550176 research-article2014
SJP0010.1177/1403494814550176Nordic Interdisciplinary Education in Infection ControlJ. Holt et al.
Scandinavian Journal of Public Health, 2014; 42: 687–690
Original article
A joint Nordic Interdisciplinary Education Programme in Infection Control: A successful, but short-lived initiative
Jette Holt1, Nina K. Sorknes2 & Lene Povlsen3 1Statens
Serum Institut (SSI), Copenhagen, Denmark, 2Norwegian Institute of Public Health, Oslo, Norway, and 3Nordic School of Public Health NHV, Göteborg, Sweden
Abstract Introduction: Prevention of healthcare-associated infections and a restrictive antibiotics policy in the Nordic countries have contributed to a low prevalence of multi-drug resistant microorganisms, compared to many other countries. This requires professional competences acquired through education in infection control, both in hospitals and in primary health care. Methods: This paper describes a joint Nordic Interdisciplinary Education Programme in infection control, established at the Nordic School of Public Health NHV (NHV) in 2007. Results: The education programme was considered highly relevant and successful by students and their employers. Conclusions: The paper describes the background and contents of the programme, which may serve as inspiration in the development of future educational initiatives in other countries. Key Words: Antibiotic resistance, education programme, infection control, core competencies, interdisciplinary education, Nordic countries, public health policy
Introduction
Background
This paper describes a joint Nordic interdisciplinary education programme in infection control, which was established at the Nordic School of Public Health NHV in 2007. Based on a high number of applicants, as well as oral comments and evaluations, the programme was considered relevant and successful by students and their employers. Furthermore, the programme was recognised by Training in Infection Control in Europe (TRICE), a project focusing on education in infection control within the framework of the European Centre for Disease Prevention and Control (ECDC) [1]. As the Nordic Council of Ministers has decided to close down NHV at the end of 2014, this description of the background and contents of the programme may serve as inspiration in the development of future educational initiatives within infection prevention and control.
The Nordic countries (Denmark, Iceland, Finland, Norway and Sweden) have a long tradition for infection control practice, which is based on close collaboration between infection control nurses and medical doctors specialised in infectious diseases or clinical microbiology [2]. Experiences from the Nordic countries show that a focus on prevention of healthcare-associated infections and a restrictive policy on antibiotics have contributed to a lower prevalence of multi-drug resistant microorganisms, compared to many other countries [3]. However, the rapidly increasing prevalence of resistant microorganisms has also affected the situation in the Nordic countries, and stresses the importance of strict and continuous intensive measures and policies within infection control. Thus, there is a need for further educational initiatives for health professionals within the field of infection control, in order to provide them with the knowledge
Correspondence: Lene Povlsen, Nordic School of Public Health NHV, Box 12133, SE-40242 Göteborg, Sweden. E-mail: [email protected] (Accepted 11 August 2014) © 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494814550176
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
688 J. Holt et al. Table I. Themes and topics included in the education programme at NHV (with ECTS point values). Public Health related courses
Special courses in infection control
Public health and health promotion (12 ECTS) Quantitative and qualitative research methods (15 ECTS) Epidemiology (5 ECTS) Scientific writing (3 ECTS)
Microbiology (2 ECTS) Immunology, vaccinology and resistance to antibiotics (5 ECTS) Infection control (10 ECTS) Communicable disease epidemiology (5 ECTS) Individual project assignment within infection control (3 ECTS)
ECTS: European Credit Transfer System; NHV: Nordic School of Public Health NHV.
