Impact of Policy on Practice

The following assignment will analyse an incident observed in a clinical setting it will relate the impact of local, national and international policies in relation to the given incident. The use of a PEST analysis tool as shown in Marketing Teacher (2008) (Appendix “A”) will be used to analyse the incident and explore the particular factors which are political, economic, sociocultural and technological. The assignment will also show the impact of the incident to patients and professionals if it had been different.

The legal issues have been addressed in this assignment as it will at all times adhere to the NMC code of professional conduct: standards for conduct, performance and ethics (2004, paragraph 5. 1) which states that all information must be kept confidential, so therefore names and places have been changed to this affect and trust policies will be anonymised. The incident described was observed within a placement area on a ward which shall be known as Hope ward, which is a day surgery unit within a hospital.

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A nurse who shall be referred to as Helen and the student were completing the Lewisham observation tool (LOT) as shown within National Patient Safety Agency (2007) (Appendix “B”) which is a tool used to complete a hand washing and hand hygiene audit. During this audit Helen and student sat down for twenty minutes and observed the health professionals and other people in the room to see whether or not they used the opportunities available to wash their hands.

Using the LOT the health professionals observed by Helen and the student within the clinical area used every given opportunity to wash or sanitise their hands using either soap and water or the alcohol gel. On the ward was a patient who shall be called Carol who was receiving Infliximab which is an intra-venous medication used to treat auto-immune disorders, Carol was receiving it for Crohn’s Disease. Special care must be taken when treating any patients receiving Infliximab as they are extremely susceptible to infections.

During the twenty minutes observation period a member of the public entered the clinical area and did not sanitise their hands the staff nurse on duty who shall be referred to as Sylvia saw this and asked them politely to use the alcohol gel provided at the end of the ward to clean their hands before they came into contact with Carol. At the end of the twenty minute time period the hand washing audit was completed with a perfect 100% compliance level. Infection control is a very vast subject it incorporates many different factors from hospital cleanliness to hand hygiene.

The aspect to be focused upon primarily within this assignment will be that of hand hygiene. Political Factors There are various international policies regarding infection control and hospital acquired infections (HAI). The World Health Organisation (WHO) (2006) produced a publication for guidelines on hand hygiene as part of the “Global Patient Safety Challenge 2005-2006: Clean care is safer care”.

Within the global consensus guidelines it is recognised that hand hygiene is a worldwide issue that needs to be addressed by each country through Staff education and motivation, adoption of an alcohol-based hand rub as the primary method for hand hygiene, use of performance indicators, and strong commitment by all stakeholders, such as front-line staff, managers and health care leaders, to improve hand hygiene. ” (WHO, 2005) The WHO (2008) have also produced a statement of aims in response to the prevention of infection in health care which sets out a list of objectives to subsequently assist all member states with assistance on fighting the infection epidemic.

There has been a recent long term strategy developed for the surveillance of communicable diseases (European centre for disease prevention and control, 2008) which will endeavour to reduce the incidence and prevalence of communicable diseases in Europe. The need for effective infection control within the National Health Service (NHS) at present derives from a number of different mediated incidents that have occurred in the NHS over the past few years. The main two infection incidents are the clostridium difficile (C.

Diff) cases and deaths at Maidstone and Tunbridge Wells NHS Trust for which the investigation report (Healthcare Commission, 2007) document has been constructed and the outbreaks of Meticillin-resistant Staphylococcus aureus (MRSA) within the NHS. Through these incidents the pressure on the New Labour government has been immense with the public demanding for better infection control within the NHS to eradicate these potentially life threatening infections. The article (Mail Online, 2007) (Appendix “C”) is an example of one of the many media reports on the infection control risks in the NHS hospitals.

In response the government has introduced legislation the most recent of which is still under construction and introduced into parliament in 2007 the Health and Social Care Bill (Great Britain. Parliament. House of Lords, 2007) this bill aims to create one regulatory body for all health and social care called the “Care Quality Commission” which holds greater enforcement powers in infection control. The bill also updates the statute (Great Britain. Public Health (Control of Disease) Act 1984) with the aim of providing a more effective and proportionate response to infectious diseases.

The statute (Great Britain. Health Act 2006) developed certain aspects of the law (Great Britain. Health and Social Care Act 2003) in regards to the previous inspection regulatory bodies. Within the statute (Great Britain. Health and Social Care Act 2003) a regulatory body known as the “Commission for health care audit and inspection” had been developed to oversee the general running of the NHS but did not incorporate any specifics about infection control. Whereas the law (Great Britain. Health Act 2006) specified on a code of practice relating to prevention and control of health care associated infections.

