Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Infection Control Nurses Association (PH 4)


  1.  Introduction

  2.  The Role of PCGs/PCTs

  3.  Surveillance

  4.  Organisational Development

  5.  Conclusion

  6.  References.


  1.1  The Infection Control Nurses Association is a professional organisation for nurses working in infection control. These nurses may be employed in acute hospitals, community healthcare trusts, mental health trusts, the private sector and public health departments of health authorities.

  1.2  Regardless of employment settings infection control nurses work both at a strategic level and an operational level.

  1.3  At a strategic level they are actively involved in decision-making processes, the development of risk management strategies and the development of evidence based policies and guidelines.

  1.4  At an operational level they are involved in the implementation of services such as:

    —  education of staff, patients and the public;

    —  quality assurance activities;

    —  surveillance of infection;

    —  management of outbreaks of infection;

    —  advising on new products and medical devices;

    —  advising on site and facilities developments; and

    —  formulation and promulgation of policies, guidelines and public information materials.

  1.5  For infection control nurses employed by healthcare trusts the boundaries of the trust usually defines their area of practice.

  1.6  Infection control nurses employed in health authorities work with the Consultant in Communicable Disease Control and contribute to the prevention and control of communicable disease and in some cases control of environmental hazards.

  1.7  Within a trust infection control nurses work with all professions and departments.

  1.8  Those nurses employed by health authorities are familiar with multi-agency working in the community at both strategic and operational levels. The development of good multi-agency working relationships is fundamental to control of infection and communicable disease control in the community.


  2.1  When considering the role of PCGs/PCTs in the delivery of a social model of health it is important to remember the key professional issue for doctors and nurses is the relationship between the professional and the patient and the individual context within which care is delivered. At the moment the rhetoric around delivering the public health agenda is failing to recognise this context of care and the value of the public health messages which can be articulated at this level.

  2.2  Immunisation is a key public health activity carried out by PCG/PCT staff. The delivery of these immunisation programmes is essential if morbidity and mortality rates due to infectious diseases are to be controlled. However, the resources for delivering the ever more complex programmes as new vaccines are licensed need to be examined.

  The contribution nurses working in primary care are to make to the promotion and delivery of public health is well documented. However, it is not possible for nurses to both deliver (in the form of immunisation programmes) and promote (in the form of population based initiatives such as those to reduce teenage pregnancies) at the same time. Staffing levels at the moment mean that a decision between the two has to be made.

  In terms of health protection all the immunisation programmes ie childhood, adult and travel are vital, mostly nurse led services. PCGs and PCTs should, as part of their public health role, examine the resources they allocate to these programmes and the employing organisations should re-examine their commitment to professional development and education for the nurses undertaking this vital role.


  3.1  A strategic responsibility of the Health Authority is to ensure that robust surveillance systems are in place. Surveillance of healthcare related infection and communicable disease is the key to prevention and control.

  The National Audit Office Report has highlighted the importance of surveillance of infection in hospitals and documents the impact robust surveillance programmes can have on the number of hospital acquired infections. Surveillance programmes have resource implications (human, IT and time). The issue here is similar to the issue in 2.2—infection control nurses cannot promote infection control and deliver surveillance programmes within current resources.

  3.2  The same report recommends extending surveillance systems for health care related infections into the community setting. PCGs and PCTs will have a role in these programmes, however, the co-ordinating role of the infection control team will need to be considered again with resource implications.

  3.3  Surveillance of communicable diseases plays an important part in protecting the public health, new infectious agents are emerging and some considered under control are now re-emerging. The importance of base line data collected at a local level and collated at regional, national and international level must be emphasised. Comprehensive surveillance informs health care planning, informs preventative programmes, evaluates preventative programmes and treatment strategies and the base line data collection informs epidemiological studies.

  Strengthening and supporting surveillance systems in infection control and communicable disease control to inform preventative programmes and reduce infection rates will have an impact on access to health care and reduction of inequalities in standards of infection control.


  4.1  Infection control nurses are experienced in working across professional boundaries and in the case of nurses employed in health authorities across agencies. One of the key difficulties in effecting change that we experience is cultural. Unless organisational and professional cultures are appreciated and accommodated infection control strategies will not be implemented. A social model of public health also encounters this cultural diversity within the many organisations involved, and this is possibly one of the biggest barriers to promoting and delivering public health. Public health policy to reduce health inequalities has more chance of succeeding if the diversity and culture of all those involved in implementing such a policy is valued and shown to be valued. There appears to be very little evidence of organisational development programmes taking place to address this problem.


  The health protection which a robust and well-supported infection control and communicable disease control service affords will contribute greatly to the public health. It is essential the infrastructures for such a service are maintained and the role health protection plays in current public health policy valued and articulated at all levels of this policy development.


  1.  Cowley S, 1999: From population to people: public health in practice. Community Practitioner 72:4 88-90.

  2.  Department of Health 1995: Making it happen—Public Health Contribution, Role and Development of Nurses, Midwives and Health Visitors. Standing Nursing and Midwifery Advisory Committee.

  3.  Labonte R, 1997: Community and public health: an international perspective. Health Visitor 70:2 64-67.

  4.  NAO 2000: The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England. Report by the Comptroller and Auditor General National Audit Office.

  5.  Plowman et al 1999: Socio-economic burden of hospital acquired infection. Central Public Health Laboratory, London School of Hygiene and Tropical Medicine.

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