Date Published: 30 July 2008

Hand hygiene alone will not reduce healthcare associated infections, warns RCN

Strong leadership, appropriate staffing levels and better management of staff workloads should be just as important as hand hygiene and environmental cleanliness in the battle to reduce healthcare associated infections (HCAIs), such as MRSA and C difficile. That is the key finding of Hospital Organisation and Management Factors in Infection Control, an independent report by King’s College, London, commissioned by the Royal College of Nursing (RCN).

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said:

Much has been written about what patients, visitors and healthcare professionals can be doing as individuals to reduce infection rates in hospitals, hand-hygiene being a prime example. However, there has been very little research on what impact the actions of organisations and management can have on infection control.

There is rarely no single cause for outbreak of infection or a simple cure. But we hope that by increasing awareness of the risk factors leading to outbreaks of infection that we can better tackle the causes so that patients and their families are assured a safe and worry-free hospital stay.

This report suggests that infection rates appear to be lower where there is strong leadership, where wards are fully staffed and where workloads are manageable.

The authors highlight the positive impact modern matrons can have in leading by example; challenging poor practice and empowering staff. Positive effects of modern Matron leadership from the study include: Positive impacts identified by respondents included improved patient environment (e.g. cleanliness), care standards, networking and communication, staff morale, responsible education and training, promotion of innovation and development, and infection control management.

However, it is important to recognise that these roles require support and clear authority if they are to be successful in implementing improvements in patient care.”

The report identifies a number of circumstances affecting the occurrence of outbreaks of infection:

  • Strong leadership at ward level. The authors point to findings from the Healthcare Commission investigations into outbreaks of C. difficile which concluded that poor management and inadequate team work led to staff feeling unable to raise concerns.
  • A multi-disciplinary approach to infection control with teams across a range of settings and professions working together to tackle infection.
  • Low staffing. The authors make the link between improved patient outcomes and higher nurse-patient ratios and note that there appears to be a link between infections and the high use of bank and agency staff.
  • Heavy workloads can lead to a fall in the quality of care patients receive and may also contribute to higher infection rates.
  • Low staff morale is identified as a cause of higher staff turnover and vacancy rates which in turn has negative impact on patient outcomes.
  • High bed occupancy and high patient volumes can also cause a strain.

Dr Carter added that:

We hope that by highlighting the risk factors leading to infection outbreaks; it will allow healthcare providers to stay vigilant in monitoring factors such as staffing levels, morale and workloads which play a role in infection control.

We know there is no silver bullet solution to ridding our hospitals of infection and the public, organisations and the government all have a role to play. Investment in infection prevention and control is critical, with the emphasis on prevention rather than reacting when things go wrong. We call on the government to provide the promised investment for more infection prevention nurses and that healthcare providers ensure there are stronger reporting mechanisms to enable nurses to raise their concerns about poor hygiene practices.”

Source: Royal College of Nursing (RCN), UK.
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