Role of Nurse Unit Manager in Identifying Onset of Hospital Acquired Infection

The essay highlights the role Nurse Unit Manager (NUM) in identifying the onset of hospital acquired infection (HAI) in the ward from last three months. The primary role of Nurse Unit Manager is to supervise the operating unit within health care facility comprising of supervising the nursing staff and monitoring patient’s health condition. The essay will focus on two main strategy developed and implemented by the registered nurse that includes hand hygiene strategy and Aseptic technique strategy.

Running head: NURSING LEADERSHIP
NURSING LEADERSHIP
Name of the Student:
Name of the University:
Author note:

1NURSING LEADERSHIP
The essay highlights the role Nurse Unit Manager (NUM) in identifying the onset of
hospital acquired infection (HAI) in the ward from last three months. The primary role of
Nurse Unit Manager is to supervise the operating unit within health care facility comprising
of supervising the nursing staff and monitoring patient’s health condition (Salmond &
Echevarria, 2017). In this essay, the registered nurse will develop two main strategies that can
be implemented within the hospital premises and reduce the potential risk of hospital
acquired infections. The source that leads to these infection will be highlighted by the nurse
and accordingly strategies will be develop to reduce the incidence of infection. Hospital
acquired infection is also known as nosocomial, is defined as a type of infection that is
prevalent and acquired in the hospitals. Bacteria are the major cause of hospital acquired
infection that can be severe and hard to treat (Khan, Ahmad & Mehboob, 2015). A detail
insight is provided on the concept of hospital acquired infection and the problems caused due
to this infection that can affect the patient and the working staff members within the hospital
premises. The role of registered nurse is to critically analyse the problems caused by hospital
acquired infection and according identify an alternative strategy to reduce the complexity of
the infection. The essay will focus on two main strategy developed and implemented by the
registered nurse that includes hand hygiene strategy and Aseptic technique strategy
(Asadollahi et al., 2015). The nurse will highlight the effect of implementing the strategies by
describing the method used for implementing the strategy, highlighting the facilitators and
barriers of using the strategy. Hence, in this essay a complete focus is provided on the role of
registered nurse to identify primary causes of hospital acquired infection and implement
strategies in nursing practice to reduce the potential risk of hospital acquired infection for the
patient.
Hospital acquired infection (HAI) is defined as the infection caused to the patient who
are hospitalized or are present within the hospital premises. Nosocomial is the medical term

2NURSING LEADERSHIP
that is used for addressing hospital acquired infection that is triggered mostly due to bacteria
(Sahealth.sa.gov.au, 2019). It is hence referred as a common medical complication, which
occurs during any medical treatment due to the present microorganism like viruses and
bacteria. These microorganism are either found in hospital environment or within the body of
an individual. The patient with surgical wound or any inserted medical devices such as
urinary catheter, intravenous drip and wound drain are under high risk of acquiring hospital
acquired infection. In Australia, approximately 6% of the patient who are admitted to the
hospital acquire the infection during admission with more than 165,000 cases of HAI each
year (Spelman, 2019). In Australia, the most common type of hospital acquired infection are
surgical wound infection, urinary and respiratory tract infection and contamination linked
with intravascular cannulas. According to National Nosocomial Prevalence Survey, 6.3% of
hospitalised patient out of 28,643 patient had acquired the infection. Hospital acquired
bloodstream infection is considered as the eight principal cause of demise in Australia. The
risk of developing hospital acquired infection is more prevalent in bigger hospitals than
compared to the smaller hospitals (Fernando, Gray & Gottlieb, 2017). Different strategies can
be used to reduce the prevalence of hospital acquire infection, Australia had developed an
Australian surveillance project that will aim to compare the rate of hospital acquired infection
among different hospital and identify the most leading cause of the infection within
Australian hospitals.
The first strategy identified for controlling the prevalence of hospital acquired
infection is hand hygiene technique. Large population of patient’s die because of hospital
acquired infection while receiving treatment or health care. Hands are considered as the
primary pathway of acquiring infection as direct contact of germ transmission can take place.
Hence, hand hygiene is the most crucial technique that can be used or practiced to avoid any
direct contamination of germs and to prevent the prevalence of hospital acquired infection.