and competences needed for prevention, surveillance, supervision and quality assurance. Both the prevalence of healthcare-associated infections and the organisation of infection control in the Nordic countries are comparable. Due to the limited size of each country, it has proven difficult to establish and maintain continuous and updated national education in infection control. To ensure continuity, a joint education programme for Nordic health professionals was, therefore, considered relevant; and at the same time it was seen as a way to create opportunities for exchange of knowledge and experiences, and for strengthening professional networking. Methods Establishing a Nordic education The initiative in establishing a joint education emerged from a self-appointed working group consisting of national nursing and medical professionals responsible for infection control in Denmark (Statens Serum Institut (SSI)), Norway (the Norwegian Institute of Public Health) and Sweden (the Swedish Institute for Communicable Disease Control, currently named ‘The Public Health Agency of Sweden’). At a meeting in 2006, the group received a mandate from relevant Nordic public and professional organisations to establish a joint Nordic education programme in infection control, at the Nordic School of Public Health NHV, situated in Gothenburg, Sweden. NHV was chosen because it was an established educational institution within the field of public health since 1953, under the auspices of the Nordic Council of Ministers. It was further decided that the education programme should not constitute a formal exam; instead, a diploma would be obtained when all courses were completed. This facilitated that students who wanted to continue their studies
and end up with a Master of Public Health (MPH) exam (120 European Credit Transfer System (ECTS)) were able to transfer 60 ECTS courses included in the diploma programme into their MPH exam. The Diploma Programme at NHV The Diploma Programme in Infection Control at NHV started in the spring of 2007 and aimed to provide the students with key competencies in infection control, as well as basic academic knowledge and skills within the field of public health. The programme primarily targets experienced doctors and nurses from the Nordic countries who either work or aim to work within infection control. It consists of a total of 60 ECTS courses, equivalent to 1500 – 1800 hours of study, of which 35 ECTS are single courses within public health and 25 ECTS are special courses within infection control (Table I). Previous recommendations for improving patient safety in Europe and recommendations for training of infection control practitioners from ECDC, including the latest version from 2013 [1], have continuously been considered and incorporated into the courses. Learning outcomes are described for each course, according to the Bologna Process in European Higher Education [4] and hold descriptions on key competences in the shape of knowledge, skills and attitudes appropriate to each context [5]. Teaching is based on adult education principles and problem-based learning, which require the active participation of the course participants. All courses are single courses of 1 – 2 weeks’ duration, which means that students can study at their own pace and convenience, taking into account work and family life. Courses are primarily taught in Danish, Norwegian and Swedish. To ensure a high professional level, course leaders and lecturers at the special courses are recruited from qualified infection control teams in the Nordic countries.
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
Nordic Interdisciplinary Education in Infection Control 689 The final course of the programme consists of an individual assignment in infection control, in which the student must document his/her knowledge and the competences acquired by attending the other courses that are included in the programme. The individual assignment starts from the student’s work and field of responsibility, and includes carrying out a minor project based upon a previously written project plan. The overall aim of the assignment is that the student demonstrates the ability to identify, gather and process data on a problem within the field of infection control, and subsequently describe and report the results. From 2007 until the last admission at the beginning of 2013, a total of 177 students were admitted to the programme. Of these, 23.2% came from Denmark, 0.6% from Finland, 0.6% from Iceland, 29.4% from Norway and 46.3% from Sweden. A majority (78%) were nurses, 12.5% were medical doctors, while 9.5% had various other professional backgrounds. By the end of 2013, 13 students (7%) had dropped out of the programme. Before NHV is closed down at the end of 2014, it is estimated that a total of 100 students will have received a diploma in infection control, approximately. Furthermore, 35 students from the diploma programme have continued on, to the NHV’s Master of Public Health (MPH) programme. Of these, it is estimated that around 25 students will to be able to complete their MPH, before the NHV is closed down. Results Evaluation of the courses and the programme Each course is evaluated by means of a discussion in class and a written questionnaire. The course evaluation is made public and compiled by the course coordinator, who analyses and suggests possible changes for the subsequent course. The entire diploma programme has only been evaluated once, at the beginning of 2010, when nine students who had completed the programme participated in telephone interviews (unpublished data). The interviewer was appointed by NHV, but was not directly involved in planning nor conducting the programme. As a whole, the students described the courses as useful, and above all, they highlighted the Nordic and interdisciplinary design and the fact that a public health platform was applied. The special courses in infection control contained highly relevant professional topics and aspects, and the public health related courses were excellent complements to the special courses. The opportunity to meet and make contacts
with students from the other Nordic countries was emphasised. The social gatherings were seen as an important part of the education, and the students still kept contact with fellow students. Having completed the programme and acquired new knowledge and skills was perceived as a positive career enhancement. The students felt they could handle emergent situations in a more professional and safe way, and that they had acquired the tools to handle dilemmas they might face. What was needed in the design of the diploma programme was a course on pedagogy. This was considered essential, as many students’ work focused on informing, supporting and supervising patients, health care professionals and others. Conclusions The complex field of infection control calls for continuous education and training of the infection control practitioners, in order for them to learn how to address emerging problems and to provide the evidence-based advice and counselling needed to enhance safety for both patients and health care professionals. Based on the relatively high number of applicants and the low drop-out rate, the Diploma Programme in Infection Control at NHV has met the need for a Nordic interdisciplinary education at a high professional level; and has at the same time, linked infection control to public health. The continuously updated versions of the European core curriculum for infection control professionals [1] were useful in designing the programme, and students have acquired the relevant and needed competences by means of the courses and educational methods applied. However, because NHV will soon be closed down, the Nordic countries are at present in exactly the same situation as seven years ago. The number of potential students is still too small for each country to establish their own national education programmes and the prevalence of resistant microorganisms in the Nordic countries is increasing. Accordingly, efforts have been initiated to seek to establish a future Nordic education programme similar to the one at NHV; but naturally, it will be adjusted according to the lessons learned. Acknowledgements We wish to thank all current and previous members of the Nordic working group responsible for designing and planning the programme, for conducting and teaching at the special courses, and for supervising the students.
