Introduction
Methods
Study design
Topic list | |
1. Delineation of the ICLN program o the start o the goals ■ what are the goals? ■ what actions are necessary to achieve goals? ■ how do you know if you have achieved a goal? ■ what helps in achieving goals? ■ what does not help? o the plan ■ where adjustments made to the plan? ■ how would you know if adjustments are necessary? 2. Embedding of the program ■ how do you secure continuity and effectiveness? ■ what is the role of the infection control practitioners? ■ what is the role of others? |
Data collection
Data analysis
Results
Proportion (%) | |
---|---|
* Median (IQR) | |
Characteristics of ICLN programs | |
Goals for the program and link nurses | |
Increase awareness for infection prevention | 46/48 (95.8) |
Act as a role model and opinion leader | 39/48 (81.3) |
Disseminate knowledge on infection prevention | 43/48 (89.6) |
Act as a source of information for peers | 44/48 (91.7) |
Contribute to development of ward based infection prevention guidelines | 24/48 (50) |
Implement guidelines or improve adherence | 40/48 (83.3) |
Liaise between ward and infection prevention and control team | 45/48 (93.8) |
Qualities for link nurses to achieve program goals | |
Enthusiastic | 17/40 (42.5) |
Motivated | 33/40 (82.5) |
Assertive | 3/40 (7.5) |
Persistent | 6/40 (15) |
Proactive | 28/40 (70) |
Natural leader | 4/40 (10) |
Approachable | 15/40 (37.5) |
Resilient | 4/40 (10) |
Responsible | 15/40 (37.5) |
Respectful | 2/40 (5) |
Preparation of ICLN programs | |
Mode of selection of link nurses | |
Nominated by the ward management | 32/48 (66.7) |
Designated by the ward management | 29/48 (60.4) |
Approached and invited by the infection prevention and control team | 10/48 (20.8) |
Voluntary registration | 19/48 (39.6) |
Recruited though an application procedure | 1/48 (2.1) |
Other modes of selection | 2/48 (4.2) |
Health Care Workers involved | |
Nurses | 47/48 (97.9) |
Physicians | 1/48 (2.1) |
Other HCW (e.g. surgical assistants, physiotherapists, laboratory technicians) | 30/48 (62.5) |
Departments involved | |
Inpatients Wards | 47/48 (97.9) |
Outpatients Clinics | 36/48 (75) |
Diagnostics – Day care | 38/48 (79.2) |
Other departments (e.g. laboratories, operating theatre, facility services) | 30/48 (62.5) |
Education of ICLN | |
Educational program (yes) | 42/48 (87.5) |
Number of training sessions and meetings per year | |
< 4 | 20/40 (50) |
4 | 14/40 (35) |
5 | 4/40 (10) |
6 | 2/40 (5) |
Duration of training sessions or meetings (in hours) | 2 (1.4–3.3) * |
Modes of education | |
Introduction course | |
provided by an external party | 6/42 (14.3) |
an in-house introduction program | 24/42 (50) |
e-learning | 4/42 (9.5) |
Regular training/education | |
lectures | 32/42 (76.2) |
skills training | 21/42 (50) |
simulation based learning | 3/42 (7.1) |
hospital tours and visits | 8/42 (19) |
brainstorm sessions | 11/42 (26.2) |
group discussion/meeting | 27/42 (64.3) |
teambuilding sessions | 3/42 (7.1) |
Training and education of link nurses | |
Developed by the infection prevention and control team | 32/40 (80) |
Developed in collaboration with experts (e.g. microbiologists, education experts) | 8/40 (20) |
Topics for training and education | |
Selected by the infection prevention and control team | 14/38 (36.8) |
Determined by link nurses and the infection prevention and control team | 23/38 (60.5) |
Topics for education and training | |
Planned out in an annual plan | 7/35 (20) |
Depend on occurring events | 28/35 (80) |
Responsible for the link nurse program | |
Mainly one infection control practitioner | 23/45 (51.1) |
The infection prevention and control team | 11/45 (24.4) |
Share the responsibility with other departments | 17/44 (38.6) |
Evaluation of ICLN programs | |
Evaluation | 23/45 (51.1) |
Based on | |
- satisfaction with the program by link nurses and other stakeholders | 15/22 (68.2) |
- compliance with guidelines in relation to the activities of the link nurses | 6/23 (26.1) |
- prevalence of Nosocomial infections in relation to the activities of the link nurses | 2/23 (8.7) |
- other | 6/23 (26.1) |
Effects of Infection control link nurse programs | |
No effect | 2/20 (10) |
Positive effects | 17/20 (85) |
Positive and negative effects | 1/20 (5) |
The start of ICLN programs
In the first phase of setting up a program, the infection control practitioners pitched and discussed their ideas with middle and higher management.we needed this outbreak of vancomycin-resistant enterococci to convince our hospital management that we needed to implement an ICLN program [interview 4]
I have been to all wards and talked to the management … we were preparing our hospital for a JCI accreditation [interview 1]
