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Critically appraise the principles and practices of infection prevention and control in health care and/or social care settings appraise findings of audit(s) relevant to infection prevention and control

`Infection Prevention and Control` (IPC) 

Welcome to the `Infection Prevention and Control` (IPC) module. You can find the module dates in the `Module information` section of Blackboard, and details of this module`s assessment under the `Assessment` section. The IPC module has nine units of learning and week 10 is for you to work on your assignment before submitting it in week 11. You can work through the materials at your own pace. During the module, you will work with a module leader, or a member of their team, who will facilitate the discussions and guide you through the programme.

This important module is shared across subject disciplines related to health and nursing. The module attracts a wide range of professionals involved in the provision and delivery of a global, changing and expanding health care agenda. It is therefore highly likely that you will be studying with students from a wide range of backgrounds who may have different experiences and interests to you. They will live in different parts of the world and will have very different roles relating to infection prevention and control. This is an ideal opportunity for you to gain a global understanding.

On successful completion of this module, you will be able to:

Critically appraise the principles and practices of infection prevention and control in health care and/or social care settings appraise findings of audit(s) relevant to infection prevention and control develop recommendations for practice based on audit findings

Apprenticeship information

Information only for those students studying this module as part of the Enhanced Clinical Practitioner (ECP) Apprenticeship.

If you are studying this module as part of the enhanced clinical practitioner apprenticeship. As you work through this module you will be gaining knowledge, skills and behaviours (KSBs) to contribute to your apprenticeship progression.

This module enables you to make progress towards the following KSBs:

Knowledge

 K1: Tools and techniques used to systematically search, select and present evidence.,

 K2: Techniques to critically appraise evidence such as local and national quality standards and frameworks and ways to relate this to own practice.,

 K3: Requirements of their on-going professional registration and code of conduct in relation to their scope of practice such as when and how to escalate or refer in line with defined scope of practice.

 K5: Legislation, clinical frameworks, contemporaneous evidence-based practice guidelines, outcomes from clinical audit and algorithms to support decision making.,

 K6: Anatomy and physiology and pathophysiology to support complex holistic patient assessment including the underlying psychological, social and long-term impact of illness.  K7: Tools and techniques to critically evaluate clinical information to inform decision making and care management planning.

 K8: Underpinning anatomy and complex applied physiology, disease, toxicities, treatments and interventions which guide the selection of specialist diagnostics.

 K9: Methods to support complex intervention decision making aligned to national and international guidelines.

 K10: Principles and theories of co-production, health coaching, peer support and self-management used to build knowledge, skills and confidence to enable patient self-management.  K11: Diverse sources of information and evidence to underpin decision making and techniques to interpret and assimilate a diverse range of information and evidence.

 K12: Principles and theories of coaching used in supporting others in complex clinical decision making and care delivery.,  K17: Principles of different communication strategies and theories, communication modes (written, digital, verbal, nonverbal) and clinical communication tools.

 K18: Models and theories for negotiating and mediating, such as de-escalation and diffusing strategies.

 K19: Communication strategies and tools used to share complex information with different audiences and individuals.  K21: Local and national approaches and planning processes to support quality improvement.

 K27: Principles of psychological well-being, the importance of maintaining own and others well-being and counselling techniques used within own scope of practice.

 K29: Strategies to plan and prioritise resources and manage immediate and longer-term service requirements.

 K30: Local, regional, and national strategic priorities for patient populations within area of specialist practice.

Skills

 S1: Conduct systematic literature searches to source evidence to inform enhanced clinical practice.

 S2: Critically appraise evidence and use findings to plan and provide enhanced patient-centred clinical care.

 S3: Provide enhanced clinical care in line with professional registration, code of conduct and defined scope of practice, being responsible and accountable for own decisions, actions and omissions.

 S4: Select available tools, technologies and techniques needed to perform complex and holistic.

 S5: Assimilate, synthesise and apply complex information to promote and advocate best interests of others, upholding the principles of safeguarding and evidence-based practice.  S6: Undertake holistic patient-centred assessments using available tools, technologies and techniques.

 S7: Analyse the data arising from the assessment process to inform clinical decision-making.

 S8: Identify, request and interpret specialist diagnostics within own scope of practice to inform the delivery and management of specialist care for patients and families.

