Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework

Mireille Dekker; Irene P Jongerden; Martine G Caris; Martine C de Bruijne; Christina M J E Vandenbroucke-Grauls; Rosa van Mansfeld

doi:10.1186/s12913-023-09111-5

Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework

BMC Health Serv Res. 2023 Feb 9;23(1):140. doi: 10.1186/s12913-023-09111-5.

Authors

Mireille Dekker¹, Irene P Jongerden², Martine G Caris³, Martine C de Bruijne², Christina M J E Vandenbroucke-Grauls^{3

4}, Rosa van Mansfeld³

Affiliations

¹ Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands. m.vanoijen@amsterdamumc.nl.
² Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³ Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
⁴ Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.

Abstract

Background: Important elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines.

Methods: We used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance.

Results: Between 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance).

Conclusions: Our infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.

Keywords: Infection prevention; Nosocomial infections; Nursing practice; Patient safety; Quality improvement.

MeSH terms

Emotions
Guideline Adherence
Hospitals*
Humans
Infection Control*
Nurse Clinicians*
Program Evaluation