The characteristics of ICLN programs
The top three goals of ICLN programs were to increase awareness for infection prevention, to create a liaison between the wards and the IPC team, and to make ICLN a source of information for their peers. Some infection control practitioners were able to described these program goals in a clear manner and incorporated knowledge and skills from other departments (e.g. quality department, training and education department) to supplement their own and ICLN’ competences whereas others found it challenging to prepare a plan of action.I hope to learn each link nurse to detect potential infection prevention risks …that they will contact me when they have detected a risk or when they have an IPC related question... I want to team up with these nurses [interview 4]
To achieve the program goals, the most sought qualities for ICLN were being motivated, proactive, and enthusiastic. Infection control practitioners’ views on the interaction with the ICLN and communication in the context of the ICLN program varied. Some infection control practitioners focused their efforts on providing support for the ICLN in implementing IPC policies, where others focused more on receiving support from the ICLN in monitoring the compliance with IPC measures.as an infection control practitioner I am obliged to support link nurses, but I don't know how to do that best [interview 2]
you need to listen to the needs of your link nurses...I want to serve them and support them to disseminate their knowledge to their peers on the wards [interview 3]
The preparation of ICLN programs
Our link nurse meetings must become a bit more interactive. We need to ask , what did you learn? What will you do differently tomorrow? What is the next issue you will address? [interview 3]
The education of ICLN
Survey item | Proportion (%) | Perceived accomplishment of program goals (range 1–10) (n = 48) | |
---|---|---|---|
Median (IQR) | p - value | ||
Written role profile | 0.22a | ||
Yes | 34/47 (72.3) | 7.0 (6.0–8.0) | |
No | 8 /47 (17.4) | 6.0 (6.0–8.0) | |
don’t know | 5/47 (10.6) | 6.5 (6.0–8.0) | |
Education | 0.02a | ||
No education | 6/48 (12.5) | 5.0 (2,5–6.8) | |
Education on infection prevention topics | 21/48 (43.8) | 6.0 (6.0–7.5) | |
Education on infection prevention topics and training in implementation skills | 21/48 (43.8) | 7.0 (7.0–8.0) | |
Support | 0,09b | ||
Support of ICLN by ward management | 32/45 (71.1) | 7 (6.0–8.0) | |
No support of ICLN by ward management | 13/45 (28.9) | 6 (6.0–7.0) |
Education | perceived accomplishment of program goals (range 1–10) | |
---|---|---|
Adjusted p - valuea | ||
(0) | (1) | |
(0) No education program | – | |
(1) Education on infection prevention topic | 0.24 | – |
(2) Education on infection prevention topics as well as training in implementation skills | 0.03 | 0.41 |
The progression of ICLN programs
Infection control practitioners described the challenge to develop a program that interconnects ICLN of various departments, to create opportunities for ICLN to exchange experiences and ideas. The variation in work environment and training background is considered to cause this lack of interaction between ICLN of different departments.at the start of this program ICLN educational meetings were mandatory… at that time, we were in the middle of an outbreak, we didn't have enough time to educate our link nurses... nowadays we do not educate in central meetings, we leave it up to the individual IPC team members to maintain intensive contact with their wards and their link nurses. Each Infection control practitioner is responsible for their own contacts and for what is going on in those departments [interview 4]
The limited time for IC tasks available for link nurses and for ICLN program tasks of the IPC team was mentioned as a barrier to the implementation of ICLN programs.we initially wanted to bring link nurses from clinical wards and outpatient clinics together …. during the training it turned out that there was a big difference in knowledge between those two groups…. and that did not correspond so well. They were not able to have meaningful discussions [interview 4]
last year we could not start the ICLN education for new link nurses …the time was allocated for general education of nurses on the new electronic patient files program [interview3]
The evaluation of ICLN programs
Link nurses say that we are more visible ... they know how to find us, they consult us. I think that is positive [interview3]
I see more information leaflets on infection prevention topics in wards were a link nurse is active [interview 4]