Infection prevention (IP) education is integral to help staff understand the rationale behind measures implemented to prevent infections. There are many areas to cover. Education should be offered efficiently and reach everyone involved, including clinicians, nurses, aides, respiratory therapists, environmental services, engineering, food services, and licensed practitioners.
Then there is content. What should be included or excluded? How much time is needed? Should online courses be offered or live programs? In addition, opportunities arise for new employee orientation, annual staff education, and targeted inservices in the event of an outbreak or a particular internal situation, such as a meningococcal meningitis outbreak or having an Ebola patient in your ICU. The task of providing these education opportunities is daunting.
Many healthcare organizations opt for online training to satisfy annual education requirements where staff view and listen to a slide presentation, taking a quiz upon completion. These modules usually cover isolation practices, tuberculosis, and bloodborne pathogens. But information may not be retained if the staff speed quickly through all of the sections to complete the education related to IP as well as Safety, Hazardous Materials, and other mandatory modules.
Patient and family education is also important. APIC offers handouts for patients and families on a multitude of infection prevention issues1 but who is responsible for explaining them to the patient – the IP or nurse? It is not sufficient to just give a patient or family the information.
A method that is not new but often overlooked due to time and staffing constraints is return demonstration (RD).
A poster presentation at the 2015 National APIC Conference2 demonstrated that RD by the Central Processing Director ensured competency of high-level disinfection practices in non-central processing department locations. Another poster evaluated the effectiveness of simulated training for CVC maintenance.3 Looking back at the the Ebola transmission to two nurses in Texas, it was found the team that admitted and cared for the infected patient had little or no advance training in putting on and removing personal protective equipment (PPE).4 This lack of training could be a common occurrence in many hospitals. The CDC’s current recommendations list 12 steps to don PPE and 21 steps to remove PPE. How can healthcare organizations implement this one facet of education for all indicated staff while also keeping up with surveillance, public reporting, routine education, and all of the other responsibilities of the infection prevention department?
In another example, at one hospital where I worked, central venous catheter (CVC)-associated bloodstream infections increased. The infection prevention team educated the staff, rates decreased for two months, but then increased again. A second program was initiated where every nurse had to demonstrate how to change a central line dressing. This program was quite telling because a very small percentage got every step correct. Each nurse had to do an RD until it was perfect. Needless to say, this method is very time and labor intensive but proved valuable in keeping rates down.
Even with limited resources, the IP and education departments should be given the support to provide continuing education to their staff, not only to prevent infections in patients but also in their personnel. “See one, do one, teach one” should no longer be an option. That philosophy is not adequate for staff to retain skills needed to keep patients safe in this technologic environment. In addition to routine online or live education, these other options should be considered:
- Repeat demonstration is effective but it is not a one-time occurrence. As with all education, the process should be repeated at designated time intervals. Competencies need to be completed, tabulated, and followed up.
- Simulated training using an electronic mannequin is useful in teaching many procedures such as Foley and CVC insertion, among others, though the cost can be prohibitive.
- Sales representatives can be helpful with some projects but IP staff still need to be involved with the process.
Do you have examples of how your institution facilitates all required and optional education?
1. Infection Prevention and You: Materials for Healthcare Facilities. Retrieved from the Internet on July 9, 2015. http://apic.org/For-Consumers/Materials-for-healthcare-facilities
2. Rettig SL, Hoegg CL, Teszner E, Smatheres SA, Satchell L, Sammons J. Ensuring Competency of High-level Disinfection (HLD) Practices in Non-Central Processing Department (CPD) locations. Poster Abstracts / Am J Infect Control. 2015; 43(6), p S22.
3. Bubb TN. Evaluating an Education Intervention of Central Venous Catheter Maintenance among Oncology Nurses. Poster Abstracts / Am J Infect Control. 2015; 43(6), p S37.
4. Klompas M, Yokoe DS. The Ebola transmission paradox. Am J Infect Control. Published online June 11, 2015. Publication stage: In Press Corrected Proof.