Journal of Infection Prevention

Group B streptococcus (GBS) is the commonest cause of early onset sepsis in UK newborns. Several risk factors for early onset GBS sepsis (EOGBS) have been described. The presence of these risk factors provides an opportunity for intrapartum antibiotic prophylaxis (IAP) and forms the basis of current UK EOGBS prevention guidance. Having observed poor compliance with national guidelines in a review of EOGBS cases within the UK Neonatal Infection Surveillance Network (NeonIN), we reviewed 14 NeonIN unit guidelines. We found substantial variation in recommendations within and between units on indications for IAP and treatment of asymptomatic neonates, and discrepancies between obstetric and neonatal guidelines, potentially increasing infants’ risk of infection. The lack of high quality evidence in this area and related ambiguity in national guidance may have contributed to diverse local approaches. A common approach would permit prospective evaluation of an EOGBS prevention strategy, generating an evidence base to benefit future guidelines.

We describe a quality improvement programme used in a large teaching hospital trust to reduce the number of hospital acquired blood stream infections (HA-BSI) relating to vascular devices. Our strategy included the appointment of a lead nurse whose role was to engage with clinicians, to develop guidelines, to standardise and facilitate good practice, to train to uniform standards, and to retain local ownership, while working to avoid risk compensation. Information was gathered using our laboratory data search system, as well as observation and audit of vascular access device practice. Vascular access device training became part of all induction and update programmes for clinical staff.The results showed a significant and sustained decline in frequency of patient episodes of HA-BSI. The numbers of patients from whom coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Klebsiella and Enterobacter spp. were isolated in any given month all declined significantly. The numbers of patients with positive blood cultures with Escherichia coli did not decline. The improvement has been sustained for more than 3.5 years. This study shows that when standardisation, facilitation and education are developed with stakeholder involvement, it is possible to achieve a sustained reduction in the incidence of vascular device associated infections.

This four-phase evidence-based practice initiative was designed to determine preliminary contextual characteristics of collegian nursing students in receiving, or their lack of receiving, the flu vaccine. Subsequently, strategies were developed to improve and maintain the students’ participation in flu vaccines.

This study relates to the welfare of student nurses and patients in their care. Students perform patient care in hospitals, clinics, and other settings where patients in compromised health are especially vulnerable to influenza. The Centers for Disease Control and Prevention reported that the 2009 H1N1 pandemic resulted in more than 12,000 influenza-related deaths in the US. The Joint Commission requires hospitals and long-term care facilities to provide on-site access to influenza immunisation to staff and licensed independent practitioners; however, no provisions for student nurses are specified. Employer-mandated influenza immunisation as a term for employment was associated with a significant increase in healthcare employees receiving the flu vaccine, but, in the main, students are currently not mandated to receive the flu vaccine. A one-day reduction of influenza-like illness for every two college and university students vaccinated has been reported. Therefore, improving influenza immunisation rates may have academic and performance benefits for nursing students.

A model was developed by an infection control department to assist in the delivery of change and innovations in a challenging and complex organisation. It was entitled UNIFIES and was based on the experience gained on previous projects to introduce and sustain changes in practice. The methodology and application included lean systems and social marketing principles. The model takes into account the requirement for leadership, teamwork and time to participate. The use of metrics to determine progress, success, failure and lessons learnt are a keys aspect of the model.

The purpose of this study was to evaluate nurses’ knowledge of infection prevention procedures, the degree to which they were applied correctly, and whether length of service affected either knowledge or application. Nurses with over five years of experience had significantly increased understanding of infection prevention (p=0.009) and significantly increased application of knowledge to practice (p=0.001), compared to nurses with five years or less experience. In particular, understanding of hand hygiene and use of personal protective equipment (PPE) was poor although application was compliant, while knowledge of care of patients with meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile was poor, which was reflected by substandard application of knowledge to practice. The results of this study suggest that focusing infection prevention education around patients with specific infections, such as MRSA and C. difficile, rather than on individual standard precautions may more effectively increase knowledge and therefore application of infection prevention practices.