Leadership in Preventing Nosocomial Infection

This essay discusses the role of leadership in preventing nosocomial infection in hospital settings and the need for change in healthcare practices. It explores key leadership attributes and skills required to bring about change and highlights the importance of hand hygiene and environmental modifications. The essay concludes that effective clinical leadership is crucial in promoting improvements in quality of care and patient safety.

Running head: LEADERSHIP
Leadership
Name of the student:
Name of the University:
Author’s note

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Nosocomial infection or health care associated infection (HCAI) is the
transmission of pathogens like Staphylococcus aureus,
Klebsiella and Escherichia coli through direct contact with contaminated
environment or health care staffs resulting in increased hospital stay, high rate of
morbidity and mortality and increased health care cost for patient and health care
facilities. Nosocomial infection affects millions of people globally and it severely
threatens patient safety (Yallew, Kumie & Yehuala, 2017). As nosocomial infection
occurs due to lack of appropriate implementation of hygiene protocols to prevent
transmission of infection, the role of clinical leaders is paramount to influence
change in hospital setting. Leadership plays a role in promoting effective
governance and bringing system wide changes to achieve and sustain improvements
to care quality and patient safety. The main purpose of this essay is to provide an
overview of the issue of nosocomial infection in hospital setting and critically
analyse the need for change in health care practice. In response to the change
required for preventing nosocomial infection in clinical setting, the essay discusses
about key leadership attributes and skills required to change the process. The thesis
for the essay is that leaders have the capability to transform the hospital culture and
prevent eliminate environmental factors contributing to nosocomial infection.
Nosocomial infecton or HCAI is a type of infection that is transmitted to
patients or health care staffs during the process of care. It results in increase in
occupational infection among staffs as well as adverse event and prolonged hospital
stay for patient (World Health Organization, 2018). There are multiple causes
behind the transmission of such infection in hospital setting. Firstly, the hospital

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environment is itself the cause behind risk of nosocomial infection. Infections can
be transmitted through three routes such air, water and surface and this is seen
particularly in mechanically ventilated patients and those requiring invasive device
for treatment. Malfunction and ventilation system results in accumulation of dust
and moisture within the system resulting in increased risk of spread of
environmental fungi and bacteria (Beggs et al., 2015). Apart from environmental
factors, the most crucial factor that lead to nosocomial infection includes lack of
hand hygiene and poor compliance to hand hygiene among nurses and other staffs.
This is said because majority of nosocomial infections are transferred through hands
of care personnels and hand is the first method for prophylaxis (Sharif et al., 2015).
However, research evidence shows poor compliance to hand hygiene practices and
use of alcohol based disinfectants by nurses. Hence, as hand hygiene is directly
linked to nosocomial infection, poor compliance to hand hygiene justifies the need
for leadership role in bringing changes to practice.
Effective clinical leadership is vital to bring change in health care system and
engage in implementation of steps to promote improvements in quality of care. As
nosocomial infection has influence on the quality and reputation of hospital
performance, leadership skill is crucial for influencing group activities and
eliminating barriers during the change process (Daly et al., 2014). Based on analysis
of the cause behind HCAI in hospital setting, both environmental factors as well as
staff related factors have been identified as the cause behind burden of HCAI. The
lack of compliance to hand hygiene particularly demonstrates lack of
implementation of appropriate protocol or culture to promote hand hygiene. Hence,

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as per the leadership vision, it is necessary to identify the barriers that result in poor
hand hygiene cultured and increased risk of HCAI. As this issue particularly suggest
the need to bring major change within the hospital setting, the transactional
leadership style is considered important to bring changes in the system. This
leadership is relevant for the problem because transactional leaders act as the
manager of change and they engage in appropriate exchange with employees and
other stakeholders to improve performance and production (Sfantoo et al., 2017).
Therefore, identifying barriers to change process is crucial to make effective plans
for reduction in HCAI incidence.
To achieve the goal of high quality care, the main role of a leader is to instill a
culture of safety among health care staffs. The significance of this strategy is that it
supports creating environment for safer care. In the context of HCAI, proper hand
hygiene technique and education of staffs regarding hand hygiene is regarded as
crucial to achieve the quality improvement goals. However, criticial analysis of the
cause behind non compliance to hand hygiene is critical to implement effective
change. Firstly, for patients admitted to hospitals, compliance to hand hygiene is
affected by barriers like critical illness, lack of access to hand sanitizers, presence of
morbidity like confusion and delirium. After patient, the health care staffs like nurse
are important source of pathogens by direct contact during care of patient. However,
health care workers also increase the likelihood of infection transmission due to lack
of awareness regarding outcome of poor hand hygiene, poor attitude towards hand
hygiene and lack of appropriate hand hygiene protocol (Fox et al., 2015). Teker et
al. (2015) argues that lack of appropriate safety culture, excessive workload and

