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 2 the role of infection control link nurses, infection control link nurse programs and their effects were evaluated, and gaps in the evidence base were identified. Involving link nurses in infection prevention and control has been implemented in hospitals worldwide to improve clinical practice. We aimed to identify key elements of infection control link nurses (ICLN) and ICLN programs, to evaluate the effect of such programs, and to identify gaps in the evidence base. In a scoping review, 29 research- and opinion-based papers on ICLN in acute care hospitals were included. Three key elements were identified: the profile of ICLN, strategies to support ICLN, and the implementation of ICLN programs. The majority of included studies delineated the ICLN profile with accompanying roles, tasks and strategies to support ICLN, without a thorough evaluation of the implementation process or effects. Few studies reported on the effect of ICLN programs in terms of patient outcomes or guideline adherence, with positive short-term effects. This review revealed a lack of robust evidence on the effectiveness of ICLN programs. Best practices for an ICLN program included a clear description of the ICLN profile, education on infection prevention topics as well as training in implementation skills, and support from the management at the ward and hospital level.
In chapter 3 the variation and success factors in infection control link nurse programs in Dutch acute care hospitals were assessed. At that time, the Netherlands had 74 hospitals. In a mixed-methods study, 72 infection control practitioners from 72 different hospitals were surveyed. The outcomes of the survey were supplemented with four additional semi-structured interviews. The survey was based on items of the Template for Intervention Description and Replication (TIDieR) checklist. A link nurse program was present in 67% of the hospitals; responsibility for 76% of these programs lied solely with the infection prevention and control team. The core component of most programs (90%) was education. Programs that included education on infection prevention topics and training in implementation skills were perceived as more effective than programs without such education or programs where education included only infection prevention topics. The interviews illustrated that these programs were initiated by the IPC team with the intention to collaborate with other departments to improve practice. Content for these programs was created at the time of their implementation. Infection control practitioners varied in their ability to express program goals and to engage experts and key stakeholders. From the interviews it transpired that infection control practitioners seemed more satisfied if they were able: 1) to express a more coherent vision and more long-term strategic goals, 2) to involve more experts (e.g. educational experts) in the enhancement of their program, and 3) to engage more key stakeholders, including management, and their direct colleagues, the IPC team, to create support.

See dissertation for the complete summary.