3NURSING LEADERSHIP
According to Wold Health Organization, hand hygiene is considered as the significant
method to reduce hospital acquired infection (Apps.who.int, 2019). Five different moments
for hand hygiene were established by world health organization that included following the
procedure of hand hygiene before direct contacting with the patient, before aseptic technique,
after any body fluid contact risk, after contacting with the patient and their surroundings.
Different strategies under hand hygiene was highlighted by world health organization that
assist the healthcare providers or nurses to reduce the risk of infection. The nurses and
healthcare professionals must clean their hands by using alcohol-based sanitizers and adapt
this under their routine hygiene practice (Who.int, 2019). They can also wash their hand
using soap and water if they are dealing with any fluid discharge from the patient body.
Hence, two major approaches are included in hand hygiene strategy including hand rub
technique using antiseptic sanitizers and hand wash technique using soap and water. Hand
hygiene strategy will help the hospital management to effectively deal with hospital acquired
infection as the nurse and healthcare professionals will be educated on the benefits and
advantage of practicing hand hygiene strategy before and after any contact with the patient.
The implementation of hand hygiene will be initiated by providing adequate education and
knowledge to the staff members and doctors of the hospital. Training will be conducted for
the patients, staff, visitors and family members that will focus on the concept of hand hygiene
and the advantage of using hand hygiene to reduce the risk of infection (Van der Meer et al.,
2015). Different brochures, pocket cards and posters will be used for the training process in
the ward. A constant observation and feedback is conducted on the rate of infection and a
separate multidisciplinary team is established, who will supervise and administer the process
of hand hygiene method. In the ward, monitoring program is set up that will look into the
implementation and monitoring of the technique. If the nurse is assessing the patient they
must use hand rub method by using effective sanitizers to avoid the risk of infection and even

4NURSING LEADERSHIP
educate the patient to use this approach while undergoing health assessment (Megeus et al.,
2015). The registered nurse is responsible for implementing this technique in the ward hence,
the nurse must educate the staff members and patient regarding the hand hygiene guidelines
that demonstrate knowledge and competence within the healthcare facilities (Sickbert et al.,
2016). In order to successfully implement the strategy of hand hygiene, the registered nurse
has to overcome the barriers that can impede the implementation of hand hygiene strategy.
The barriers considered for hampering the hand hygiene strategy includes lack of adequate
skill and knowledge, optimism, reinforcement, social influences and belief regarding
consequences. The major barrier considered for implementing hand hygiene technique was
the lack of sufficient knowledge and idea among the staff members and the patient regarding
approach of hand hygiene technique (carter et al., 2016). The staff members did not use any
prior precaution while dealing with the patient hence, it was very crucial for the registered
nurse to take up the authority and educate the staff members and nurses of the ward regarding
the precautions that has to be considered before touching the patient and after touching the
patient. The staff members who are dealing with fluid discharge of the patient must wear a
sterilized gloves to avoid any outside contamination. Use of gloves will help the nurses to
minimize the risk of infection as no direct contact through hands will take place between the
patient and the nurse. The gloves must be sterilized to avoid any outside contamination of the
microorganism with the patient (Jun, Kovner & Stimpfel, 2016). The facilitator of using hand
hygiene strategy is in reducing the prevalence rate of hospital acquired infection by creating a
guideline that is less time consuming and hygienic. This strategy will help the patient to be
free from any infection during their stay in the hospital. The staff members and healthcare
providers will develop awareness and knowledge among themselves and will follow the
guidelines to help the hospital management in reducing the risk of hospital acquired infection
(Bolon, 2016). In order to implement the strategy of hand hygiene the registered nurse must

5NURSING LEADERSHIP
adhere to the framework of clinical governance. Clinical governance is defined as the system
through which management, governing body and clinicians divide and share their
responsibility to take care of patient, reduce level of risk and monitor the patient regularly in
order to improve the quality of patient care. There are seven pillars under clinical governance
and the implementation of hand hygiene protocol uses risk management and learning efficacy
for effectively implementing the strategy of hand hygiene in order to reduce hospital acquired
infection (HAI) (Graves et al., 2016).
The second strategy identified for controlling the prevalence rate of hospital acquired
infection was aseptic technique. Aseptic technique is used to inhibit pathogenic
microorganisms that results in health associated infection. The technique must be followed
before any direct contact between the staff members and the patient either through any
equipment or surface. Aseptic technique will protect the patient during intrusive clinical
practise by using appropriate infection inhibition measures, which reduces the occurrence of
microorganism (Pickering & Marsden, 2015). Risk assessment strategy of clinical
governance is used in this type of infection control strategy. Before practising aseptic
approach, asepsis method is guaranteed by executing risk assessment practice before any
procedure in order to identify the crucial sites and parts of the procedure that has to be
reserved sterile to ensure no transmission of infection between the patient and the staff
members. Infection inhibition measures are constructed and included in the aseptic technique
that must be followed before any contact of patient and nurses or before initiating any
procedure (Sahealth.sa.gov.au, 2019). The measure includes environmental controls, non-
touch practice, aseptic field administration, practice of personal protective equipment (PPE)
and hand hygiene. The implementation of aseptic technique require proper education and
knowledge to the healthcare professionals and staff members regarding the burden to hospital
acquired infection and the strategies under aseptic technique to reduce the burden of infection

