You need to be at the top of your game to protect your residents, as COVID-19 outbreaks erupt in the major cities of Australia.
But is every IPC lead on top of it all? Or are some people struggling?
Read on to find out.
The Background to the IPC Role
At the end of 2020, the Royal Commission released a special report on COVID-19. It called for an infection control manager in every aged care facility in Australia.
We consider that the ideal model is for each aged care home to have at least one dedicated ‘infection control champion’. … This is a model that should be spread throughout the sector without delay.
~ Royal Commission, Aged care and COVID-19: a special report
The government accepted the recommendation.
They ‘provided funding of $217.6 million to residential aged care providers’ and required all sites to engage an IPC lead.
The Department of Health has strict requirements for training and qualifications:
The IPC lead must be a designated member of the nursing staff who has completed an identified IPC course (or initially is in the process of completing). This requirement has been placed at nurse level (RN or EN) in recognition of the need to be involved in the clinical aspects of a service, level of expertise expected and ability to have influence at a service.
Most Australian aged care homes now have an Infection Prevention and Control lead.
But what do the nurses themselves think of their new role?
We interviewed seven IPC leads from New South Wales to find out.
A Wide Range of Opinions
“The role’s a formality for me, just a new title.”
“I already knew most of the training.”
“I don’t have a clear role description.”
“It’s a big learning curve.”
“It’s a challenging role, because it’s so new.”
Ranging from ‘it’s a breeze’ to ‘it’s a nightmare’, there could hardly have been a wider spectrum of feelings on the IPC lead role.
The nurses’ opinions correlated with their facility’s awareness of infection control. The less their organization knew, the more difficult their new position was.
You could be in this situation, thinking, “It’s too much work. Maybe I’m just behind everyone else! I don’t know how to do this.”
You’re not alone.
Our interviewees had pressing problems with their role, their coursework, and the practical application of their newfound knowledge.
Let’s explore those problems.
Problems with the Role
Hong Kong’s Elderly Health Service conducted the first infection control audits in residential aged care in 2003, in response to a SARS outbreak.
The first aged care IPC officer was commissioned in Hong Kong shortly after these audits.
It wasn’t an easy role then. Now it’s harder, demanding modern tech skills paired with communication and nursing experience.
Infection Protection and Control occupies a unique position in the field of patient safety and quality universal health coverage since it is relevant to health workers and patients at every single health care encounter.
The advent of medicine and the pace of change have called for new demand of the infection control nurses. These demands are demands for computer skills, report generation, application of infection definition and epidemiology.
~ Helena Li, President, Hong Kong College of Medical Nursing
In Australia, this challenging job was created by the pressures of a global pandemic and Royal Commission.
It’s new. It’s unfamiliar. And for several of our interviewees, it’s still ill-defined.
Problem 1: No Clear Role Description
Four of our seven IPC interviewees said they had no clear role description.
One said management held them responsible for all infection-related issues. Another focused on administering vaccines and outbreak crisis management.
The responsibilities description provided by the government is short and nonspecific.
…observes, assesses and reports on IPC of the service, and assists with developing procedures/provides advice within the services.
This is consistent with of the ‘non-prescriptive’ approach that defines the current Aged Care Standards. Facilities must decipher these broad terms and turn them into practical solutions.
The Royal Commission’s Final Report criticized this language, and the Aged Care Standards are destined to be reviewed.
What Should You Do?
Be proactive.
Go to your supervisor or committee, and ask what you’re directly responsible for, and what you should be doing every day. Work with your management team to get a role description written.
To start you off, here’s the definition from the current Hong Kong Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly:
The responsibilities of [Infection Control Officers] include:
- Coordinate and oversee all matters related to infection control and the prevention of infectious diseases in the [aged care facility]
- Disseminate updated information and guidelines on infection control to all staff and residents in the [aged care facility] and to orientate new staff to the updated information
- Assist the home manager in arranging training on infection control for staff
- Assist the home manager in overseeing that the infection control guidelines are being observed and implemented properly, including the observation of personal, environmental and food hygiene
- Oversee that all medical equipment and other instruments are properly disinfected after use, and soiled linen and wastes are properly handled and disposed of
- Assist the home manager in arranging the provision of the necessary PPE and advise and supervise staff on the proper application and disposal of PPE
- Observe for signs and symptoms of infectious diseases (such as unusual clustering of fever, upper respiratory tract infection or gastrointestinal symptoms) in residents and staff
- Assist the home manager to report cases/ outbreak or suspected cases/outbreaks of infectious diseases to [the relevant authorities]
- Provide information as necessary to [the relevant authorities] to facilitate investigation; and collaborate with [the relevant authorities] to contain the spread of the infectious disease
We’d add one simple item to this list:
- Look for outside expertise. Your hygiene partners and suppliers should be able to provide you with insights on best practice for various practical areas.
Problem 2: Unlimited Responsibilities
One of our interviewees from independent homes identified another issue.
They said, “whatever suggestion I make, total responsibility for policy, procedures, training and implementation lands back on my shoulders.”
Unclear responsibilities in the workplace are recognized to lead to stress, conflict and even burnout.