With so much pressure placed on the government about the importance of infection control from an international level and that of the media and public, a new local policy Healthier people, excellent care: A Vision for South East Coast (South East Coast NHS, 2008) aims that by 2011 there will be no avoidable cases of MRSA and less than 2,000 cases of C. Diff. It is influenced by national policies such as Our NHS, Our future: NHS next stage review- Interim report (Great Britain. Department of Health, 2007) and the Health and Social Care Bill (Great Britain. Parliament.

House of Lords, 2007) which places fines on hospitals that fail to meet hygiene standards. The local Trust Policy (2008) based on infection control corresponds with certain aspects of the statute (Great Britain. Health Act 2006) as it sets out eleven duties of the local Primary Care Trust (PCT) which relates to the code of practice included within the law (Great Britain. Health Act 2006). The “Clean your hands campaign” organised by the National Patient Safety Agency (2007) is a nationally organised initiative which is delivered on a local level within hospitals and throughout the community.

This initiative has impacted on the development of local policy (2007) which states that hands should be washed when visibly dirty, before and after routine tasks in the clinical area, before and after any clinical procedure, on arrival and departure from clients homes, before and after touching patients, before and after touching food, before contact with susceptible sites, after contact with blood or bodily fluid, after any cleaning procedure, after bed making, after removing gloves, after removing an apron, after using the toilet, after blowing nose, couching, sneezing and smoking.

This policy will impact on the way clinical practice is carried out and ensures that the transmission of infection is minimised through hands. Economic Factors The publication High quality care for all: NHS Next Stage Review final report (Great Britain. Department of Health, 2008) states that the budget for the NHS in England 1996-1997 was i?? 33 billion it has now risen to i?? 96 billion in 2008-2009, and HAI can place an immense burden on this budget. In 1999 a report The socio-economic burden of hospital acquired infection (Great Britain.

Department of Health, 1999) stated that at any one time one in ten patients contracted a HAI. It also focuses on the financial aspect which states that an average person who contracts a HAI will on average cost i?? 3154 extra out of the NHS budget and the average length of stay through HAI is fourteen daysAH. The estimated amount of days lost through HAI to the workplace is between five and six. This means that the burden placed on the NHS through HAI is severe and the British economy is also placed under stress through sickness days at work.

As alcohol gel and hand cleansing agents are supplied on a local level and prices can vary but the WHO (2006) through a case study suggest that to initially set up a 500 bed hospital with alcohol gel at the end of each bed would cost i?? 3000. So therefore it would be cost effective if just one patient did not contract a HAI. The National Patient Safety Agency (2007) have stated within the “Clean your hands campaign” that through effective hand-washing to reduce the possibility of patients contracting HAI will save the NHS over i?? 140 million and save 450 lives a year.

The epidemiology of HAI varies from country to country as stated within Hawker, Begg, Blair, Reintjes and Weinberg (2005). The possibility for these differences in prevalence and incidence can be related to many factors such as geology, climate, physical surroundings, biological factors, crowding, sanitation and availability of health services. Sanitation which is a mainly economic factor is a very important variable in hand hygiene poor sanitation which can be seen in third world countries increases the risk of HAI. Socio-cultural Factors

There have been many cultural changes to the NHS in regards to hand-washing and infection control the publication Getting ahead of the curve: A strategy for combating infectious diseases (including other aspects of health protection) (Great Britain. Department of Health, 2002) discusses ways in which infection control can be addressed. It includes a need for greater clinical governance, standards, surveillance systems and stronger infection control policies. Another cultural change to the NHS was the implementation of A Matrons Charter: An action plan for cleaner hospitals (Great Britain.

Department of Health, 2004) which saw the development of the matrons role in infection control and the generation of new matron positions across the country. There can be many social and cultural barriers when trying to implement effective hand-washing. Among health professionals the views of hand-washing are very different as is shown by the compliance level on a world wide basis by the report WHO (2006). They also state that nurses are generally more likely to comply with hand-washing policy compared to doctors or health care assistants (HCA).

This view is shared by Priest (2003) who comments upon how doctors move from one patient to another without a thought for cross-infection. As seen in this incident discussed earlier the doctors all complied with the hand cleansing policy so within this clinical area the doctors are mindful of infection control policies and the impact of HAI on patients. Religion and religious beliefs can cause barriers to effective hand hygiene as seen within the Hindu religion as individuals are not allowed to use standard soap because it contains animal fat, this barrier can be counteracted as non-animal fat soaps can be purchased.

