The Atlas of Shared Learning

Case study

Improving infection control in nursing care homes using a quality improvement tool

Leading change

Infection, prevention and control (IPC) nurses at Bassetlaw Clinical Commissioning Group (CCG) led the development and implementation of a quality improvement tool for IPC in nursing homes. This has improved patient safety and outcomes and improved staff knowledge on IPC.

Where to look

Care Homes: Infection, Prevention and Control guidance (Public Health England, 2013) is an information resource for care homes targeting prevention and control of infection(s) in care homes. It details that ‘the steps taken in care homes to protect residents and staff from infection represent an important element in the quality of care, particularly as some infections have the capacity to spread within environments where susceptible people share eating and living accommodation. It is also important to be aware of the possibility of infection in residents and for care workers to identify these promptly. Infections acquired in care homes may be serious and, in some cases, life-threatening.’

An internal review undertaken by the IPC team identified a knowledge gap regarding infection control in several care home settings in the area which presented an opportunity to develop practice. This was unwarranted variation in practice.

What to change

The IPC team at Bassetlaw CCG support care home staff and local GP practices with their infection control measures, giving practical advice, support and education to ensure effective infection control processes. This includes supporting policy development, auditing hand hygiene techniques, giving advice on effective barriers to the spread of disease, such as gloves and aprons, and supporting staff where there are outbreaks of infections and clinical support is needed.

In addition to the varying levels of IPC education and training, the audit highlighted variation in infection prevention and control standards used in care homes and inconsistency of how these were applied.

How to change

IPC nurses worked with local care home staff to establish a nursing forum for communication and education. This included representatives from care homes and other key stakeholders as well as experts within Doncaster CCG and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust. The forum reviewed the evidence and the ‘Bassetlaw Quality Improvement Tool’ (BQIT) was developed to support standardised practice. The digital tool has been devised to support care home staff to develop and sustain best practice in infection prevention and control, and ensure a safe environment for residents.

BQIT is an accreditation scheme and to gain accreditation a home needs to demonstrate learning that shows an improvement in standards of practice to acceptable levels, or if already working at a satisfactory level, demonstrate these have been sustained throughout the year. This is assessed and supported by the infection prevention and control nurses at Bassetlaw CCG which permits personalised support to meet the needs of the care home residents, as well as shared learning across the area.

Adding value

Better outcomes – Improvements have been seen in all areas of infection, prevention and control within the care homes following the introduction of the tool and associated training. Before the BQIT was launched, the environmental audits carried out in the homes averaged approximately 70%, whereas now they are maintaining their standards at 90%, with sustained engagement. This improvement is also reflected in the infection rates for the Bassetlaw area where there were no cases of MRSA Bacteraemia in the last two years.

Better experience – Staff report the tool has enhanced communication and partnership working across the IPC team (CCG) and care homes, with successful collaboration. Staff have welcomed a more streamlined audit which allows a swift measure of performance against key areas of work, such as hand hygiene and environmental cleanliness. Care home residents and their families have also responded well to the new approach and are encouraged to contribute to the assessment of standards

Better use of resources – The IPC nurses and care home staff have collaboratively worked towards more informed, knowledgeable leaders and practitioners in IPC. This has enhanced safety in the homes. The BQIT tool can be used to show how practice is improving and associated metrics can be used to demonstrate the numbers of people trained in IPC as well as continued development and knowledge testing.

Challenges and lessons learnt for implementation

Use existing evidence where available – The BQIT tool is a condensed version of the IPC tools and processes used by the local NHS Trusts to prevent and control infections. By using resources already available and not starting from scratch, this can save resources, as well as develop a common language across the different care settings; reducing unwarranted variation in practice.

The BQIT continues to be utilised in nursing homes in the Bassetlaw area and is now embedded as routine practice in the homes.

For more information contact

Sally Spridgeon-Davison
Infection Prevention and Control and Care Home Quality Lead Nurse
Bassetlaw Clinical Commissioning Group