The new requirements for reporting added to the burden. Even experienced IPC leads were struggling with the new processes such as:
- The desktop audit by local health district
- The unannounced quality agency audits
- The required outbreak management plan
What Should You Do?
Speak up.
Tell management that you need to have clear responsibilities, so all infection control tasks are completed. You can follow the RACI model, which goes like this:
Responsible for: which people are responsible for carrying out the task.
Accountable for: the person accountable for the completion of the task. They can delegate responsibilities but are ultimately accountable. (One person only)
Consulted on: the people that are consulted before and during the task – offering advice but not directly involved.
Informed about: those that are reported to about the progress of the project/task.
Also, share the load.
Your quality team are there to help, and are familiar with drafting policy, procedures and implementation plans.
They can work with you to go through current policies and make additions and amendments, as well as outlining plans.
They may also be used to working with the local health district and quality agencies, so don’t be afraid to reach out for help.
Again, use your hygiene partners, if they offer infection control support that can reduce your paperwork or help with problem-solving.
Problems with the Training Courses
The federal government released a COVID-19 focused online training course, to be completed by all IPC leads, by 31 December 2020.
Then the government required every IPC lead to complete an approved Infection Control course by 28 February 2021.
We’ve had some feedback on the training from several IPC leads.
Their opinions were varied, from “This was a ticking boxes exercise” to “it’s a 6-month course compressed into 3 months. Not easy!”
Problem: Accelerated Course
Several IPC leads were struggling with the accelerated courses.
Our interviewees considered the 80-hour course useful, but difficult to complete within the timeline. The time limits especially constrained those nurses who were unfamiliar with the subject.
If the IPC lead lacked a relationship with the quality team, the training was likely to be difficult for them.
Depending on the individual, the focus on online coursework was also challenging. One interviewee said that it was difficult to get used to being on a computer most of the day, instead of having an active nursing day.
What Should You Do?
Use the expertise you have on-site.
Your clinical team has years of experience, so talk to them about the training you’re getting. If you don’t understand a subject, they’re likely to be able to help.
For further help, reach out to Infection Prevention and Control colleagues in the aged care and even hospital industries.
Your hygiene partners will be able to help with product-specific training and best practices for the use of cleaning chemicals.
Problems with Practical Application
Less seasoned IPC leads were hoping for a specific, practical, and easy-to-access source of knowledge. Instead, they got a course described as ‘piecemeal’, without significant practical applications.
Several of our interviewees struggled to teach their newfound knowledge of infection control to staff.
Problem: Lack of Practical Information
Cleaning to reduce levels of infectious pathogens is a key part of infection prevention and control. However, the training courses didn’t instruct IPC leads how to advise cleaning teams for different situations like virus outbreaks and urine spills.
Likewise, a big part of their job during this global pandemic is to contain outbreaks if they do happen.
However, information about operations during outbreaks of specific diseases was scattered across many modules. IPC leads didn’t have a comprehensive document on how to manage the different outbreaks.
What Should You Do?
You’ll find practical guidance across government documents, online resources, and advice from your hygiene partners.
We’ve collected some useful resources here:
- https://www.health.gov.au/initiatives-and-programs/infection-prevention-and-control-leads
- http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF
We’ll be creating a troubleshooting book for many of the common, difficult infection control situations in aged care. We’ll also gather best practices for general and specialist cleaning scenarios into several guides.
Make sure you don’t miss out on these crucial handbooks. Subscribe to our newsletter on the form to the right.
Summary
An online, accelerated course can’t replace years of experience in infection control, and that’s not your fault. If you’re struggling with your new role, you’re not alone.
It’s a substantial change to many facilities, especially because it is government enforced.
But by capitalizing on your relationships in your organization and the healthcare industry, you will become familiar with infection control, and your facility will be protected.
Supplier relationships are also important. Some suppliers freely share their knowledge about infection control. Make sure you’re benefiting from their practical advice!
(If you hold an account with Veridia, you have access to all our 20+ years of accumulated information. Just ask our friendly support staff.)
Struggling with your new infection control job? Leave your name below for compliance support, practical tips and direct problem-solving.
* References
- Briggs, L., Pagone, G. (2020) Royal Commission into Aged Care Quality and Safety Aged care and COVID-19: a special report, Australian Government, 2020. Page 24. Found at: https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/aged-care-and-covid-19-a-special-report.pdf
- https://www.health.gov.au/sites/default/files/documents/2020/11/australian-government-implementation-progress-report-on-the-royal-commission-into-aged-care-quality-and-safety-report-aged-care-and-covid-19-a-special-report_0.pdf
- http://www.hkicna.org/Issue/issue35.pdf
- Department of Health, Hong Kong SAR Government. Guidelines on prevention of communicable diseases in residential care home for the elderly (3rd edition). Available from: https://www.chp.gov.hk/files/pdf/guidelines_on_ prevention_of_communicable_diseases_in_rche_eng.pdf. Accessed 8 Jan 2019.
- https://www.thoughtfulleader.com/unclear-roles-and-responsibilities/
- https://www.alembicstrategy.com/strategic-thinking/conflict-resolution-week-4-unclear/conflicting-roles
