Infection control link nurses in acute care hospitals: Strategies to improve implementation and effectiveness

Infection control link nurses (ICLN) act as a link between colleagues in their own clinical area and the infection prevention and control team. They help to raise awareness for infection control by educating colleagues and motivating them to improve practice. To fulfil this role, link nurses are trained by infection control practitioners. Programs to train and support ICLN vary in the way they are organized and implemented. In this thesis, the elements that influence the successful engagement of ICLN in acute care hospitals were systematically explored and described. The aim was to explain how current programs could be improved to support ICLN, to evaluate the effectiveness of ICLN programs in improving compliance with infection prevention and control guidelines and, finally, to provide strategies for further implementation of these programs. The first part of this thesis, chapter 2, 3 and 4, focused on the characteristics and success factors of link nurses and link nurse programs in acute care hospitals. In chapter 5 and 6, the second part of this thesis, the results of the ICLN program in a university hospital were evaluated. The third part of this thesis, chapter 7 and 8, provided a synthesis of the results and a general discussion on infection control link nurses and the programs that support these nurses. The findings from this thesis support the investment in link nurses and the accompanying programs: ICLN raise awareness of infection prevention and have the potential to improve clinical practice in acute care hospitals. ICLN programs are yet not aligned, they vary widely in content and organization. Elements that facilitated the support of ICLN included a clear role profile, commitment from the infection prevention and control team, support from hospital and ward management, education on infection prevention topics in combination with implementation skills and contact with other ICLN. At the ward level action plans helped to structure ICLNs’ activities. Two main implementation strategies were found to support implementation: the development of stakeholder interrelationships to support cultural change and the use evaluative and iterative strategies to address the areas of system change and monitoring and feedback. In view of these findings, future research should include studies to provide robust evidence on the effectiveness of ICLN programs, the application of participatory action research and human-centered design techniques to learn from implementation of these findings in real world settings, the investigation of how ICLN programs can transform into networks using social network theory and to study the influence of individual characteristics of nurses on the adoption of their link nurse role.