6NURSING LEADERSHIP
within the hospital premises (Oriel, Chen & Itani, 2017). The practice included under aseptic
technique educate the use of method of surgical asepsis that includes use of sterilized gloves,
mask and gown. The healthcare professional must adhere to this techniques while dealing
with the patient or handling the patient in surgery rooms, hospital and care clinics. The
registered nurse must create an aseptic guidelines that should be followed by the nurses and
healthcare professionals in the form of poster, brochures and pamphlets (Ramm, Thomson &
Jackson, 2015). In order to implement the technique the registered nurse must follow the
process of asepsis before performing any biopsies, surgical procedures, suturing wounds,
dressing of burns or surgical wounds, inserting any wound drain, chest tube, intravenous line
and urinary catheter, administering injections and delivering babies. While performing any of
the above mentioned activity the healthcare professional use aseptic technique in order to
reduce the risk of high infection. The chance of infection is high in the patient whose length
of stay in the hospital is prolonged hence, the registered nurse has to focus on the clean
techniques for those patients that will focus on reducing the population of microorganism.
Clean technique is also established within the aseptic technique that has to be implemented in
the ward by the registered nurse (Joel, 2017). Clean technique is suitable for the patient who
require long term care and in case of surgical operation. The registered nurse can set a gentle
reminder by developing a multi-disciplinary team (MDT), who will aim to remind the nurses
and healthcare professional to use aseptic technique before taking up any procedure or and
use the concept of non-touch practices. The registered nurse will focus on few local
determinants that will increase the risk of infection and accordingly educate the staff and
maintain accountability. The nurse should improve the surveillance and monitoring system to
check if all the components that is require for infection control are maintained and followed
by the nurse (Aholaakko & Metsala, 2015). The steps involved in the aseptic technique must
be followed by the nurses and healthcare professionals under standard precaution. In order to

7NURSING LEADERSHIP
implement effective aseptic technique the registered nurse must highlight the barriers that can
hamper the practice aseptic technique. The barriers considered for implementing aseptic
technique is inconvenient or inconsistent site for hand gel, clump of cotton in the kit, small
room for practicing the sterile activity, continuous movement of staff members in the room
thus contaminating the room, no proper sterilization technique for gloves, inefficient disposal
method of the used gloves, inadequate knowledge regarding safe practice guidelines. Use of
sterile gloves and clean area is the major component of the following aseptic technique that
will enable the nurses and healthcare providers to avoid the risk of infection and direct
contact with the patient (Clare & Rowley, 2018). The facilitators of using aseptic technique is
that the nurses and healthcare professionals will learn and develop the practice of aseptic
technique that will help them to avoid or reduce the risk of hospital acquired infection. The
healthcare professionals will develop the practice of washing hands, using sterilized gloves
and aprons before handling the patient and after handling the patient. The aseptic techniques
is also applicable for the nurse and healthcare professional after contact with patient as they
will travel in the entire ward and will communicate with many patients hence, to avoid any
risk of transfer of microorganism from one patient to another it is crucial for them to follow
the aseptic technique and minimise the risk of infection (Gallagher, 2015). The risk
assessment criteria of the clinical governance structure is used and followed in this technique.
The registered nurse will use this criteria and underline the risk that is responsible for
increased hospital acquired infection.
It can be concluded that hospital acquired infection (HIA) is one of the most prevalent
condition affecting large population of patient who are admitted in the hospital. In this essay,
a detail insight is provided on the different microorganism that leads to hospital acquired
infection. Registered nurse plays a major role in developing and identifying different strategy
to reduce the risk of infection (Rubin, 2019). The registered nurse has the authority or

8NURSING LEADERSHIP
leadership to implement strategy to reduce the risk of infection. The strategy used by the
registered nurse is hand hygiene technique and aseptic technique. A detail insight was given
on the strategies and how can these strategies be used to reduce the risk of infection. The
steps was designed and implemented by the registered nurse highlighting the barriers and
facilitators that plays an important role in implementing the strategies (Engell, 2019). The
clinical governance principle was also used in identifying the strategy and implementing the
strategy. Hence, effective strategy must be used and adopted in the ward of every hospital to
reduce the risk of infection in the patient.