 S9: Develop, implement and evaluate an enhanced care management plan which may include interventions and referral to other members of the multidisciplinary team or other agencies.

 S10: Prepare and support patients and families to manage their own health and care as independently as possible.,  S11: Interpret, assimilate and draw conclusions using diverse sources of information and evidence to inform clinical reasoning.,

 S17: Use communication strategies suitable for a variety of situations including sensitive and distressing topics., S18: Use strategies to manage conflict and challenge., S19: Discuss complex information with patients, their families, the multi-disciplinary team and other agencies.,

 S24: Identify and act on evidence of unexpected change or patient deterioration within own scope of practice,  S25: Manage self and others in unpredictable and complex environments, instigating clinical interventions where protocols may not be available.,

 S26: Identify and manage risk to patient safety and others in an unpredictable and complex environment.,

 S27: Counsel patients, family, carers and others to manage psychological well-being of self and others.,

 S28: Contribute to efficient resource management within the workplace.,

 S29: Plan, prioritise and deliver enhanced clinical care within a defined resource.

Behaviours

 B1: Treat people with dignity, respecting individual`s diversity, beliefs, culture, needs, values, privacy and preferences., B2: Show respect and empathy for those you work with., B3: Be adaptable, reliable and consistent.

You can find out further information about your KSBs on the Institute for Apprenticeships and Technical Educations (IfATE) website (2021)

Studying this module

One of the ways the world is changing is that we now have various multi-resistant micro-organisms.

In addition, every day people become sick or die due to being infected by common pathogens. Some of these are acquired when they are in health care settings. Attempts at preventing infection spread, and controlling it, seem more and more important. This module sets the foundation for you to reflect upon your knowledge, skills and competencies in this area. It enables you to improve your knowledge and to make plans to be even more effective in your dayto-day roles and caring activities.

Learning in this module

During this module, you will learn about a wide range of factors and issues that contribute to the study of IPC. You will study areas such as the aims of IPC, the basic concepts, relevant areas of concern, pathogens, pathogenesis, diseases, treatments, the cycle of infection, actions to prevent infection, different sectors and agencies, audit, roles and responsibilities, and communicating about IPC to others.

If you are studying this programme as part of the Enhanced Clinical Practitioner apprenticeship there will be additional information relevant to your apprenticeship under the banner `Apprenticeship information` . There will be information relevant to the duties and KSBs of your apprenticeship standard as well as opportunities which will help you prepare for your End Point Assessment (EPA).

Structure of learning

Each of the units within the module will have a similar structure. We know that, dependent on your current knowledge and skills base, you will all be at different stages now. Thus, you can work through the materials in the ways that work best for you.

This module will be predominantly self-paced but will also use collaborative learning. You will be asked to contribute to social learning spaces such as discussion boards to enable you to feel part of the learning community. Engaging with the module materials on a regular basis, completing the activities and spending time undertaking some of the extended learning opportunities will support you in writing the assignment. The extended learning opportunities are not compulsory, but they are designed to help you develop your knowledge further in preparation for this and other assessments. A key feature of writing at level 6 is the ability to write critically. It is important that you take the opportunities within this module and access resources that are signposted throughout the units to develop this skill. This will also support your progression to master`s level and beyond.

Skills you will develop

When working in your clinical role, it is likely you will work with your colleagues and will develop your IPC skills in many different ways. We hope that the materials you will access and analyse will be useful to your IPC practice in many ways. However, we obviously cannot actually assess you on these in this module. In addition, whilst studying this module content, you will engage with the following graduate and digital skills. These have been woven into the assignment, so you have the chance to develop:

graduate skills, such as:

1. awareness of global issues
2. development as a global citizen
3. lateral thinking and innovation
4. undertaking audits
5. analysing audit data to create a service improvement plan digital skills, such as:
   1. using online networks
   2. appraising online information
   3. searching for appropriate literature, including the use of enhanced search tools

Assessment

Figure 1.1: Assessment

Image source: Wikimedia Commons (Accessed on 02.07.2023)

There will be formative and summative assessment opportunities within this module. All the different activities and assessments are designed to enable you, on completion of the module, to demonstrate that you have met the following learning outcomes.

