Covid-19, a year in the role of Infection, Prevention and Control.

Jacky Hunt Southern Health’s Lead nurse for Infection Prevention and Control (IPC) reflects about how the ‘Cinderella of nursing’ became one of the most talked about professions over the past year.

“I joined the infection control world nearly 30 years ago shortly after graduating in nursing back in the times where IPC was definitely not seen as the most glamorous or dynamic of specialities. Acute Trusts were the only work place for IPCNs then. Most colleagues saw these specialist nurses as a cross between ‘picky’ and ‘nosey’ and would go out of their way to avoid the scrutiny of a IPCNs visit (including hiding in linen cupboards if required!).

Jacky Hunt, Southern Health’s Lead Nurse for Infection, Prevention and Control

This didn’t put me off though, I loved the fascinating world of microbes! How can something so small and invisible cause so much misery to patients and their loved ones, staff and visitors? The challenge still remains the same to this day.

In some way, I have been training for the Coronavirus pandemic all my life. Sure, we have had some nasty global pandemic scares before , SARS, MERS, Zika, Ebola, Swine Flu pandemic in 2009 (just after our Trust had set up its own Community IPC Team), but never on this scale. Hands down, this has been the most professionally interesting, all absorbing and exhausting time of my entire career.

Let’s start with the first wave, wave one.

At the start there was very limited COVID19 testing for in-patients and no established mechanism to test patients in the community for coronavirus if they had symptoms. The first challenge was to create testing pods in some of our sites so that the symptomatic public could attend for testing. This was easier said than done! We needed to get suitable empty spaces that met the criteria and source staff. Then there was a challenge of working with transport contractors to collect specimens, process them in acute Trust labs and ensure the results were received efficiently and within usual governance rules, all in a couple of weeks. After much effort together with my Southern Health colleagues, testing pods were indeed set up but it was very challenging setting something up which didn’t fall into existing structures and mechanisms- a bit like turning a bus into a submarine! Almost as soon as they were in place the pods were stopped within our Trust, and relocated to an acute Trust settings and the community testing van was launched.

It felt exiting times , whizzing around the county in a white van converted to meet IPC standards, full of PPE and testing equipment, advising staff on procedures for taking samples in the home setting, in situations which were definitely not described by the very acute Trust based PHE guidelines . We travelled in a testing van for about three weeks, appearing in sick peoples living rooms, armed with viral swabs, dressed in full protective clothing (including hair coverings, FFP3 respirators, disposable gowns, gloves and overshoes) — at that stage so little was known about the virus and it was considered a high consequence infectious disease.

By March 2020, Boris Johnson had been looking to the terrible time Italy was having and there was a lot of focus on improving our NHS bed capacity so that the NHS didn’t become overwhelmed too. I found myself advising on how to convert hotels into recovery centres for COVID19 patients leaving acute trusts and how to best use every square inch of our hospitals. I remember a surreal afternoon walking around Alton Hospital with their Matron agreeing what would be needed to move from the usual 18 beds to over 70 beds. How do you turn a toilet into a sluice overnight? The pace of the change required was frenetic as cases were rising.

Then the outbreaks started and sadly the first patient deaths occurred in our Trust. My colleagues began to go off sick, some with really serious COVID19 illness. I felt a strong sense of responsibility, it weighed heavy. The Team and I applied all the principles of infection prevention, networked with other IPC specialists/Trust leaders and scoured national guidance for any detail that helped to decide the best policies for our Trust but it was a new situation and not always clear what to do. National guidance changed frequently which didn’t help and was difficult to communicate the changes to staff who had no time to look at emails. In one week PHE guidance changed 3 times! This coupled with the anxiety about having sufficient of the appropriate PPE was extremely stressful. Staff needed, deserved and demanded black and white answers but as so little was known about the virus, often we could only provide help with risk assessment rather than the ‘absolutes’ staff were looking for .

Finally the roller-coaster of the first wave subsided, wider testing became available, clearer protocols and a more reliable supply of PPE. Then re-mobilisation began to bring back services safely. This phase was still incredibly busy for the IPC Team, there was no let up as staff, eager to do things right, looked to the IPC Team for advice.

Wave two

2 Oct 2020 wave two hit our Trust harder and faster than wave one. The new variants seemed much more infectious, if a patient without symptoms was found positive in a bay it was difficult to stop spread. Usually I can apply established IPC principles to manage outbreaks but this didn’t seem to follow the usual rules, it was as infectious as norovirus with wings! It was relentless. It felt like a war, like many of my colleagues I’ve spoken to, COVID19 occupied every aspect of my waking life. I felt like I only had one purpose.

Our little team was bombarded with emails and phone calls, we were lucky enough to recruit a couple of extra staff, everyone wanted advice and it was impossible to meet the demand. My prioritisation skills became finely honed but it was clear a new approach was required. Early November our Team adopted major incident mode and channelled all calls into a hotline and emails were managed from a shared account. The service became 7 days a week, every member of the IPC Team stepped up to meet demand and gave their all. As for many of our colleagues the 3 months that followed was a blur of sleep, eat, work repeat, hours were excessive and never have I been more proud of our IPC team. We became a machine dealing with outbreak after outbreak, ably supported by my manager Sara and our Director of Infection Prevention and Control.

Most of the time I felt I kept my head above water but every now and again a new situation would occur in the ever changing landscape of the pandemic- like a tidal wave. I felt overwhelmed, ineffective, unprepared and although I was definitely wasn’t solely responsible for the safety of others — I did feel the burden of responsibility.

“What got me through apart from a strong faith and Netflix? Kindness! -Kindness from the general public.”

In my home village in April the whole high street was covered in NHS thank you posters and effigies of ‘super hero NHS staff’. I also remember sharing an 8pm Thursday clap outside Alton Hospital surrounded by police and fire service members. Our hospital team outside, all carefully standing 2 metres apart but yet ‘shoulder to shoulder’ with the other key workers we were ‘in it together’. My brilliant manager and colleagues showed me kindness in texts, flowers, supportive words. Kindness from my wonderful IPC Team. Kindness from amazing friends and family, especially my husband and sons who made me endless meals, cups of tea, made no demands and left me alone when I needed space.

This year has taught me so much and not just the importance of the unmute button on zoom! I have learnt more about the importance of resilience, for the first time in my life I have had to think about my own wellbeing to prevent burnout. Coming from the caring profession it feels wrong but sometimes you do have to make sure your own basic needs are met in-order to be able to give to others. I have also developed a level of acceptance that you can only control so much in life. In a pandemic everything changes all of the time you must do your absolute best but you cannot get it right all of the time…. just take a deep breath and keep moving forward one step at a time.

This year has also taught me the importance of relationships. I have had the privilege of getting to know and work with so many colleagues at all levels of organisation and external organisations. Sharing information and ideas covering a vast number of teams and services. It has been a fantastic opportunity to get to understand the challenges others are facing on a day to day basis and to problem solve together.

“The Cinderella of nursing specialities has finally come to the ball! Only others could say for sure but I’d like to think IPC is no longer seen as an ‘add on’ to care but more an integral part where good compliance with IPC precautions is synonymous with caring.”

I’m not sure if IPCNs have completely shed their ‘picky’ image and I know the focus on ‘all things IPC’ will wane with the pandemic. However, after the year we have just had, a few more staff will now see IPC professionals as part of their team, supportive not judgemental, here for them and their patients, here to help keep everyone safe.

Southern Health provide community, specialist mental health and learning disability services for people across the south of England.