- Email: [email protected]
E-learning module for delivering infection prevention and control training
Letters to the Editor / Journal of Hospital Infection 76 (2010) 84–95
Toronto, Ontario M5G 1X5, Canada. Tel.: þ1 416 586 3118; fax: þ1 416 586 8358. E-mail address: [email protected] (A. McGeer) Available online 17 July 2010 Ó 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jhin.2010.04.021
E-learning module for delivering infection prevention and control training
Madam, E-learning is a useful and valuable new method for delivering education. Packages for infection prevention and control (IPC) have already been developed and shown to be effective.1,2 A recent survey of medical schools found that approximately half of respondents now use it to assist with training.3 Our hospital has recently introduced an e-learning package, ‘Training Tracker’Ô (Multimedia Design Studio Limited, UK), to assist with staff education. It assists with Trust induction and knowledge updates on mandatory training topics such as health and safety, information governance as well as including IPC. The Academy (the department organising staff training) asked the IPC team to develop the content of a module on IPC for the Training Tracker system. The content is based on information that was previously provided by lectures at induction or the update sessions for both clinical and non-clinical staff. In addition a module on antibiotic prescribing was prepared specifically for the junior doctors’ induction. The information is read on sequential screens and allows readers to proceed at their own pace. At the end is a series of questions to answer, to assess staff knowledge. The module does not register as being completed until the test has been completed successfully. We have found this an advantage over the previous system of lectures for induction or updates which had no individual assessments. The module does not need to be completed at one attempt, and the test at the end can be retaken to achieve a pass. One of the main advantages of the e-learning package is that it can be done at a time suitable for individuals, and they do not have to attend a fixed induction or update session which may be missed due to clinical duties, holidays, illness, etc. The system can be accessed in all areas of the hospital and can even be logged into from home computers at all times of the day. This should make education of night staff easier. A previous e-learning package showed high level of use by night duty and weekend staff.2 The e-learning modules are used for the induction of foundation year doctors and medical students training at the hospital; they are requested to complete the training prior to starting at the hospital. The Training Tracker system allows the Academy to monitor who has not completed the modules and reminders are sent to those who have not completed. The modules have enabled the junior doctors to become familiar with Trust procedures and IPC and antibiotic policies, and have reduced the time required for on-site induction training. The system is also used for update sessions on mandatory topic subjects by other clinical and non-clinical staff. The number
89
Table I Numbers of staff completing modules Module
May to Oct 2009
Clinical infection prevention and control Non-clinical infection prevention and control Antibiotic prescribing
Nov 2009 to Apr 2010
99
510
69
184
87
8
of modules completed is given in Table I. However, the Academy has noted some reluctance to use the system by some staff, which could be due to various reasons such as limited information technology skills or difficulty accessing a computer. To overcome this, the same information is now provided in booklet form with a self-assessment at the end of each module. This has improved uptake. Another advantage of the e-learning modules and booklets is that the IPC team now spends less time providing training. Without its use the IPC nurses would need to deliver at least two 30 min sessions per week. The e-learning method does have some disadvantages. It does not allow staff to ask questions in order to clarify issues and there is no peer discussion. In addition there are no practical assessments on topics such as hand hygiene or blood culture taking, although previously these were not included in introduction or update sessions. Demonstrations of both of these have now been included as video clips on the IPC team Trust intranet site for staff and there are plans to include them in the e-module. Hand hygiene practical sessions are currently delivered by a link nurse at ward level and blood culture taking is included in the Academy-run venepuncture course. In conclusion, the e-learning package has assisted the Trust with induction and updates on IPC and antibiotic prescribing. It has enabled staff to complete training at a time chosen by themselves and has, in addition, freed up time for the IPC team. It is now available in a booklet form for those who cannot access computers, and has the advantage over the previous lecture method of incorporating an individual assessment at the end. There are now plans to expand the number of modules available.
Conflict of interest statement None declared. Funding sources None.
References 1. Clarke E, Martin A. Computer-assisted learning in infection control for nursing students. Nurs Times 2002;98:53–54. 2. Desai N, Philpott-Howard J, Wade J, Casewell M. Infection control training: evaluation of a computer-assisted learning package. J Hosp Infect 2000;44:193–199. 3. O’Brien D, Richards J, Walton KE, Phillips MGA, Humphreys H. Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools. J Hosp Infect 2009;73:171–175.
