Searching for the Missing Link (Nurse)

March 19, 2020

A lot of it comes down to education and communication. That’s the primary takeaway from a study in Antimicrobial Resistance & Infection Control saying that the effectiveness of link nurses in helping to bolster infection prevention and control (IPC) efforts very much depends on the support those nurses and the programs they’re associated with get from hospital management, and the quality of interaction between link nurses and infection control personnel.

A link nurse is a professional more common in Europe; in the United States they’re sometimes referred to as “nursing infection control champions,” according to Saskia v. Popescu, PhD, MPH, a nationally known infection preventionist and a member of Infection Control Today®’s Editorial Advisory Board. “They are often rare, but they’re a wonderful resource if hospitals can encourage and support link nurse programs,” says Popescu. The study was conducted at hospitals in the Netherlands.

The link nurse provides just that—a link—between IPC and hospital wards and/or departments. Ideally, they increase awareness of infection control issues and motivate colleagues to improve in that regard, keeping patients and themselves safer by limiting the spread of healthcare-acquired infection (HAI). To be most effective, link nurses need to receive training from the infection control team. While infection control link nurse programs exist throughout the world, there’s wide variation on how the programs are organized and implemented. 

Corresponding author Mireille Dekker and colleagues collected data through a mixed-methods process combining a survey and semi-structured interviews with infection control practitioners. Seventy-two infection control practitioners from 72 different hospitals participated in the survey (the Netherlands has 74 hospitals). 

Nearly 90% of the hospitals in the study made education a bulwark of infection control link nurse (ICLN) efforts, Dekker and associates found. That usually included 2-hour sessions given about 6 times a year. These sessions were conducted in-house.

The survey was divided into five parts and asked whether their institution had an ICLN program or intended to set one up, what were the tasks of the link nurses, what infection prevention professionals felt ICLNs needed to be able to do a better job, what sort of education was provided and how respondents rated the programs. In the final part of the survey, respondents were asked to what extent they were able to accomplish their IPC goals through the help of ICLN, the study states. This was expressed on a 10-point Likert scale. 

Forty-eight (66.7%) completed surveys came from hospitals with an ICLN program; 18 (25%) from hospitals planning to implement one in the near future. Six (8.3%) said that their ICLN programs had been abandoned due to lack of support from the ward and/or hospital management. 

The relationship between the ICLN and the IPC team was give-and-take, but exactly who was giving what and in what amount varied. “Some infection control practitioners focused their efforts on providing support for the ICLN in implementing IPC policies, where others focused more on receiving support from the ICLN in monitoring the compliance with IPC measures,” the study states. 

Many times, the programs were created on the run. “Infection control practitioners described that they developed their programs while implementing them at the same time,” the study states. “Programs were adapted as IPC teams searched for an optimum strategy to collaborate with their link nurses to improve practice. Adjustments to the program were based on lessons learned during implementation and the dynamic IPC priorities. Infection control practitioners query what sort of training to provide, what topics to educate on and how to stimulate ICLN to be proactive.” 

Communication doesn’t always flow freely. One interviewee said that, “Our link nurse meetings must become a bit more interactive. We need to ask: What did you learn? What will you do differently tomorrow? What is the next issue you will address?” 

When it came to making ICLN program goals, the buck stopped with the IPC team in two thirds of the hospitals.  

“The IPC teams perceived the introduction of ICLN networks and the activities of ICLN as important assets that helped them to achieve their infection control goals,” the study states. “They scored this importance with a median of 7.0 (IQR 6.0–7.0) on a 10-point Likert scale.” 

The study concludes” “Although programs vary widely, education is an overall core component. Efforts to improve the uptake of IPC guidelines through ICLN programs should focus on enhancing infection control practitioners’ and link nurses’ knowledge on implementation science and designing these link nurse programs as multimodal interventions.”