9NURSING LEADERSHIP
References
Aholaakko, T. K., & Metsälä, E. (2015). Aseptic practice recommendations for circulating
operating theatre nurses. British Journal of Nursing, 24(13), 670-678.
Apps.who.int. (2019). Prevention of hospital-acquired infection. Retrieved from
http://apps.who.int/medicinedocs/documents/s16355e/s16355e.pdf
Asadollahi, M., Bostanabad, M. A., Jebraili, M., Mahallei, M., Rasooli, A. S., &
Abdolalipour, M. (2015). Nurses' knowledge regarding hand hygiene and its
individual and organizational predictors. Journal of caring sciences, 4(1), 45.
Bolon, M. K. (2016). Hand Hygiene: an update. Infectious Disease Clinics, 30(3), 591-607.
Carter, E. J., Wyer, P., Giglio, J., Jia, H., Nelson, G., Kauari, V. E., & Larson, E. L. (2016).
Environmental factors and their association with emergency department hand hygiene
compliance: an observational study. BMJ Qual Saf, 25(5), 372-378.
Clare, S., & Rowley, S. (2018). Implementing the Aseptic Non Touch Technique (ANTT®)
clinical practice framework for aseptic technique: a pragmatic evaluation using a
mixed methods approach in two London hospitals. Journal of infection prevention,
19(1), 6-15.
Engell, C. A. (2019). Surveillance and Prevention of Hospital-Acquired Infections. In Adult
Critical Care Medicine (pp. 121-145). Springer, Cham.
Fernando, S. A., Gray, T. J., & Gottlieb, T. (2017). Healthcare‐acquired infections:
prevention strategies. Internal medicine journal, 47(12), 1341-1351.
Gallagher, R. (2015). Aseptic technique and specimen collection. Essentials of nursing
practice. London: Sage, 403-422.
Graves, N., Page, K., Martin, E., Brain, D., Hall, L., Campbell, M., ... & Barnett, A. G.
(2016). Cost-effectiveness of a national initiative to improve hand hygiene

10NURSING LEADERSHIP
compliance using the outcome of healthcare associated Staphylococcus aureus
bacteraemia. PLoS One, 11(2), e0148190.
Joel, L. A. (2017). Advanced practice nursing: Essentials for role development. FA Davis.
Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and facilitators of nurses’ use of
clinical practice guidelines: an integrative review. International Journal of Nursing
Studies, 60, 54-68.
Khan, H. A., Ahmad, A., & Mehboob, R. (2015). Nosocomial infections and their control
strategies. Asian pacific journal of tropical biomedicine, 5(7), 509-514.
Megeus, V., Nilsson, K., Karlsson, J., Eriksson, B. I., & Andersson, A. E. (2015). Hand
hygiene and aseptic techniques during routine anesthetic care-observations in the
operating room. Antimicrobial Resistance and Infection Control, 4(1), 5.
Oriel, B. S., Chen, Q., & Itani, K. M. (2017). The impact of surgical hand antisepsis
technique on surgical site infection. The American Journal of Surgery, 213(1), 24-29.
Pickering, D., & Marsden, J. (2015). Techniques for aseptic dressing and procedures.
Community eye health, 28(89), 17.
Ramm, D., Thomson, A., & Jackson, A. (2015). Learning clinical skills in the simulation
suite: the lived experiences of student nurses involved in peer teaching and peer
assessment. Nurse Education Today, 35(6), 823-827.
Rubin, R. (2019). Hospital-Acquired Conditions Decline. Jama, 321(12), 1148-1148.
Sahealth.sa.gov.au. (2019). Aseptic technique :: SA Health. Retrieved from
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/
clinical+resources/clinical+topics/healthcare+associated+infections/
prevention+and+management+of+infections+in+healthcare+settings/
aseptic+technique

11NURSING LEADERSHIP
Sahealth.sa.gov.au. (2019). Hospital infections :: SA Health. Retrieved from
https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Intern
et/Health+topics/Health+conditions+prevention+and+treatment/Hospital+infections
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for
nursing. Orthopedic nursing, 36(1), 12.
Sickbert-Bennett, E. E., DiBiase, L. M., Willis, T. M. S., Wolak, E. S., Weber, D. J., &
Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding
high compliance with hand hygiene practices. Emerging infectious diseases, 22(9),
1628.
Spelman, D. (2019). 2: Hospital-acquired infections. Retrieved from
https://www.mja.com.au/journal/2002/176/6/2-hospital-acquired-infections
van der Meer, E. W., van der Gulden, J. W., van Dongen, D., Boot, C. R., & Anema, J. R.
(2015). Barriers and facilitators in the implementation of recommendations for hand
eczema prevention among healthcare workers. Contact dermatitis, 72(5), 325-336.
Who.int. (2019). Hand Hygiene: Why, How & When? Retrieved from
https://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pd
f