S.J. Dawsona,* H. Bennettb V. Ongleyc a Department of Microbiology, Great Western Hospital, Swindon, UK b
Infection Prevention and Control, Great Western Hospital, Swindon, UK c
The Academy, Great Western Hospital, Swindon, UK
90
Letters to the Editor / Journal of Hospital Infection 76 (2010) 84–95 *
staff convene.5 In 2005 there was a statistically significant increase in uptake in the nursing division (13% in 2004 vs 28% in 2005; c2 ¼ 75.025, P < 0.01). The main reason for this, we believe, was the ‘fear factor’ triggered by the high media profile given to the avian influenza epidemic in the winter of 2005/2006. Since 2006 we have observed a steady increase in uptake across all occupational groups within our hospital but in 2008 our overall uptake (20%) still compared unfavourably with that cited in the international literature.6 In 2008, we increased our mobile clinics, ‘rewarded’ vaccine recipients with a chocolate bar, which featured in our promotional campaign, and used stickers with a catchphrase to raise awareness of the campaign. We observed an increased uptake in all clinical HCW groups which achieved statistical significance in the nursing sector (c2 ¼ 208.930, P < 0.01). With the backdrop of pandemic H1N1 influenza in 2009, a brainstorming exercise with a multidisciplinary group of staff members identified a perceived deficit in our educational material content that did not sufficiently emphasise the importance of appealing to HCWs’ altruism in terms of protecting family members, colleagues and patients. Other suggestions that were implemented included positive reinforcement with ‘rewards’ of chocolate, greater use of posters around the hospital, the use of ‘local champions’ and night-time and weekend clinics. We also introduced screen savers of well-known hospital personalities receiving their ‘flu jab’ which generated a lot of attention and debate. Other units have since availed of this technology to promote inter alia observance of good infection control practice. Our staff uptake of seasonal influenza vaccine increased significantly in 2009 across all clinical HCW groups (medical: c2 ¼ 27.136, P < 0.01; nursing: c2 ¼ 10.422, P < 0.02; healthcare assistants: c2 ¼ 19.747, P < 0.01; health and social care professionals: c2 ¼ 15.091, P < 0.01). While our improved campaign may have contributed to this, we also believe that the ‘fear factor’ associated with pandemic H1N1 (as occurred in 2005) also promoted uptake. Furthermore, the opportunity for staff to avail of two vaccines simultaneously may have facilitated uptake even further. We believe that there are both internal and external factors which influence the uptake of influenza vaccination amongst HCWs within the hospital setting. The internal factors are largely controlled by the programme providers, i.e. the OHS, and include educational, motivational and leadership aspects together with methods of delivery. Our experience suggests that rewards also play a part. External factors which attract media attention such as the arrival of novel influenza strains may periodically serve to increase awareness and influence vaccine uptake in the short term. Our experience with avian influenza in 2005 suggests that this influence on uptake is unlikely to be maintained long term. Other approaches such as ‘mandatory’ vaccination programmes, introduced on a trial basis in the USA, may need to be considered, though one suspects that they are less likely to be acceptable in a European healthcare setting.4
Corresponding author. Address: Department of Microbiology, Great Western Hospital, Swindon SN3 6BB, UK. Tel.: þ44 (0) 1793 604800; fax: þ44 (0) 1793 604803. E-mail address: [email protected] (S.J. Dawson) Available online 14 July 2010
Ó 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jhin.2010.05.002
Factors determining uptake of influenza vaccine among healthcare workers in a hospital setting Madam, We read with interest the paper by Balestas et al. and note their impressive vaccination rates of 48.8–76.5%.1 Worldwide, uptake of influenza vaccine among healthcare workers (HCWs) is suboptimal. While single interventions (e.g. mobile carts, rewards) have been shown to have some impact on uptake, it is suggested that multifaceted strategies are more likely to achieve sustained and significant improvements.2 However, these are resource consuming for occupational health services (OHS). Key elements include education, clinical leadership and delivery of vaccine at work location.3 More recently, although controversial, ‘mandatory’ programmes have achieved uptake levels of 88%.4 This has been justified because influenza vaccination is an evidence-based intervention which prevents infection and saves lives. We outline our experience in a 640 bed tertiary