Many religions have rules regarding the use of alcohol this causes a great many problems when the hand cleansing product of choice for most health professionals is alcohol gel. Strict Muslims are not allowed to have any physical contact with alcohol and because alcohol gel is absorbed by the skin into the body a Muslim could refuse to use it for religious reasons. Although this is possible there is currently no decisive research to arrive at a conclusion on this aspect of hand hygiene.

A social barrier to effective hand-washing is education, if people do not know the dangers of not washing their hands between patients and before and after procedures they may not comply with guidelines. Also individuals may not recognise the opportunities available for hand-washing. Through the large amount of mediated press on MRSA and C. Diff outbreaks and the campaigns that use posters in hospitals, education levels on the dangers of poor hand hygiene seems to be less of a challenge than it was ten years ago. Technological Factors

There are many technological factors that now influence infection control and hand hygiene. The production of alcohol gel has increased the compliance of infection control policy immensely. Before alcohol gel was readily available in the NHS the major barrier to effective hand hygiene was time. As the use of alcohol gel has been implemented time is no longer a factor in healthcare within the NHS. It only takes a couple of seconds to apply the alcohol gel and allow it to be absorbed by the skin this can be done “on the go”.

Which compared to effective hand washing techniques as stated by Infection control training manual (Great Britain. Department of Health, 2008) that need to take between fifteen and thirty seconds to decontaminate your hands successfully. Another benefit with the compliance level through using alcohol gel rather than other hand sanitizers such as Hibiscrub(tm) and soap and water is the lower cases of skin irritation as stated by Larson, Girard, Pessoa-Silva, Boyce, Donaldson and Pittet (2006).

Therefore health professionals are more willing to sanitise their hands with alcohol gel. There has been a large amount of finance generated into the development of further training in infection control; within the local NHS Trust an infection control online learning portal (On Click) is part of the mandatory training for all NHS staff. This computer based learning tool has derived from The epic project: developing national evidence-based guidelines for preventing healthcare association infections phase 1: guidelines for preventing hospital acquired infections (Great Britain.

Department of Health, 2001) which has enabled all NHS staff to become more aware about the dangers of poor hand-washing techniques and poor infection control. The development of infection control research has been of definitive guidance to the development of policy and has greatly increased the knowledge into effective infection control. Research funding can come from many different areas although with regards to hand hygiene products it usually comes from the producers of soaps and the hand hygiene products according to Boyce, Larson and Weinstein (2002) such as Procter and Gamble, 3M, Johnson and Johnson and Steris.

This can occasionally cause bias among results as the company funding the research wants their product to succeed. There has been a technological development in infection screening, such as the MRSA screening programme that is currently being randomly tested in certain hospitals within NHS Trusts. The policy guidelines Screening for Meticillin-resistant Staphylococcus aureus (MRSA) colonisation: A strategy for NHS trusts: a summary of best practice (Great Britain. Department of Health, 2006) requires for all NHS trusts to expand on their implementation of MRSA screening guidelines and to improve wherever possible.

MRSA screening will eventually become universal procedure for all patients admitted into hospital within the NHS. An article (Lomas, 2008) debates the usefulness of MRSA screening following research into is effectiveness in Sweden where 22,000 surgical patients were studied. The study showed no significant difference in transmission rates with and without MRSA screening. So at present the impact of MRSA screening on hospital admission is un-conclusive. Conclusion This incident described within the beginning of this assignment is a positive one.

Without all of the present health professionals and members of the public washing their hands and using effective hand hygiene procedures at every given opportunity the transmission of HAI would have been possible. In Carol’s case if she had contracted a HAI it would possibly prove fatal as even a simple common cold can cause serious problems for a patient receiving auto-immune intra-venous treatment. Without the nurse recognising that the member of the public had not sanitised their hands on entering the ward could have caused terrible consequences for Carol.

Without the research and development in the effectiveness of hand hygiene and infection control it would not be possible to have known about the dangers that Carol or other patients may face in the transference of HAI. If any of the patients within the ward had contracted a HAI it could have caused a longer stay within the hospital and a slower rate of recovery. HAI can cause fatalities even patients that are reasonably fit and healthy. Without the infection control policies in place the situation for Carol could be dangerous every time she entered hospital.

To conclude, the observed incident has been analysed and critiqued using the PEST analysis tool. The assignment has shown the effect of how international, national and local policy effects practice, health professionals, patients and the public. It has reviewed policies and how they meet the needs of individuals, communities and populations. It is shown that through continuous development of infection control policies that the government is aiming to maintain good standards within the NHS and to consistently lower the possibility of patients contracting HAI.