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Currently, Caroline comes to the hospice each week and visits the inpatient unit, the Hospice in the Home team, Virtual Ward, estates and health & safety, checking in with each team and ensuring that PPE is fit for purpose and being worn correctly. She also gives individual staff time and space to discuss any of their infection prevention and control (IPC) or PPE queries or concerns.
Behind the scenes, Caroline is always on hand to forward new guidance and information, discuss any challenges and make practical suggestions to keep IPC procedures simple yet effective.
I have aimed to bring about a greater understanding of infection control and its application not just in clinical care but the other areas that impact on the health and wellbeing of patients and staff, for example environmental issues, water safety, food hygiene, ventilation.
The IPC policies have all been updated and brought into line with the acute sector and follow national guidance. For example for cleaning we use a detergent/chlorine combination together with a microfibre cleaning system which ensures greater cleaning and disinfection efficacy.
Discharge cleans have been colour coded to ensure understanding. The everyday cleaning is ‘green’, a discharge clean is ‘amber’ and a discharge clean from a patient with a known infection is ‘red’ (curtains are changed in addition to the cleaning and clearing of the room).
Staff have received training to better understand the chain of infection and the IPC measures that break that chain. For example a patient with an infection needs to be isolated in their room but, should they request an assisted bath or to visit the garden, it is our responsibility to try and make that happen in a safe way. It is all about understanding the chain of transmission, how to break that chain by employing IPC measures and risk assessing the individual situation.
In general IPC at St Helena has been updated and regulated to bring it in line with NHS acute trusts both with regard to application, reporting and assurance. This has been done without detriment to the relaxed, welcoming atmosphere within the hospice.
Proper social distancing, effective ventilation and fresh air, hand hygiene and remembering to keep hands away from face. Mask wearing is important and I think that will be with society for the foreseeable future.
In clinical settings it is the above plus the proper use of safe and effective personal protective equipment including visors to protect the eyes. The virus gains access via the mucous membranes and people focus a lot on protecting the nose and mouth but the evidence is available to show the importance of protecting the eyes too.
Clearly these factors are helping but the success is multi-factorial, i.e. all of the above, combined with an effective vaccination programme and people taking responsibility and complying with the guidance.
I think people have realised how effective good IPC can be. For example, it was previously unheard of to go through a winter without reports of outbreaks of Norovirus or flu, as has happened this year. People are very much more aware of the importance of effective and timely hand hygiene. I imagine that everyone has seen their household consumption of soap go up and that tells you something.
With regard to Covid-19, I suspect this is only the beginning and as a society we have had a huge wake-up call as to how we live, animal welfare, how prepared we are for such eventualities. SARS (2002), H1N1 Flu (2009) and MERS (2012) were the warm-up acts so the fact that, as a country, our emergency stock hubs were not kept up to date and supply rotated through should be a big take-away lesson. There is no room for complacency.
I think IPC practices will become embedded in everyday life, not just in the clinical setting. That will happen in the short term definitely but for how long is an open question. The pandemic has undoubtedly changed our lives and hopefully made us appreciate some of the things that might have been taken for granted: seeing friends, physical contact, freedom to travel.
IPC is everyone’s responsibility and success relies on people’s co-operation and doing the right things at the right time. People don’t always see that their one omission or shortcut has an impact because the result is not immediately obvious, for example you will never know whether the one time you skipped washing your hands spread an infection because that infection won’t materialise for several days. It is important to practise routine IPC all the time to keep yourself and your family and patients safe.
I love being involved with new building or building refurbishment work. Working alongside architects and engineers to ensure that good infection control is built into the physical clinical environment is very satisfying.
Over my career I have been fortunate to be involved in several major projects including an oncology day care and chemotherapy unit and a cardiac centre. Sometimes it involves quite technical decisions such as ensuring the appropriate ventilation and air turnover depending on the building use. Other times it can be quite straightforward, for example designers love uplighters because they give a softer, calmer and more diffused light. That might be fine in a domestic setting but they gather dust (MRSA, Staphylococcus aureus and multiple other organisms live and survive in dust) and so are not appropriate for any clinical setting.
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