referral centre in Dublin, Ireland. Since our Department of Health and Children first recommended HCW immunisation (2001), we have made many efforts in our hospital to educate, motivate and facilitate staff to receive vaccine during our annual seasonal influenza vaccination campaigns. Table I summarises the percentage uptake of vaccination by clinical and non-clinical HCWs over a six-year period. We used the Pearson c2 with corrected P-values for multiple comparisons for calculating degree of significance when comparing the data during three key intervals: 2004–2005, 2007–2008 and 2008–2009. In 2004, our campaign to improve uptake included promotion by hospital newsletter, emails to department heads and consultants, presentations at clinical and management meetings and mobile clinics to clinical areas, but this had little effect. The poor uptake figures prompted us to undertake a study in our hospital of the determinants of vaccination uptake among our HCWs which identified the need for a multifaceted education programme that included encouraging senior staff to lead by example and the provision of vaccine at locations where
Table I Uptake of seasonal influenza vaccine among healthcare worker (HCW) groups between 2004 and 2009 (and pandemic H1N1 vaccine in 2009)a Occupation Medical Nursing Administrative and general support Healthcare assistants Health and social care professionals Total % uptake
2004
2005
2006
2007
2008
2009
2009 H1N1
76/403 (19) 137/1043 (13) 210/1080 (19) 18/97 (19) 74/360 (21)
109/434 (25) 331/1175 (28)* 289/1171 (25) 33/113 (29) 98/407 (24)
91/453 (20) 192/1172 (16) 231/1315 (18) 37/113 (33) 92/415 (22)
94/556 (17) 202/1420 (14) 222/1244 (18) 34/105 (32) 85/438 (19)
99/425 (23) 242/1231 (20)* 187/1223 (15) 41/128 (32) 108/440 (25)
177/415 (43)* 324/1169 (28)* 195/1140 (17) 77/99 (78)* 154/419 (37)*
259/415 (62) 602/1169 (51) 632/1140 (55) 84/99 (85) 260/419 (62)
17
* Statistically significant (P 0.05). a Values are: no. vaccinated/total no. of HCWs (%).
26
20
18
24
33
57
Toronto, Ontario M5G 1X5, Canada. Tel.: þ1 416 586 3118; fax: þ1 416 586 8358. E-mail address: [email protected] (A. McGeer) Available online 17 July 2010 Ó 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jhin.2010.04.021
E-learning module for delivering infection prevention and control training
Madam, E-learning is a useful and valuable new method for delivering education. Packages for infection prevention and control (IPC) have already been developed and shown to be effective.1,2 A recent survey of medical schools found that approximately half of respondents now use it to assist with training.3 Our hospital has recently introduced an e-learning package, ‘Training Tracker’Ô (Multimedia Design Studio Limited, UK), to assist with staff education. It assists with Trust induction and knowledge updates on mandatory training topics such as health and safety, information governance as well as including IPC. The Academy (the department organising staff training) asked the IPC team to develop the content of a module on IPC for the Training Tracker system. The content is based on information that was previously provided by lectures at induction or the update sessions for both clinical and non-clinical staff. In addition a module on antibiotic prescribing was prepared specifically for the junior doctors’ induction. The information is read on sequential screens and allows readers to proceed at their own pace. At the end is a series of questions to answer, to assess staff knowledge. The module does not register as being completed until the test has been completed successfully. We have found this an advantage over the previous system of lectures for induction or updates which had no individual assessments. The module does not need to be completed at one attempt, and the test at the end can be retaken to achieve a pass. One of the main advantages of the e-learning package is that it can be done at a time suitable for individuals, and they do not have to attend a fixed induction or update session which may be missed due to clinical duties, holidays, illness, etc. The system can be accessed in all areas of the hospital and can even be logged into from home computers at all times of the day. This should make education of night staff easier. A previous e-learning package showed high level of use by night duty and weekend staff.2 The e-learning modules are used for the induction of foundation year doctors and medical students training at the hospital; they are requested to complete the training prior to starting at the hospital. The Training Tracker system allows the Academy to monitor who has not completed the modules and reminders are sent to those who have not completed. The modules have enabled the junior doctors to become familiar with Trust procedures and IPC and antibiotic policies, and have reduced the time required for on-site induction training. The system is also used for update sessions on mandatory topic subjects by other clinical and non-clinical staff. The number