On successful completion of the module, students will be able to:

1. critically appraise the principles and practices of infection prevention and control in health care and/or social care settings
2. appraise findings of audit(s) relevant to infection prevention and control
3. develop recommendations for practice based on audit findings Formative assessment

Formative activities are opportunities for you to apply, practise and make sense of the learning materials and content that you have encountered. Formative learning activities, such as practice examples, video exercises and reflection points are made available. These activities are not graded but, if undertaken, will help you to work towards success in the summative assessment.

In this module, you can expect your tutor to encourage you to engage in the identified formative activities of the module and to provide swift and detailed feedback on your work from these activities. This will take the form of reviewing and commenting on some of your Personal Journal entries and Discussion Board contributions throughout the module. Your module tutor will also perform engagement checks using the Blackboard platform to run reports. These reports will show how often you have engaged with the learning materials and for how long.

Summative assessment

Summative assessments are the pieces of coursework that you complete which contribute towards your final grade in this module. You should take the feedback that you receive from the completion of your summative assessment in this module and use it to help you improve your performance in future assessments.

The summative assessment for this module is to:

Create a service improvement plan based on the findings of an infection prevention and control audit (3,000 words).

You can find further information about your summative assignment in the assessment section of this module.

Extended learning opportunities

At the end of each unit of learning you will find extended learning opportunities. These are not mandatory but are designed to help you develop your academic writing skills and deepen your knowledge and understanding in relation to the topic studies in each unit.

As you have already learned, service improvement is entwined with the cycle of audits. Service improvement is not a new concept and, like audits, it can be used to improve standards, make better use of available resources, streamline services and reduce clinical errors (Craig, 2018). Yusefi et al. (2022, p.131) highlight that one of:

the main missions of healthcare organizations like hospitals is to provide quality services to meet patient expectations.

The reason for this is that it can reduce the length of hospitalisation or the need for care and increase patient satisfaction. Patients continue to demand higher quality services which health care systems are required to provide with finite resources, and thus the need for service improvement initiatives continues to be a necessity.

Achieving service improvement can feel like an arduous task. However, the key is in the preparation. Helping staff to feel empowered to embrace change is critical in ensuring that your service improvement plan will be successful. By encouraging continuous service improvement and acting as a change agent, you can motivate others to embrace the changes required. Critically appraise the principles and practices of infection prevention and control in health care and/or social care settings appraise findings of audit(s) relevant to infection prevention and control develop recommendations for practice based on audit findings

Identifying an area of improvement and developing a plan to do this are only part of the journey in service improvement. The use of a change model with service improvement is an important consideration if you are wanting staff to embrace the change you are planning to introduce. Service improvement in England is a part of the NHS change model (figure 2.2) which was developed to enable stakeholders to create informed systematic and sustainable approaches to improving the quality of care (NHS England, n.d.).

Figure 2.2: The NHS change model

Image source: NHS England (2018) (Accessed on 23.08.2023)

The model is a combination of eight components, all of which should be considered when implementing change. These include the following:

1. Our shared purpose - The shared purpose is what happens when a group of individuals come together to create a shared goal or value. The purpose is about why we should change. It acts as the guide and driver of any decisions. It is important to find this shared purpose before proceeding with any project. When thinking about service improvement you should engage stakeholders to create a common goal for your project. This will mean creating a safe space for your discussions and coproducing an action plan to motivate people to be involved.
2. Spread and adoption - This is about supporting the successful spread and adoption of any change. Most service improvement projects are designed to improve the quality of patient services or experiences. This is about using existing evidence to inform our plans to make them fit for purpose. It is about enabling everyone to actively share and adopt best practice from others.
3. Improvement tools - Improvement tools provide an underlying structure for change. By using an evidence-based methodology, change can be developed in a tried and tested way. There are many models and tools available to support an improvement project for health care. You might use the `Plan, Do, Study, Act` model (discussed later in the unit) to support your improvement.
4. Project and performance management - This is about creating a clear plan of action, targets and milestones with ongoing reviews. Project and performance management can increase the likelihood that changes will deliver the planned benefits of the project. When thinking about service improvement, you should be asking key questions such as `how will I share my plan and with who?` `Are the targets and milestones achievable?` `What are your key performance indicators?` `Have you set clear deadlines?`
5. Measurement - Measuring the outcomes of change is essential to provide evidence that the change is being implemented successfully and it is having the desired effect. When thinking about your service improvement plan, consider what you are going to measure to know if your change has been successful.
6. System drivers - These are the factors that increase the likelihood of changes being successful - for example, are there incentives or rewards, or penalties to be avoided? In reducing its carbon footprint, for example, an organisation might offer the use of free public transport as an initiative to get employees from train stations to their place of work. System drivers are the tools and enablers that allow systems to work. If they are misaligned, then changes are unlikely to be successful. System drivers may be intrinsic, such as curiosity, autonomy and belonging, or extrinsic, such as money, fear of failure or competition. A balance of intrinsic and extrinsic drivers will mean the project is more likely to be successful.
7. Motivate and mobilise - This is enabling and motivating stakeholders to act and become part of the change. It is about educating them and creating energy to drive the project forward. To be successful, you will need to understand what motivates those affected by the change, why it matters to them and why they need to make the change happen.
8. Leadership by all - These are the skills and behaviours you need to lead a significant change. This model is based on the theory of shared leadership, which means that it generates commitment to a shared goal which is developed through collaboration. They role model leadership behaviours, skills and attributes whilst setting a high ambition for performance. The NHS healthcare leadership model comprises nine dimensions designed to help people develop as leaders. You can find further information about the health care leadership model on the NHS website.

