A week in my . . . infection control room: ‘Rings and watches can be major carriers of bacteria’

Joanne Flanagan is the infection prevention and control nurse specialist at the Blackrock Clinic in Dublin

  Joanne Flanagan: “We take hand hygiene very seriously. We swab hands constantly.”  Photograph: Cyril Byrne

Joanne Flanagan: “We take hand hygiene very seriously. We swab hands constantly.” Photograph: Cyril Byrne

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Crack of dawn

I start work at 6.30am on the mornings I need to catch the night staff, but usually it’s a 7.30am or 8am start. All staff who have contact with patients have to be trained in infection control. I work with everyone from the cleaning staff to the builders to the consultants. And I can’t expect people who are on duty all night to come back in during the day to meet me. Actually, if you need to meet a consultant, the best time to catch them is often the crack of dawn.

You can’t take five steps in this hospital without coming across a sink. There is one in every corner. We take hand hygiene very seriously. We swab hands constantly. Some people don’t realise that rings and watches can be major carriers of bacteria.

None of the clinical staff is allowed to wear watches, dangly bracelets or rings, apart from plain wedding bands, because of the high risk of contamination. We put pockets with zips into the uniforms so people can put jewellery there. Staff complained initially, but I think we convinced them that this is important. And it’s not a new thing: I started nursing in the 1990s, and if you walked in wearing rings you could be sent home.

Thankfully it has paid off, because we scored 93.5 per cent in a recent hand hygiene audit using the national Health Protection Surveillance Centre (HPSC) standard.

My job is to educate people, and hand-hygiene classes are mandatory for all clinical staff. You often see people washing their hands in public toilets and all they do is wet their fingertips, then pat their hair and put on a bit of lipstick.

When we expanded the Blackrock Clinic we basically built a hospital on top of a hospital but we never stopped operating, even when the building work was going on. Construction started four or five years ago.

I had to risk-assess every job so I spent a lot of time with the builders. We had to ensure there was zero dust in the air. If someone’s immune system is suppressed and they breathe in dust, that can cause serious injury or even death. There were times when six or eight projects were ongoing at the same time: for example, demolition, construction, digging out trees to be replanted elsewhere, and installing equipment. All of it had to be risk assessed. I was taking air samples constantly.

We had to worry about Aspergillus, a fungus that is in all dust, new as well as old . We were able to work with the builders. We had a presentation for them to explain how detrimental dust is to patients, and they really understood.

Infections

I trained as a general nurse and later did a higher diploma in infection control at the Royal College of Surgeons in Ireland. I feel I was born to be a nurse. Other jobs just never satisfied me as much. The role as infection prevention and control nurse definitely suits my personality as I still have lots of clinical contact with patients.

I have been working at the Blackrock Clinic since 2007. The job is very mixed. I am moving around the hospital all the time. I could be in the lab and then back on a ward checking on a patient, and half an hour later I could be checking air samples, or liaising with builders, or doing a Powerpoint presentation for staff on our Ebola contingency plan.

I am part of a multidisciplinary hygiene committee that meets regularly and does cleaning audits. We go into patients’ rooms and do the “white glove test” looking for dust. We check objects such as patients’ phones, bells and the TV remote controls, because these are high risk.

On admission, we screen every patient for MRSA. Someone could be carrying it on the skin or the nose without actually being infected. We can eliminate it before it causes infection. People pick it up in hospitals or care homes. We carry out tests looking for a number of different bacteria such as CRE.

I come across MRSA cases at least every week. Some weeks it’s every day. In winter, more high-risk patients are admitted; these are older patients with chronic illnesses. Most people would not have any idea that they are carrying MRSA. We can eliminate it, but it can recolonise.

Sometimes I find that a patient who is having heart surgery is more alarmed to discover that they have MRSA. We have pre-screening clinics and, where possible, bring patients in a month before they are due to be admitted for something like hip surgery. People can eliminate the bacteria at home. The treatment is simple.

Every inpatient has a single room, of which there are 170 now. All have even surfaces, with no tiles or grouting. The more bumps and lumps you have, the more dirt and bacteria can gather. You won’t see skirting boards, grouting or tiles in the Blackrock Clinic.

We use white rock, which is often used in catering kitchens. I wanted a seamless floor-to-ceiling finish, which allows rooms to be hosed. With single rooms you can contain something like the winter vomiting bug immediately. You can’t do that if a patient has to share a bathroom with four other patients.

Our new emergency department opened recently. The scenario of patients squashed together on corridors in emergency departments is horrifying. I am in the whole of my health and I would not like to be on a trolley for two days.

My job involves collecting a lot of data. If people are having surgery, I risk-rate them to see how likely they are to get an infection. Factors such as obesity, smoking or being on high doses of steroids are important.

I have two breaks during the day for breakfast and lunch but I don’t tend to go out because I don’t like to go out in uniform. And we have two restaurants here. I work alone a lot, so it is nice to catch up with a few mates for lunch.

Ebola

We have to have a contingency plan for Ebola. The Mater hospital is the National Isolation Unit but we can’t presume that a patient won’t present themselves here saying they think they might have it. The Mater has trained ambulance personnel and anyone regarded as high risk would be transferred there immediately.

We have a key team who have been trained. There is a buddy system, as you need someone to help put on and take off the personal protective equipment so you don’t contaminate yourself.

Training reception staff is crucial because if someone walks in and says they were away, have a temperature and wonder whether if it could be Ebola, staff there need to know what to do. And the first thing is to give the person a surgical mask, because while Ebola is not airborne they might be coughing.

It is becoming less and less likely that Ebola will reach Ireland but we have the facilities to look after even an end-stage Ebola patient. I cannot presume it will never happen.

Out of hours: We love to watch rugby

I love to go to a body pump class, which helps me to switch off. I also love to disappear with a good book. Winter nights are definitely well spent in front of some good TV with a cup of tea, or a glass of wine at weekends.

I am originally from Shankill in Co Dublin and my parents still live in my childhood home. We are very close. I have two great sisters; they are my best friends. My eldest sister has three amazingly lovable children who are now 13, 10 and seven years old. Being an aunt is very special and I take the role pretty seriously. And, to be honest, the kids make it really easy to adore them.

My dad is 72 and still works in his bridal shop, The Town Bride in Powerscourt Townhouse centre. It was very handy working with him over the years for extra pocket money and it was a bit of fun checking out all the dresses.

I got married in December, so a lot of my spare time at the end of last year was taken up with getting organised for the best day of my life.

Dad is passionate about rugby and has passed that on to his three daughters. We love watching matches together, shouting at the TV.

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