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
690 J. Holt et al. Conflict of interests The authors declare that there is no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. References [1]
European Centre for Disease Prevention and Control (ECDC). Core competencies for infection control and hospital hygiene professionals in the European Union, www.ecdc.europa.eu/en/
publications/publications/infection-control-core-competencies.pdf (2013, accessed 1 July 2014). [2] Jepsen OB. Infection control in Danish healthcare: Organization and practice. J Hosp Infect 2001;47:262-65. [3] Frimodt-Møller N, Hammerum AM, Bagger-Skjøt L, et al. Global development of resistance: Secondary publication. Dan Med Bull 2007;54:160-62. [4] European Commission. The EU contribution to the European higher education area, http://vieja.fundacioncyd. org/img/HighereducationEUleaflet.pdf (2010, accessed 1 July 2014). [5] European Commission. Key competences for lifelong learning: European Reference Framework, www.britishcouncil.org/sites/britishcouncil.uk2/files/youth-in-actionkeycomp-en.pdf (2007, accessed 1 July 2014).
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
SJP0010.1177/1403494814550176Nordic Interdisciplinary Education in Infection ControlJ. Holt et al.
Scandinavian Journal of Public Health, 2014; 42: 687–690
Original article
A joint Nordic Interdisciplinary Education Programme in Infection Control: A successful, but short-lived initiative
Jette Holt1, Nina K. Sorknes2 & Lene Povlsen3 1Statens
Serum Institut (SSI), Copenhagen, Denmark, 2Norwegian Institute of Public Health, Oslo, Norway, and 3Nordic School of Public Health NHV, Göteborg, Sweden
Abstract Introduction: Prevention of healthcare-associated infections and a restrictive antibiotics policy in the Nordic countries have contributed to a low prevalence of multi-drug resistant microorganisms, compared to many other countries. This requires professional competences acquired through education in infection control, both in hospitals and in primary health care. Methods: This paper describes a joint Nordic Interdisciplinary Education Programme in infection control, established at the Nordic School of Public Health NHV (NHV) in 2007. Results: The education programme was considered highly relevant and successful by students and their employers. Conclusions: The paper describes the background and contents of the programme, which may serve as inspiration in the development of future educational initiatives in other countries. Key Words: Antibiotic resistance, education programme, infection control, core competencies, interdisciplinary education, Nordic countries, public health policy
Introduction
Background
This paper describes a joint Nordic interdisciplinary education programme in infection control, which was established at the Nordic School of Public Health NHV in 2007. Based on a high number of applicants, as well as oral comments and evaluations, the programme was considered relevant and successful by students and their employers. Furthermore, the programme was recognised by Training in Infection Control in Europe (TRICE), a project focusing on education in infection control within the framework of the European Centre for Disease Prevention and Control (ECDC) [1]. As the Nordic Council of Ministers has decided to close down NHV at the end of 2014, this description of the background and contents of the programme may serve as inspiration in the development of future educational initiatives within infection prevention and control.
