the same time. Staffing levels at the
moment mean that a decision between the two has to be made.
In terms of health protection all the immunisation
programmes ie childhood, adult and travel are vital, mostly nurse
led services. PCGs and PCTs should, as part of their public health
role, examine the resources they allocate to these programmes
and the employing organisations should re-examine their commitment
to professional development and education for the nurses undertaking
this vital role.
3. SURVEILLANCE
3.1 A strategic responsibility of the Health
Authority is to ensure that robust surveillance systems are in
place. Surveillance of healthcare related infection and communicable
disease is the key to prevention and control.
The National Audit Office Report has highlighted
the importance of surveillance of infection in hospitals and documents
the impact robust surveillance programmes can have on the number
of hospital acquired infections. Surveillance programmes have
resource implications (human, IT and time). The issue here is
similar to the issue in 2.2—infection control nurses cannot
promote infection control and deliver surveillance programmes
within current resources.
3.2 The same report recommends extending
surveillance systems for health care related infections into the
community setting. PCGs and PCTs will have a role in these programmes,
however, the co-ordinating role of the infection control team
will need to be considered again with resource implications.
3.3 Surveillance of communicable diseases
plays an important part in protecting the public health, new infectious
agents are emerging and some considered under control are now
re-emerging. The importance of base line data collected at a local
level and collated at regional, national and international level
must be emphasised. Comprehensive surveillance informs health
care planning, informs preventative programmes, evaluates preventative
programmes and treatment strategies and the base line data collection
informs epidemiological studies.
Strengthening and supporting surveillance systems
in infection control and communicable disease control to inform
preventative programmes and reduce infection rates will have an
impact on access to health care and reduction of inequalities
in standards of infection control.
4. ORGANISATIONAL
DEVELOPMENT
4.1 Infection control nurses are experienced
in working across professional boundaries and in the case of nurses
employed in health authorities across agencies. One of the key
difficulties in effecting change that we experience is cultural.
Unless organisational and professional cultures are appreciated
and accommodated infection control strategies will not be implemented.
A social model of public health also encounters this cultural
diversity within the many organisations involved, and this is
possibly one of the biggest barriers to promoting and delivering
public health. Public health policy to reduce health inequalities
has more chance of succeeding if the diversity and culture of
all those involved in implementing such a policy is valued and
shown to be valued. There appears to be very little evidence of
organisational development programmes taking place to address
this problem.
5. CONCLUSION
The health protection which a robust and well-supported
infection control and communicable disease control service affords
will contribute greatly to the public health. It is essential
the infrastructures for such a service are maintained and the
role health protection plays in current public health policy valued
and articulated at all levels of this policy development.
6. REFERENCES
1. Cowley S, 1999: From population to
people: public health in practice. Community Practitioner
72:4 88-90.
2. Department of Health 1995: Making
it happen—Public Health Contribution, Role and Development
of Nurses, Midwives and Health Visitors. Standing Nursing
and Midwifery Advisory Committee.
3. Labonte R, 1997: Community and public
health: an international perspective. Health Visitor 70:2
64-67.
4. NAO 2000: The Management and Control
of Hospital Acquired Infection in Acute NHS Trusts in England.
Report by the Comptroller and Auditor General National Audit Office.
5. Plowman et al 1999: Socio-economic
burden of hospital acquired infection. Central Public Health
Laboratory, London School of Hygiene and Tropical Medicine.
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