Good Infection Prevention and Control Standards Are Absolutely Essential Part of Our Practise

Lesley Brady Podiatrist NHS Lothian

Thank you to the HAI team at NES for inviting me to speak here today. It's pretty scary to be here to be quite honest! We are a part of a multi-disciplinary team we liaise will all members of that team including GPs, practise nurses, district nurses, orthodontists and physiotherapists primarily.

Good infection prevention and control standards are absolutely essential part of our practise.

Here's why: These are examples of the types of patients as a profession we see on a daily basis. That can be in an acute setting, nursing homes, domiciliary and (where I'm based) community clinics.

In NHS Lothian there are 89 of us spread over 45 clinical sites covering 700 square miles – most of which are part time clinics – most of which including myself are part time members of staff.

What follows is what we as a department have managed to introduce at local level to our department since I qualified as a cleanliness champion in 2009.

The first thing the program did for me – and some of you may be exactly the same – it made me a lot more reflective of my own practise and my own environment in all aspects of infection control. I had the opportunity to share audit results and updates with my colleagues at team meetings, via presentations – I'd never in my life attempted any power point presentation or any type of public speaking prior to engaging in the cleanliness champions program.

I decided to start with the most important one and delivered the hand hygiene update immediately after I qualified as a cleanliness champion. The aim was two fold. It was to reinforce what we already receive in mandatory training but also to raise awareness in staff that hand hygiene audits from every department had been a requirement since 2006 and basically that I would be auditing in our department from that point forward.

For several years I audited hand hygiene, clinical waste, sharps disposal, waste disposal and the most recent the environmental in 2011 along with a request to assist with pier reviews for our domestic services team led me to the NHS Lothian cleaning matrix. Cleaning matrix in NHS Lothian was developed to ensure that standards of cleanliness across NHS Lothian were the same regardless of what area you were in. It also separated out cleaning tasks which had to be undertaken which were the responsibility of the domestic services team, which were the responsibility of the clinicians themselves.

When I asked our staff what was their responsibility to clean it threw up as you can imagine quite a varied list of things and suggestions.

1 But unfortunately it left some areas wide open to being missed entirely. Therefore it had the potential to increase risk in HAIs.

Using code G of the cleaning matrix which is specific to GP surgeries and medical centres I spent the best part of a year developing, piloting and discussing with my colleagues in order to develop basically a check-list for the podiatrists to follow to ensure that what was our responsibility from a cleaning point of view were being achieved.

Podiatry cleaning matrix is what we call this in use today in our department, The aim being to prevent those knowledge gaps close them up, let staff know what was their responsibility to clean and limit the risk if the healthcare inspectorate did decide to pay us a visit it could limit the risk of things we as independent clinicians could control.

It also provided daily documented evidence of cleaning tasks having been achieved.

We have audited it since. prior to the audit in November 2012 we used the emails and asked staff to use voting buttons to answer the question:

"In your opinion since starting the cleaning matrix, have standards of cleanliness within the department improved?".

And the staff had to respond by answering YES / NO / MAYBE and you see the results.

Our cleaning matrix is due to be audited again in November.

The next initiative and the most recent one that we engaged in was in order to reach more staff- given our widespread geographical area – it's 700 square miles I couldn't do that by myself – we decided that with the help of my manager he authorised me to go ahead and train some other members of staff to engage with hand hygiene auditing and we developed a hand hygiene audit team for podiatry.

All clinical staff were emailed and asked if they wanted to be a part of that team. I believed then and I still do now that being motivated to get the message across as well as the knowledge behind it is very important in order to improve standards with hand hygiene in particular. So it was very important for me that staff who were on the team wanted to be there and that they weren't there because they had been asked to take it on as part of their job.

I developed a training program which was split into two sections: The first part was self directed learning and that was completed before the group work and that comprised the HAI modules which are part of mandatory training but also the NES module for promoting hand hygiene.

Both those modules were completed then we did group work. The group work was weighted on practical and observation because obviously that's what the hand hygiene auditors would be doing. We got five volunteers together for the group work. I delivered a power point presentation and then we checked our own hand hygiene technique using the

2 Glow Germ Light box.

I also developed as a training tool a DVD comprising 3 20 second films that we basically was myself failing to comply in various ways with hand hygiene protocol wearing false nails, rings with stones, nails with varnish (you get the picture).

We also discussed challenging behaviour and the reasons people suggest for being non compliant with hand hygiene: Everything from "I didn't have time" to "I got these nail extensions put on for my cousins wedding". And how to respond and how to encourage and feedback in those sort of situations.

I then ran through how to input the audit onto QiDS which is the data system we use in NHS Lothian for all infection control audits.

It took 2 hours to complete the session, the feedback was all very positive from everybody. We have 5 members of staff who completed the training all of whom are currently auditing within podiatry in NHS Lothian at this time and contributing to the monthly hand hygiene audits and I'll be training another 4 members of staff at the end of next month.

So in conclusion I've found the cleanliness champions program to be very rewarding. It's allowed me to develop my career in ways I never thought possible. Especially in developing things like DVDs for training purposes, building teams and speaking to you good people right now would be a good example of that.

I would recommend the cleanliness champions program to any AHP in community or acute setting because regardless of where you work – how far spread apart you are - everybody can contribute and hopefully make a positive difference.

Thank you very much for your time.

25th September 2013