89
Table I Numbers of staff completing modules Module
May to Oct 2009
Clinical infection prevention and control Non-clinical infection prevention and control Antibiotic prescribing
Nov 2009 to Apr 2010
99
510
69
184
87
8
of modules completed is given in Table I. However, the Academy has noted some reluctance to use the system by some staff, which could be due to various reasons such as limited information technology skills or difficulty accessing a computer. To overcome this, the same information is now provided in booklet form with a self-assessment at the end of each module. This has improved uptake. Another advantage of the e-learning modules and booklets is that the IPC team now spends less time providing training. Without its use the IPC nurses would need to deliver at least two 30 min sessions per week. The e-learning method does have some disadvantages. It does not allow staff to ask questions in order to clarify issues and there is no peer discussion. In addition there are no practical assessments on topics such as hand hygiene or blood culture taking, although previously these were not included in introduction or update sessions. Demonstrations of both of these have now been included as video clips on the IPC team Trust intranet site for staff and there are plans to include them in the e-module. Hand hygiene practical sessions are currently delivered by a link nurse at ward level and blood culture taking is included in the Academy-run venepuncture course. In conclusion, the e-learning package has assisted the Trust with induction and updates on IPC and antibiotic prescribing. It has enabled staff to complete training at a time chosen by themselves and has, in addition, freed up time for the IPC team. It is now available in a booklet form for those who cannot access computers, and has the advantage over the previous lecture method of incorporating an individual assessment at the end. There are now plans to expand the number of modules available.
Conflict of interest statement None declared. Funding sources None.
References 1. Clarke E, Martin A. Computer-assisted learning in infection control for nursing students. Nurs Times 2002;98:53–54. 2. Desai N, Philpott-Howard J, Wade J, Casewell M. Infection control training: evaluation of a computer-assisted learning package. J Hosp Infect 2000;44:193–199. 3. O’Brien D, Richards J, Walton KE, Phillips MGA, Humphreys H. Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools. J Hosp Infect 2009;73:171–175.
S.J. Dawsona,* H. Bennettb V. Ongleyc a Department of Microbiology, Great Western Hospital, Swindon, UK b
Infection Prevention and Control, Great Western Hospital, Swindon, UK c
The Academy, Great Western Hospital, Swindon, UK
90
Letters to the Editor / Journal of Hospital Infection 76 (2010) 84–95 *
staff convene.5 In 2005 there was a statistically significant increase in uptake in the nursing division (13% in 2004 vs 28% in 2005; c2 ¼ 75.025, P < 0.01). The main reason for this, we believe, was the ‘fear factor’ triggered by the high media profile given to the avian influenza epidemic in the winter of 2005/2006. Since 2006 we have observed a steady increase in uptake across all occupational groups within our hospital but in 2008 our overall uptake (20%) still compared unfavourably with that cited in the international literature.6 In 2008, we increased our mobile clinics, ‘rewarded’ vaccine recipients with a chocolate bar, which featured in our promotional campaign, and used stickers with a catchphrase to raise awareness of the campaign. We observed an increased uptake in all clinical HCW groups which achieved statistical significance in the nursing sector (c2 ¼ 208.930, P < 0.01). With the backdrop of pandemic H1N1 influenza in 2009, a brainstorming exercise with a multidisciplinary group of staff members identified a perceived deficit in our educational material content that did not sufficiently emphasise the importance of appealing to HCWs’ altruism in terms of protecting family members, colleagues and patients. Other suggestions that were implemented included positive reinforcement with ‘rewards’ of chocolate, greater use of posters around the hospital, the use of ‘local champions’ and night-time and weekend clinics. We also introduced screen savers of well-known hospital personalities receiving their ‘flu jab’ which generated a lot of attention and debate. Other units have since availed of this technology to promote inter alia observance of good infection control practice. Our staff uptake