Authors: Leila Hail (University College Hospital London, UK)
I completed a European Nursing and Spanish degree, which included exchange placements to Spain. Since qualifying in 2001 I have gained clinical experience in a variety of specialities that included Accident and Emergency, Hepatology and in Intensive care settings covering general, hepatology and burns.
In my spare time I have provided emergency nursing cover on film/TV sets and at large public events such as music festivals, concerts and sporting fixtures. I have worked in Infection Prevention and Control since 2008 and have been the Senior Nurse at University College Hospital London for the past 3 years.
My alarm goes off…
At 6:15am and the first thing I do is press snooze! I’m a night owl rather than morning lark. I factor in my snooze requirements by setting my alarm extra early! Once I’m up, it’s all go, it’s busy in the morning ensuring my sons are ready on time, dropping them off at school and then navigating through London rush hour to get to work (In my mind I often hear the Benny Hill music as we all charge around the house).
I’m responsible for…
Managing an infection control and wound surveillance team alongside my job share and the Consultant Nurse/DIPC, we play a vital role in ensuring patient safety by preventing, investigating, monitoring and controlling the spread of infections amongst hospitalized patients. We work alongside a wider multidisciplinary team, which includes microbiologists, virologists and an epidemiologist.
I feel privileged to work within such a dynamic and innovative team, who come from a variety of professional backgrounds including emergency medicine, cardiac, intensive care, hematology, neurology, renal and hepatology. This immense wealth of nursing experience is indispensable to take on the challenges we face in infection control today.
The role is diverse and requires specialist training as we collect, analyze, and interpret infection data in order to track trends, plan appropriate interventions and report mandatory data to external agencies such as Public Health England. We sit on advisory groups and participate in national and internal exercises in emergency preparedness such as that of influenza planning. The purposes of these exercises are to test our resilience in such a situation and how we would work.
We also collaborate with staff to embed best practice. Our role is to prevent patients acquiring infections in hospital by isolating sources of infections and limiting transmission, which could include patients as well as equipment. A huge part of our role is to educate staff and the public about infectious diseases and how to limit their spread.
It may also be surprising to know that we are heavily involved in the construction and design of healthcare facilities as the environment is a reservoir and potential for organisms if it is not designed or maintained adequately. There is a great deal of building work going on in our hospital and there are decisions and building plans that require our input, agreement and sign off. We look at room layouts, bed spacing, bed to sink ratios, air and water quality and have spent many an hour discussing dead legs and biofilms! We work with the Estates Department and cleaners to ensure that we maintain a safe and clean environment for our patients.
My typical day…
Starts at 9am but I tend to be in just after 8am, I like to start the day calmly reading my emails or catching up with my manager whilst eating my breakfast and drinking a large coffee.
At 9am the team gather for our daily handover, we discuss all our significant patients and prioritize which patients require reviewing on the wards, we then discuss other issues that may have arisen e.g. a confirmed measles case in an open ward that may require contact tracing of staff and patients, this can involve one or two cases but equally sometimes we have had to contact trace over 500 contacts to check immunization history and risk factors.
I don’t really have a typical day, which I think makes this role fascinating; no two days are ever the same. Because of the diversity, it can be difficult to always plan your day, you come in and think you have your day organized and then something unexpected happens. I could be dealing with a water leak in theaters or perhaps ventilation failure, to dealing with a new emerging antibiotic-resistant organism or infectious disease.
In today’s globalized world, infections can spread quickly and are no longer contained in one geographical place. Recent examples of this were the influenza, Ebola and MERS outbreaks; we literally had to drop everything we were doing and focus on an outbreak. The severity and potential impact were unknown and staff were anxious about possible exposure and the implications. Considerable work was undertaken by our team to ensure that all those on the front line or at risk of exposure were educated, appropriately kitted out with the right personal protective equipment and kept informed.
The strangest thing that has happened…
Having spent the best part of 20 years working in the NHS as both a student and qualified nurse I have witnessed many strange things and in my experience these occurrences tend to coincide with a full moon! These incidents have involved a horse, bed bugs, a tree, and looking after King Kong (the patient had officially changed their name by deed poll). I also once had to count £10,000.00 all in £50 notes as part of a patient admission property check. But the most memorable was when a patient on the care of the elderly ward decided to add a few squirts of alcohol hand hygiene gel to their own as well as their neighbors tea, as I quote ‘just a little something to add some spice’ luckily there were no repercussions, and this was one of the catalysts for switching from gel to foam to deter the temptation of ingestion.
The best part of my job…
Is working with my team, although interestingly my job share and I have often been confused for each other, even though we look nothing alike… We get comments such as ‘…didn’t you have curly/straight hair yesterday…!’
I can’t say there have never been tears associated with work pressures and sad cases or events we have come across, but we like to laugh and share a joke or two! It’s not been unknown to find plastic body parts positioned precariously on your desk or photoshopped pictures or posters stuck to your chair! It’s a way of blowing off steam in what can be a stressful environment. The team ethos I believe in is that laughter produces a good working environment; it helps combats stress and conflicts, allows for good team connections and inspires creativity helping to solve problems, so much so there was talk of the team attending a laughter yoga session one day after work… after all ‘laughter is the best medicine.’
I also really feel this specialty lends itself to making a difference. We are involved in many quality improvement initiatives trust wide and have seen some real positive impact on the work we have done to improve patient safety; such as in the reduction of our MRSA and Clostridium difficile rates following national set targets and the implementation of multiple strategies. There is always more work to be done and more challenges we face, especially with antibiotic resistance to keep us on our toes.
The worst part of my job…
Is that we are often seen as bearers of bad news and that can be challenging, we are also usually behind the scenes preventing infections and our hard work can go unnoticed until something happens.
A big challenge is to balance the risk of preventing the spread of infections to maintain patient safety by taking the difficult decision to close bays or wards to admissions, particularly if there is evidence of transmission or there is a risk of further spread. This can then affect the number of beds available for use in the organization at a time where bed pressures are immense. It can then impact A&E trolley waits or cause surgical delays or even in extreme cases surgical cancellations, which can similarly cause harm to the patient. For example, if there is a case of influenza on a ward, we’ll try to isolate the patient and contain the infection in one area so that we can still look after other patients safely, but this is not always possible, especially if bed movements can’t occur due to capacity. This can require careful and skillful risk assessment and management of our limited isolation rooms as well as difficult decision-making.
I like to unwind by either going for a run or attending an army style boot camp, come rain, snow or shine! There’s nothing quite like exercising outdoors and battling the elements, it makes you feel alive and helps shake off any stresses. I’ve been known to take part in trail running and Tough Mudder events too! I have also completed a silver smith course at the London College of Fashion and if I had more time, I would love to continue making more jewelery, one day!
I always wanted to be…
An archaeologist, until I saw all the scorpions and spiders in Indian Jones; I then decided nursing wasn’t a bad plan B.