Infection Control Link Nurses

A different educational approach

to a familiar concept.

Tracey Cooper
Consultant Nurse Infection Control
Southampton University Hospitals NHS
Trust
Tracey Cooper
 Background
• ‘Inherited’ link nurse group
• Some staff ‘told’ to be ICLN
• Short meetings monthly
• Role not defined
• Objectives not defined
• Difficult to identify positive impact of
role
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 Current Evidence?
• Little published objective evidence
• Subjective benefits identified
– Improved awareness
– Higher profile for infection control
• Measurable objectives described by 1 study
• (Ching & Seto 1990)

Tracey Cooper
 Traditional ICLN Model
• No input to
programme by ICLN’s
• ICN sets content
• Little networking
• Follows traditional
educational model
• ..a bit of a dinosaur!

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 Educational Theory…….
• Traditional model
– Students passive recipients of information
– No control over content, method
– Based upon knowledge of how children learn
• Adult Learning
– Adults learn differently
– Need control over content, methods
– Must be relevant

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 …....Into Practice
• Role description, application process
• Quarterly, half-day meetings
• Facilitation of change-management skills
• Group selection of primary topic for action
• Agreement on plan for the year

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The Plan
• Baseline audit
• Analysis & feedback
• Practice interventions
• Re-audit
• Analysis & feedback

• Supported by ICNS

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 Research Studies
• 3 inter-related studies

– Link Nurses knowledge and attitudes

– Measurable practice improvement
– Link nurses experience

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Study 1: Knowledge & Attitudes
• Pre & post questionnaires administered
• Attitudes: very positive throughout
• Knowledge
– Significantly improved at end of study
– Lowest scores at start improved the most

BUT: Small sample size (n=10)

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 Study 2: Practice Improvement
• Handwashing facilities chosen
• Audit tool developed using Delphi method
• Self-administered
• Analysis by ICT & feedback to ICLN
• Practice interventions by ICLN
• Audit intervention re-audit

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 Study 2: Measurable Outcomes
• Comparative data: 222 sinks in 14 areas

• 10 of the 11 standards showed:

– Significant improvement
– Improvements were associated with the study
period (p 0.05)

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 Study 3: Experiences
• ICLN need to challenge poor practice
– Confidence
– Skills
– Empowerment
– Traditional model did not facilitate this

Focus group used to gather data

Phenomenology: The Lived Experience

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 Study 3: Themes
1. Experience of application process
2. Effect of the educational programme
3. Authority, influence & empowerment
4. Support & facilitation of the role
5. Barriers to effectiveness
6. Quality & practice improvement

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 Empowered Practice?
• ‘I always looked
around to see what
was going on but I
wouldn’t have
challenged them quite
the same. Now you
say – this is my role,
this is what I’m trying
to do.’
Tracey Cooper
 Conclusions
• There appears to have been knowledge
improvement
• Practice improvement has been demonstrated
• This approach has had a positive impact on the
ability of ICLN’s to deliver practice improvement

• Further studies are required, building upon this

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 Can This Be Used Elsewhere?
• Repeat in other organisations?
• ‘Pick n Mix’

• Utilise structure for practice improvement

• Involve ICLN’s in planning programme

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 And Finally…………….
• Link Nurses can make a difference to
practice
• It is possible to demonstrate this objectively
AND
• A link nurse programme can make a
positive difference to the Link Nurses

Tracey Cooper
 Work Supported By:

Isle of Wight
Healthcare NHS Trust

Tracey Cooper