of seasonal influenza vaccine increased significantly in 2009 across all clinical HCW groups (medical: c2 ¼ 27.136, P < 0.01; nursing: c2 ¼ 10.422, P < 0.02; healthcare assistants: c2 ¼ 19.747, P < 0.01; health and social care professionals: c2 ¼ 15.091, P < 0.01). While our improved campaign may have contributed to this, we also believe that the ‘fear factor’ associated with pandemic H1N1 (as occurred in 2005) also promoted uptake. Furthermore, the opportunity for staff to avail of two vaccines simultaneously may have facilitated uptake even further. We believe that there are both internal and external factors which influence the uptake of influenza vaccination amongst HCWs within the hospital setting. The internal factors are largely controlled by the programme providers, i.e. the OHS, and include educational, motivational and leadership aspects together with methods of delivery. Our experience suggests that rewards also play a part. External factors which attract media attention such as the arrival of novel influenza strains may periodically serve to increase awareness and influence vaccine uptake in the short term. Our experience with avian influenza in 2005 suggests that this influence on uptake is unlikely to be maintained long term. Other approaches such as ‘mandatory’ vaccination programmes, introduced on a trial basis in the USA, may need to be considered, though one suspects that they are less likely to be acceptable in a European healthcare setting.4
Corresponding author. Address: Department of Microbiology, Great Western Hospital, Swindon SN3 6BB, UK. Tel.: þ44 (0) 1793 604800; fax: þ44 (0) 1793 604803. E-mail address: [email protected] (S.J. Dawson) Available online 14 July 2010
Ó 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jhin.2010.05.002
Factors determining uptake of influenza vaccine among healthcare workers in a hospital setting Madam, We read with interest the paper by Balestas et al. and note their impressive vaccination rates of 48.8–76.5%.1 Worldwide, uptake of influenza vaccine among healthcare workers (HCWs) is suboptimal. While single interventions (e.g. mobile carts, rewards) have been shown to have some impact on uptake, it is suggested that multifaceted strategies are more likely to achieve sustained and significant improvements.2 However, these are resource consuming for occupational health services (OHS). Key elements include education, clinical leadership and delivery of vaccine at work location.3 More recently, although controversial, ‘mandatory’ programmes have achieved uptake levels of 88%.4 This has been justified because influenza vaccination is an evidence-based intervention which prevents infection and saves lives. We outline our experience in a 640 bed tertiary referral centre in Dublin, Ireland. Since our Department of Health and Children first recommended HCW immunisation (2001), we have made many efforts in our hospital to educate, motivate and facilitate staff to receive vaccine during our annual seasonal influenza vaccination campaigns. Table I summarises the percentage uptake of vaccination by clinical and non-clinical HCWs over a six-year period. We used the Pearson c2 with corrected P-values for multiple comparisons for calculating degree of significance when comparing the data during three key intervals: 2004–2005, 2007–2008 and 2008–2009. In 2004, our campaign to improve uptake included promotion by hospital newsletter, emails to department heads and consultants, presentations at clinical and management meetings and mobile clinics to clinical areas, but this had little effect. The poor uptake figures prompted us to undertake a study in our hospital of the determinants of vaccination uptake among our HCWs which identified the need for a multifaceted education programme that included encouraging senior staff to lead by example and the provision of vaccine at locations where
Table I Uptake of seasonal influenza vaccine among healthcare worker (HCW) groups between 2004 and 2009 (and pandemic H1N1 vaccine in 2009)a Occupation Medical Nursing Administrative and general support Healthcare assistants Health and social care professionals Total % uptake
2004
2005
2006
2007
2008
2009
2009 H1N1
76/403 (19) 137/1043 (13) 210/1080 (19) 18/97 (19) 74/360 (21)
109/434 (25) 331/1175 (28)* 289/1171 (25) 33/113 (29) 98/407 (24)
91/453 (20) 192/1172 (16) 231/1315 (18) 37/113 (33) 92/415 (22)
94/556 (17) 202/1420 (14) 222/1244 (18) 34/105 (32) 85/438 (19)
99/425 (23) 242/1231 (20)* 187/1223 (15) 41/128 (32) 108/440 (25)
177/415 (43)* 324/1169 (28)* 195/1140 (17) 77/99 (78)* 154/419 (37)*
259/415 (62) 602/1169 (51) 632/1140 (55) 84/99 (85) 260/419 (62)
17
* Statistically significant (P 0.05). a Values are: no. vaccinated/total no. of HCWs (%).
26
20
18
24
33
57