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poor access to alcohol based agents at vital points of care lead to missed moments
of hand hygiene. These barriers are important data for clinical leaders to understand
the areas where change is needed.
The critical analysis of the issue indicates that lack of safety culture and
reinforcement of the importance of hand hygiene is the major cause behind high rate
of HCAI in clinical setting. As the change in this context is related to safety culture,
the main leadership skills and attribute that is necessary to implement appropriate
measures for change includes having a clear vision, demonstrating commitment to
safety in decisions and behaviours, collaboration and maintaining transparency
during the change process (Joint Commission, 2017). This means the first step is to
critical develop a vision or goal based on which require change needs will be
identified. The main leadership goal in the context of HCAI is to establish hand
hygiene culture and reduce length of hospital stay due to nosocomial infection.
Furthermore, coalition building, communication and interpersonal skills are
necessary for leaders to involve all members in the change process. Coalition
building skill can help leaders to have all senior members on board and discuss the
necessity for change (Bakari, Hunjra & Niazi, 2017). In hospital setting, clinical
leaders can work with hospital administrative staffs, clinicians and managers to
discuss about resource limitation and structural errors that lead to HCAI. This form
of discussion would help to bring different skills to the table and facilitate
implementation of useful steps towards change.
Based on evaluation of barriers, one of the leadership interventions that can help
to bring down the rate of HCAI includes implementation of hand hygiene protocol

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and providing all support to staffs to comply with the protocol by providing
education and resource to adhere with the guidelines. The main rationale behind
choosing hand hygiene protocol as one of the strategy to prevent HCAI is that it
helps in the establishment appropriate guidelines for hand hygiene and delivery of
proper education to increase knowledge of health care workers regarding
significance of hand hygiene on patient safety (Beggs et al., 2015). Therefore, in the
context of quality improvement process for this report, the main quality
improvement strategy guiding the change process includes dissemination of hand
hygiene protocol in the setting, training every nurse regarding hand hygiene,
increase access to hand sanitizers at vital point of care and monitoring patient’s
hand hygiene at critical moments of care (Fox et al. 2015).
As in hospital setting, contact with multidisciplinary team increases the chances
of transmission of infection, a pluralistic approach to infection control is vital for
positive change process. Hospital doctors, nurses, microbiologist and engineers
must be involved to develop a culture of hand hygiene and eliminate environmental
risk factors of infection. Leadership skills of communication will play a vital role in
ensuring that all staffs understand the need for change and they are motivated to
execute proper steps to engage in change process (Asrar-ul-Haq & Kuchinke, 2016).
The application of the health belief model can help leaders to develop knowledge
and insight regarding the benefits and gains of implementing a hand hygiene
protocol. Clinical leaders can use their communication skills to discuss about
perceived susceptibility and seriousness of not complying with hand hygiene. After
this process, leaders can give direction for change by informing members about the

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cues to action and steps that have been implemented to reduce risk and increase self
efficacy of staffs in maintain hand hygiene. This process will facilitate all
stakeholders to be clear about the change process and make right steps towards
achieving the goal of change (Skinner, Tiro & Champion, 2015).
Based on communication with interprofessional team, the clinical leaders can
effectively implement hand hygiene protocol without any resistance or barriers.
However, implementation and dissemination of hand hygiene protocol itself will not
determine success of the protocol in promoting compliance to hand hygiene and
increasing environmental safety for patient. This will depend on leadership insight
regarding strategies needed to develop self efficacy of employees in delivering the
desired performance (Doppelt, 2017). This strategy will ensure sustainability of the
new change plan. To ensure all nurses and health care workers appropriately use the
protocol, delivery of educational session will be necessary to take constructive steps
towards change. The advantage of implementing education session is that it will
build the foundation for solid knowledge improvement and changes in attitude
towards hand hygiene among staffs. Bhagawati (2018) revealed that awareness
regarding source of pathogens in hospital setting is low among health care workers
and this further results in poor attitude towards hand hygiene. Nurses will less
important to hand hygiene during their daily clinical work. However, with
educational interventions, behavioural aspects of change can be promoted which
lead to appropriate behaviour control.
After development of skills of staffs in preventing HCAI, other leadership
strategy that is vital for achieving the vision includes maintain appropriate supply of

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equipments and resources to bring the change. This will require maintaining
appropriate supply of alcohol rubs and hand sanitizers in hospital and changing
structural layout in hospital setting. The significance of this strategy from leadership
perspective is that it will facilitate addressing infrastructure or institutional barriers
to hand hygiene. To reduce risk of HCAI due to ventilation system, leaders can
focus on making investments in improving the central air condition systems of the
wards. The design of the system can be changed so that recirculated air pass through
appropriate filters. Taking steps to ensure total air changes per room per hours and
maintaining adequate space around bed is also vital to ensure clean ventilation
system. In addition, access to hand rubs and sanitizers can be increased by making it
readily available near the bed of patient, near wash basins and other vital areas. Use
of visual cues is also encouraged that staffs are reminded of complying with hand
hygiene and they do not miss hand hygiene (Mehta et al., 2014). Finally, to promote
sustainability of the process, one crucial leadership step is to implement appropriate
audit process so that new hand hygiene process is adequately monitored and
recorded. Based on this form of audit, all possible changes in protocol and clinical
setting can be done to ensure that any limitations or failed areas are rectified in a
timely manner.
From the discussion regarding the need for leadership role in preventing the
burden of nosocomial infection, it can be concluded that HCAI is an issue that
negatively affects quality of care and result in increased hospital stay. It also
increased the burden of health care due to additional cost in treatment. Best on
critical analysis of the issue and the need for change, the essay discussed that

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leadership skills of clear vision, coalition building, effective communication and
transparency is vital to bring desired change and gain necessary from all
stakeholders regarding the change process. The leadership intervention that was
prioritized included taking critical steps to promote hand hygiene through
implementation of hand hygiene protocol followed by environmental modification
to prevent missed moments of hand hygiene and aerial dissemination of pathogens.

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