The Nordic countries (Denmark, Iceland, Finland, Norway and Sweden) have a long tradition for infection control practice, which is based on close collaboration between infection control nurses and medical doctors specialised in infectious diseases or clinical microbiology [2]. Experiences from the Nordic countries show that a focus on prevention of healthcare-associated infections and a restrictive policy on antibiotics have contributed to a lower prevalence of multi-drug resistant microorganisms, compared to many other countries [3]. However, the rapidly increasing prevalence of resistant microorganisms has also affected the situation in the Nordic countries, and stresses the importance of strict and continuous intensive measures and policies within infection control. Thus, there is a need for further educational initiatives for health professionals within the field of infection control, in order to provide them with the knowledge
Correspondence: Lene Povlsen, Nordic School of Public Health NHV, Box 12133, SE-40242 Göteborg, Sweden. E-mail: [email protected] (Accepted 11 August 2014) © 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494814550176
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
688 J. Holt et al. Table I. Themes and topics included in the education programme at NHV (with ECTS point values). Public Health related courses
Special courses in infection control
Public health and health promotion (12 ECTS) Quantitative and qualitative research methods (15 ECTS) Epidemiology (5 ECTS) Scientific writing (3 ECTS)
Microbiology (2 ECTS) Immunology, vaccinology and resistance to antibiotics (5 ECTS) Infection control (10 ECTS) Communicable disease epidemiology (5 ECTS) Individual project assignment within infection control (3 ECTS)
ECTS: European Credit Transfer System; NHV: Nordic School of Public Health NHV.
and competences needed for prevention, surveillance, supervision and quality assurance. Both the prevalence of healthcare-associated infections and the organisation of infection control in the Nordic countries are comparable. Due to the limited size of each country, it has proven difficult to establish and maintain continuous and updated national education in infection control. To ensure continuity, a joint education programme for Nordic health professionals was, therefore, considered relevant; and at the same time it was seen as a way to create opportunities for exchange of knowledge and experiences, and for strengthening professional networking. Methods Establishing a Nordic education The initiative in establishing a joint education emerged from a self-appointed working group consisting of national nursing and medical professionals responsible for infection control in Denmark (Statens Serum Institut (SSI)), Norway (the Norwegian Institute of Public Health) and Sweden (the Swedish Institute for Communicable Disease Control, currently named ‘The Public Health Agency of Sweden’). At a meeting in 2006, the group received a mandate from relevant Nordic public and professional organisations to establish a joint Nordic education programme in infection control, at the Nordic School of Public Health NHV, situated in Gothenburg, Sweden. NHV was chosen because it was an established educational institution within the field of public health since 1953, under the auspices of the Nordic Council of Ministers. It was further decided that the education programme should not constitute a formal exam; instead, a diploma would be obtained when all courses were completed. This facilitated that students who wanted to continue their studies
and end up with a Master of Public Health (MPH) exam (120 European Credit Transfer System (ECTS)) were able to transfer 60 ECTS courses included in the diploma programme into their MPH exam. The Diploma Programme at NHV The Diploma Programme in Infection Control at NHV started in the spring of 2007 and aimed to provide the students with key competencies in infection control, as well as basic academic knowledge and skills within the field of public health. The programme primarily targets experienced doctors and nurses from the Nordic countries who either work or aim to work within infection control. It consists of a total of 60 ECTS courses, equivalent to 1500 – 1800 hours of study, of which 35 ECTS are single courses within public health and 25 ECTS are special courses within infection control (Table I). Previous recommendations for improving patient safety in Europe and recommendations for training of infection control practitioners from ECDC, including the latest version from 2013 [1], have continuously been considered and incorporated into the courses. Learning outcomes are described for each course, according to the Bologna Process in European Higher Education [4] and hold descriptions on key competences in the shape of knowledge, skills and attitudes appropriate to each context [5]. Teaching is based on adult education principles and problem-based learning, which require the active participation of the course participants. All courses are single courses of 1 – 2 weeks’ duration, which means that students can study at their own pace and convenience, taking into account work and family life. Courses are primarily taught in Danish, Norwegian and Swedish. To ensure a high professional level, course leaders and lecturers at the special courses are recruited from qualified infection control teams in the Nordic countries.
