P&P manual updates: Are we having fun yet?
A lackluster yet vital duty
By Patti Grant, RN, BSN, MS, CIC,
Infection Preventionist, Dallas
To an "IP Newbie," review and updating of infection prevention and control policy and procedures (P&P) can be a daunting and superficially unrewarding task. Nevertheless, it is a vital duty and one that you must honor without fail. No doubt, too many of you have discovered that the P&P manual you inherited is not current and/or requires updating within the first few months of hire — you are not alone. I have experienced this required rapid review and update too often after starting a new job and it does not get easier over time. However, it does get less intimidating as you gather your knowledge base and networking support.
Rule No 1: Do not put something in writing that cannot be realistically accomplished and/or you are not willing to die on a sword over. Putting it bluntly, when you use words such as "always," "never," "will," and/or "shall," you are stating these behaviors are not optional; therefore, be selective when using them. Try to only use such words when writing Category I Centers for Disease and Prevention Control Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) recommendations into policy and/or state or federal mandates. Your content expertise will go far when others realize you are realistic about expectations that are grounded in science and consider flexibility when appropriate.
The housewide policies should be a useful generic document(s) that customize recommendations and mandates into the culture, role, and scope of your health care facility. These documents often can be written by you 'in a vacuum' since you are the expert with interpretation; just be careful to: a) be sure colors and terms are correct and reflect actual practice; b) cross-reference any department-specific policies that may have contradictions in them; so, c) this reminds you to check both policies during a review. Better yet, consider putting all the information in one place and then provide a cross-reference in the department-specific policy to the housewide one. For example, since compliance with hand hygiene should be something written into each department-specific policy, consider writing "all employees will practice good hand hygiene before and after patient care (see infection prevention and control policy No. 1.0)." This practice helps bedside professionals find information quickly and helps you keep a clean house (no pun intended).
Another rule of thumb is to internalize and teach that P&P review is a collaborative effort that should be easy to use and operationally valid. This means that as tempting as it might be to get this arduous task done quickly, it requires planning. You do not want to end up with an "ivory tower" document. Send out a reminder at least two months before a revision is due with a note stating, "unless I hear otherwise (by a specific date), you are approving this document for implementation." This way, you can continue with this critical task without getting bogged down in policing activities because we are all adults and understand deadlines. Also, make a site visit to areas whose department-specific policies are due for review to observe operations first hand and be available for questions.
A few helpful hints as you master the mundane and imperative skill set of P&P-ism:
- Have your resources readily accessible. At a minimum, the APIC Text is a necessity as it covers almost any circumstance, scope, and location of infection prevention imaginable (and the references to back up the recommendations).
- Familiarize yourself with the CDC web site (www.cdc.gov/). The "A-Z Index" is useful for Employee Health and disease-specific problems, and the evidence-based guidelines will become the cornerstone of bedside practices in your health care facility.
- Be careful with commercial 'ready-made and all-inclusive' P&P manuals. Although these can be helpful, there is no such thing as one size fits all.
- New service or department? Remember a new P&P is a must before opening day.