(NHS England, 2018)

In the UK, the National Institute for Health and Care Excellence (NICE) (2018) has developed a practical guide for improving the quality of care and services. This guidance has broken the process down into six achievable steps:

Step 1: Be informed - When you are thinking about a service improvement plan, then you need to know what works based on the best evidence available to you about best practice in that particular area. You can use guidance such as that issued by NICE to inform yourself about best practice.

Step 2: Take the lead - Anyone can take the lead when making a service improvement. When considering how to make a change for service improvement, start by looking at your own ways of working. Consider who you need to work with - is it a small area or will you be working across organisations?

Step 3: Understand current ways of working - This is about measuring your baseline and what happens now. This can include undertaking an audit against best practice guidelines. You should ask questions such as `exactly what happens now?` `What is the impact on patients?` `What outcomes are you measuring?` `Why are the outcomes important and who are they important to?` At this stage of your project, you need to gather information and record the results so that it is easy to share the current picture.

Step 4: Make a plan – Any service improvement requires change and people can be very fearful, no matter how small you think the change may be. Think about running a pilot to test your ideas. Use `Plan, Do, Study, Act` to help you test your ideas. Encourage people to work collaboratively through action learning, education and empowerment.

Step 5: Improve and measure - Now you should carry out the actions that you have identified. Ensure that you keep lines of communication open, making sure that you listen to the feedback and answer any concerns. Always consider what is working well, how staff and service users feel and whether anything can be improved.

Step 6: Keep going - Remember to reflect on what you have achieved. Share the success and talk about how much everyone has achieved together. Sharing success helps to motivate people and can lead to further service improvement projects. You can use local media or social media to share the improvements with the wider public .

(NICE, n.d.)

When introducing a service improvement plan, it is important that you fully understand how to implement change. You can read more about each of the steps by accessing the guidance, `Practical steps to improving the quality of care and services using NICE guidance`.

We now need to consider models of service improvement to be able to effect changes in practice.

Models of service improvement

There are many models of service improvement available for you to use. In this unit we are only going to explore two of them. NHS England (n.d.) has a full range of quality, service improvement and redesign (QSIR) tools for you to explore. Some of the tools are better suited to service improvement than others, so ensure that you read them carefully before deciding which tool is most suited to your own project.

The Plan, Do, Study, Act model

The PDSA (Plan, Do, Study, Act) tool is designed to provide a framework to support you in developing, testing and implementing the changes necessary for service improvement. It can be used when you are planning any work changes or improvements.

This tool has three key questions (shown in figure 2.3) to be answered before testing service improvement and change ideas. These three questions are:

1. What are we trying to accomplish? (the aims statement)
2. How will we know if the change is an improvement? (the measures of success we will use)
3. What changes can we make that will result in improvement? (the change concepts to be tested)

Once the questions are answered, there are a further four stages to the PDSA cycle - Plan, Do, Study and Act - as shown in figure 2.3 below.