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
Nordic Interdisciplinary Education in Infection Control 689 The final course of the programme consists of an individual assignment in infection control, in which the student must document his/her knowledge and the competences acquired by attending the other courses that are included in the programme. The individual assignment starts from the student’s work and field of responsibility, and includes carrying out a minor project based upon a previously written project plan. The overall aim of the assignment is that the student demonstrates the ability to identify, gather and process data on a problem within the field of infection control, and subsequently describe and report the results. From 2007 until the last admission at the beginning of 2013, a total of 177 students were admitted to the programme. Of these, 23.2% came from Denmark, 0.6% from Finland, 0.6% from Iceland, 29.4% from Norway and 46.3% from Sweden. A majority (78%) were nurses, 12.5% were medical doctors, while 9.5% had various other professional backgrounds. By the end of 2013, 13 students (7%) had dropped out of the programme. Before NHV is closed down at the end of 2014, it is estimated that a total of 100 students will have received a diploma in infection control, approximately. Furthermore, 35 students from the diploma programme have continued on, to the NHV’s Master of Public Health (MPH) programme. Of these, it is estimated that around 25 students will to be able to complete their MPH, before the NHV is closed down. Results Evaluation of the courses and the programme Each course is evaluated by means of a discussion in class and a written questionnaire. The course evaluation is made public and compiled by the course coordinator, who analyses and suggests possible changes for the subsequent course. The entire diploma programme has only been evaluated once, at the beginning of 2010, when nine students who had completed the programme participated in telephone interviews (unpublished data). The interviewer was appointed by NHV, but was not directly involved in planning nor conducting the programme. As a whole, the students described the courses as useful, and above all, they highlighted the Nordic and interdisciplinary design and the fact that a public health platform was applied. The special courses in infection control contained highly relevant professional topics and aspects, and the public health related courses were excellent complements to the special courses. The opportunity to meet and make contacts
with students from the other Nordic countries was emphasised. The social gatherings were seen as an important part of the education, and the students still kept contact with fellow students. Having completed the programme and acquired new knowledge and skills was perceived as a positive career enhancement. The students felt they could handle emergent situations in a more professional and safe way, and that they had acquired the tools to handle dilemmas they might face. What was needed in the design of the diploma programme was a course on pedagogy. This was considered essential, as many students’ work focused on informing, supporting and supervising patients, health care professionals and others. Conclusions The complex field of infection control calls for continuous education and training of the infection control practitioners, in order for them to learn how to address emerging problems and to provide the evidence-based advice and counselling needed to enhance safety for both patients and health care professionals. Based on the relatively high number of applicants and the low drop-out rate, the Diploma Programme in Infection Control at NHV has met the need for a Nordic interdisciplinary education at a high professional level; and has at the same time, linked infection control to public health. The continuously updated versions of the European core curriculum for infection control professionals [1] were useful in designing the programme, and students have acquired the relevant and needed competences by means of the courses and educational methods applied. However, because NHV will soon be closed down, the Nordic countries are at present in exactly the same situation as seven years ago. The number of potential students is still too small for each country to establish their own national education programmes and the prevalence of resistant microorganisms in the Nordic countries is increasing. Accordingly, efforts have been initiated to seek to establish a future Nordic education programme similar to the one at NHV; but naturally, it will be adjusted according to the lessons learned. Acknowledgements We wish to thank all current and previous members of the Nordic working group responsible for designing and planning the programme, for conducting and teaching at the special courses, and for supervising the students.
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
690 J. Holt et al. Conflict of interests The authors declare that there is no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. References [1]
European Centre for Disease Prevention and Control (ECDC). Core competencies for infection control and hospital hygiene professionals in the European Union, www.ecdc.europa.eu/en/
publications/publications/infection-control-core-competencies.pdf (2013, accessed 1 July 2014). [2] Jepsen OB. Infection control in Danish healthcare: Organization and practice. J Hosp Infect 2001;47:262-65. [3] Frimodt-Møller N, Hammerum AM, Bagger-Skjøt L, et al. Global development of resistance: Secondary publication. Dan Med Bull 2007;54:160-62. [4] European Commission. The EU contribution to the European higher education area, http://vieja.fundacioncyd. org/img/HighereducationEUleaflet.pdf (2010, accessed 1 July 2014). [5] European Commission. Key competences for lifelong learning: European Reference Framework, www.britishcouncil.org/sites/britishcouncil.uk2/files/youth-in-actionkeycomp-en.pdf (2007, accessed 1 July 2014).
Downloaded from sjp.sagepub.com at Karolinska Institutets Universitetsbibliotek on May 29, 2015
