Clinical Governance Framework

TITLE: CLINICAL GOVERNANCE FRAMEWORK
CLINICAL GOVERNANCE FRAMEWORK
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1CLINICAL GOVERNANCE FRAMEWORK
Hospital-Acquired Infections or just HAI are infections that are not incubating or
present during admission time of the patient to the hospital but occurs during the treatment
process. HAI are unfortunate and very frequently occur as an adverse event of providing care
and affects the rate of mortality, morbidity and even quality of life. Mostly, institution-driven
factors are primarily responsible for HAI’s higher rates in especially intensive care
departments. Patient factors like patient’s age, chronic illnesses, immunity, nutritional status,
medications and catheterization sustainability affect the HAI incidents very much.
Institutional factors involves high patient numbers, architectural unit structure, knowledge of
hand hygiene, the disinfection procedures and sterilization methods and not complying to
clinical guidelines. Treatment costs, mortality rates due to infections in intensive units are the
other factors. Monitoring and control of infections acquired in hospitals are pertinent to
patient care. Intensive care and registered nurses of every team have vital duties and critical
responsibilities to prevent the same.
Risks involving HAI are dependent on patient's immune system, infection control
methods and prevalence of pathogens in community and the surrounding. Risk factors that
lead to hospital-acquired infections are geriatric age, immunological suppression state
(Gerriets, 2016), prolonged hospital stay (McDevitt, 2016), chronic illnesses, re-admission to
hospitals, invasive procedures, ventilator support (Wright, Allen-Bridson & Hebden, 2017)
and indwelling devices during their stay in critical units which has an elevated risk of the
acquired infections. While the rate and incidences of hospitalizations play a unique role in
management of an acute illness but simultaneously, it keeps susceptible patients within a
multiple nosocomial, resistant pathogens environment of the hospital facility. About twenty
percent of nosocomial infections take place in an intensive care department (ICU).
Transmission of pathogens happens by direct touch with the healthcare workers and with the
contaminated environment. The pathogens colonize (Zipperer, 2016) in the warm and the

2CLINICAL GOVERNANCE FRAMEWORK
moist areas like inguinal and the perianal area, trunk and axilla. Some of the organisms can
forge tough biofilms in and around the catheters. Examples are Acinetobacter baumannii,
Pseudomonas species, Stenotrophomonas maltophilia. The extra-luminal migration by these
organisms happens to be the major infection route taken up by bloodstream infections. This
also explains why the staphylococci (coagulase negative) that is usually found in the skin
flora causes colonization of the central lines and hence, of the blood stream associated
infections. Multiple drug-resistant pathogens are a significant cause of HAI in hospitals,
particularly as so in intensive care and critical care unit, increasing hospital stay and
morbidity as well.
As for the first strategy, personal protection equipment against Hospital
acquired infections is an important plan of action. Personal protective equipment or PPE
is the clothing and the equipment used by the employees, staffs and visitors to protect their
bodies from affection with diseases (Larsen et al., 2015). PPE is a very important nursing
strategy to prevent the occurrences of hospital acquired infections. Providing leadership as a
nurse manager, showing of full commitment by each staff and maintenance of workplace
behavior is very important. Employees those who perceive a strong need for commitment to
safety (Fisher, Grosh & Felty, 2016) has been reported to be more adhered to the safety
protocols than employees who lack these safety perceptions (Johnson, 2017). Studies have
shown that, employees who feel uncomfortable not wearing PPE mask (Williams, 2019) and
gloves in a clinical setting or during the appropriate situations – adheres better to the PPE
guidelines. It is also the job of supervisors to reinforce the usage of PPE and to enforce the
policies to prevent any noncompliance chances (Larkin, 2016). Each of the healthcare
administrators (Pearson, 2016) should be assuming the responsibility for facilitating, then
promoting and then undertaking the safety actions. Healthcare facilities that fosters, promote
a culture of patient and infection safety is a high functioning ethical institution. Worker safety

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and adequate safety resources along with proper training efforts which utilize the protocols
that require the patient safety actions is crucial to dealing with consequences and preventions
of noncompliance (O'brien, 2017). Clarifying the worksite practices along with the clinical
policies that promotes the knowledge of wearing PPEs (Hancock, 2016) in healthcare
framework is useful against HAIs. A concerned effort made in the identification of best
practices in relation to infection control and in dissemination of safety information to all the
other healthcare systems can definitely increase patient safety, worker safety and this should
have very positive ramifications in favor of PPI led infection control (World Health
Organization, 2016). Respiratory protections (Banach, 2015) like disposable, airline, and
cartridge are important. Eye protections like spectacles and goggles, visors, shields are very
useful. There are hearing protections as well for example like ear muffs, ear plugs. Hand
protection with gloves and the barrier creams is available as well. Foot protection comes in
form of shoes and boots. Head protection is required in some specialties as well. Skin
protection with cream, full sleeve clothes are used intensively nowadays. Other personal
types of protective equipment like disposable clothing for working in environments of
chemicals, hazards substances is important. Examples are lead aprons to prevent the x-ray,
sleeve protectors and aprons when using the chemicals; the leather jackets, the trousers while
working in cryogenic environments.
To implement the PPE protocols in a department, at first emphasizing on the
healthcare employees education and particular training programs are to be done. Safety
education in the hospital and training of healthcare workers demonstrate an organization’s
profound commitment (Butler, & Hupp, 2016) to patient safety against HAI. Secondly,
improving the staff and patient satisfaction feedback (Chittick et al., 2016) along with
enforcing the PPE policies is vital to have a positive culture of safety practice in a workplace,
integrating the same with a habitually safe behavior.