Figure 2.3: The Plan, Do, Study, Act cycle

Image source: Adapted from NHS England (n.d.) (Accessed on

23.08.2023)

Let`s look at the model in more detail, starting with the questions:

Question 1: What are we trying to accomplish? You need to set clear goals about what it is you are trying to achieve, including measurable targets. The goals require leadership and should focus on a problem that causes concern. You should include both patients and staff in setting your goals to help stakeholders feel engaged in the process and motivated to embrace the necessary change. Goals should be bold in their aims and have relevant timelines.

For example, an aims statement could be:

to improve access, speed of consultation and treatment at the GP surgery by:

 to introduce online booking systems for patients - Target: more than 85% of patients

 to reduce the length of appointment waiting times to a maximum of five working days for 95% of patients

Question 2: How will we know if the change is an improvement?

To answer this question, you will need to measure outcomes. For the example given above in question 1, this could be: How many patients are able to access and use the online booking system? How many patients can get an appointment within five working days?

Question 3: What changes can we make that will result in improvement?

The changes you could make may be limited or bountiful, depending on the service improvement goal. In the example given above in questions 1 and 2, changes could be:

 introduction of the NHS app to enable patients to book appointments and manage their own health care

 increase the number of clinical staff available - this might be GPs, advanced clinical practitioners, enhanced clinical practitioners or physician associates, for example

 increase the number of emergency appointments available each day to aim to reduce waiting times for access to primary care services

Once you have answered these questions, you are ready to start the PDSA cycle.

Plan – At this stage of the cycle, you will need to list the tasks you needed for your service improvement , identify the person responsible for each task, when it is to be done by and where it is to be done. This involves all aspects of the improvement from the practical use of resources to education of staff and patients. This could include the use of audit information to inform your planning.

Do - You are now ready to run the test.

Study - Describe what happened when you ran the test. You also need to describe the measured results - how did they compare with your predictions/targets? What did you learn from the cycle?

Act - Consider what you have learned from running the test and what modifications you will need to make based on what you have learned.

(NHS England, n.d.)

Once you have completed your first PDSA cycle and decided on the changes you need to make, you should then continue with repeated cycles to identify those changes which have the greatest benefit.

Having identified the changes with the greatest benefits for making the improvement, you will then need to undertake a stakeholder analysis and consider project management to enable you to introduce the change across the whole service.

The 6S

The second model for service improvement you are going to learn about is the 6S. This is a visual model (figure 2.4) for improvement that is designed to create and maintain a clean, high performing workplace.

Figure 2.4: The 6S model

Image source: Adapted from NHS England (n.d.)

This model will help you to measure improvement more accurately and is particularly focused on how working environments affect services, as well as helping you to identify where change needs to be made (NHS England and NHS Improvement, n.d.).

The 6S model includes:

1. Sort: remove what is not needed;
2. Set in order: agree what goes where and make it easily accessible;
3. Shine: keep the environment clean
4. Safety: identify and prevent unsafe conditions;
5. Standardise: a consistent process agreed by all
6. Sustain: continually improve

(NHS England and NHS Improvement, n.d.)

Let`s look at the 6S in a bit more detail:

1. Sort: You can involve the whole team at this stage of your project. Clear away anything that is not needed, is broken or is outdated. For example, in relation to handwashing there may be broken soap or paper towel dispensers. Then ask the staff to tag items, using your local systems. For example: green if required, amber for unsure and red for not required or used or that they don`t think are required or used. If staff highlight something is not required, then you should decide whether you are going to dispose of it, replace it or store it.
2. Set in order: Ensure that frequently used items are close by. Arrange items in the best position for day-to-day working. This includes computer filing systems. You could colour code items to show where they are stored. This can reduce error and save time.
3. Shine: Keep the environment clean and decide who is responsible for doing what. Include a chart with signatures to show that whatever the standard is has been completed/undertaken.
4. Safety: Identify and prevent unsafe conditions. Build vigilance into the team about the importance of safety. Ask them to monitor and report any safety issues as they arise.
5. Standardise: Agree a consistent process for everyone The organisation or service improvement lead will need to set standards that are consistent across all areas and teams. This saves time and allows routine tasks to be undertaken in a routine way.
6. Sustain: Sustain is about continual improvement. This is the final step and is concerned with maintaining the standard and removing any obstacles to maintaining the standard. Identify why problems are occurring and work to prevent, reduce or remove them.

If you would like further information about the 6S, you can find it on the NHS website.