HNN320 Leadership and Clinical Governance: Reducing HAIs Strategies

This report addresses the critical issue of hospital-acquired infections (HAIs) and outlines two key strategies for their reduction: personal protective equipment (PPE) and hand hygiene. It emphasizes the importance of leadership, staff commitment, and adherence to safety protocols in implementing PPE effectively. The report also discusses the role of clinical governance in ensuring accountability and promoting evidence-based practices for infection control. Hand hygiene is presented as a core element of safety practice, with detailed guidelines for implementation and the use of alcohol-based hand rubs. Facilitators and barriers to both PPE and hand hygiene implementation are explored, highlighting the significance of education, training, and a culture of safety. The report concludes that a well-administered clinical governance framework is vital for supporting improvements in infection control and ultimately enhancing patient safety.

TITLE: CLINICAL GOVERNANCE FRAMEWORK
CLINICAL GOVERNANCE FRAMEWORK
Name of Student
Name of University
Author note

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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

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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.

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There are some facilitators and barriers to PPE’s implementation process. Compliance
with the universal precautions against infections can be determined by myriad of factors that
includes the higher knowledge regarding infection transmission modes. There are certain few
barriers to PPE implementation like a strict time constraint, some rare inconveniences and
even presumption about the patient being not infected are critically attached to a system and
daily clinical practise. Other barriers like lack of required equipment, conflict of interest in
the team, tremendous work stress. Facilitators can be like perceived commitment to safety
practices, a good risk perception, not risk taking personality ability and adherence to safety
guidelines resiliently. Healthcare workers who have the knowledge of HAI transmission
models, better perceptions regarding the susceptibility to clinical infections have much better
compliance rates with best practises. Improvement of knowledge (Brosio et al., 2017) nurse
training and increasing awareness about various modes of transmission used by a disease
pathogen is important. Low aspirations levels and commitment levels to a specific patient
care task are barriers too. Self-efficacy, vicarious experiences by seeing disciplined
colleagues practicing universal precautions in various circumstances along with social
persuasions like verbal boost and verbal encouragements can help in better application of
PPE usage. Strengthening self-efficacy along with strengthening of practical experiences
with universal precautionary measures are important facilitators.
Clinical governance (Brusaferro et al., 2015) is a summation of important social
relationships and individual responsibilities provided by a particular health service between
the state or the territory’s health framework and the governing body. The clinicians, patients
and the other stakeholders ensures a positive clinical outcome within the governance
framework. It ensures about the community and the health institutions can be confident about
delivering a safe health care which continually growing towards a practice change. Clinical
governance integrates the components of a corporate governance within health

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organizations. In this case, the clinical governance framework should ensure that the
clinicians to the medical managers and administrators are accountable to patient’s safety and
delivery of HAI free improved patient centered health services, effectively. Effectively
administered clinical governance is vital to supporting of the improvements in various phases
of infection control. The focus of clinical governance should be on infection control practice
and safe evidence based practices that incorporate surveillance and even regular auditing to
analyze and reinforce the self-regulation techniques and staff’s performance feedback.
Expectation of clinical care determines the expression of patient satisfaction. Different levels
of satisfaction – reflects on various and many perspectives of the patient care and providing
safety against HAI is one of them. For example, if doctor’s performance and overall safety
care meet a subject’s expectations, the satisfaction level of both the patient and the clinician
will be concurrent.
As for another strategy, hand hygiene to prevention the spread of hospital acquired
infections is second part of the practise change plan of action. Hand hygiene is considered as
a core element of safety practice and infection control methods. Health care associated
infections, severity of diseases and treatment complexities, superimposed by pathogen
infections make the patient’s overall recovery and prognosis difficult and this can be
prevented as simply as by a measure like hand hygiene. Scientific literature states that if
hand hygiene is properly implemented (Graves, 2016) - can significantly minimize the risk of
acquired infection within healthcare framework. Practicing hand hygiene is actually the
simplest ways of reducing the incidences of HAIs. Hand hygiene prevents the routing and
rooting of resistant pathogens (Lutze et al., 2017) from the clinical atmosphere to patients
system. Studies have revealed that washing hands eradicates the transfer of pathogens from
the hands of health care workers working in intensive care unit. Hand washing and hand
hygiene compliance (Gould et al., 2019) has decreased the occurrence of HAIs. According to

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a study which performed randomized control trials found out that healthcare associated
Klebsiella sp. transmission can be prevented using hand hygiene. Evidence has also
suggested that the adherence to the hand hygiene best practices has reduced pathogens
acquisition rates on hands, ultimately reducing the prevalence of hospital acquired infections.
To implement the hand hygiene in the department – firstly, washing hands every time
with soap, water before and after a procedure is important. Visibly contaminated hands with
blood or another body fluid or alcohols, idophors and stuffs like antiseptic agents – should be
cleaned meticulously following the hand washing guidelines. After being in the restroom, the
nurses in the department should wash their hands with antimicrobial soap (Giuliano, &
Rybak, 2015) – each time following the detailed hand washing guidelines. It would be safe
for them and for the patients. Hands should be washed before and after taking meal as well.
Moreover, training workshops and seminars on hand hygiene are to be promoted as a practise
change implementation plan. Alcohol-based hand-washes (Fox et al., 2015) are to be used
regularly for decontamination of hands and it should be done before and after having direct
touch with patients, while intervening with catheters, just before putting the urinary catheters,
peripheral catheters and invasive devices without surgical procedure. Hands should be
washed touching the patient’s skin that is while measuring patient’s blood pressure or pulse.
Hands must be washed after touching body fluids, excretions, body’s mucous membranes,
skin, and even wound dressings. After touching the inanimate objects (like medical
equipment), that is close vicinity of patient, the nurses will be guided and taught to clean their
hands. After removing hand gloves, it is indicated the nurse should dispose the glove and
clean her hands again. If the contaminated or the surgical site is touched – hands should be
washed as well.
Facilitators and barriers to hand hygiene implementation are to be addressed as well.
Scenario-based learning (SBL) is a pivotal factor in learning of hand hygiene. SBL can be

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seen as a facilitator to get the nursing students very closer to realities of deconstruction and
construction of a learning experiences. Reflection is a self-induced learning approach and
reflection is another facilitator in HH (Hand hygiene) implementation (Graves, 2016).
Nursing students has been shown in many research reports to have amplified their HH
practices with reflection being the main facilitator in identifying one’s own made clinical
mistake and rectifying it reflectively. Colleagues questioning the practice of another
colleague has been reported to be beneficial in correcting the error. Reflection can be used an
effective learning tool in teaching the nursing student about hand hygiene and online teaching
with face-to-face learning (McCutcheon et al., 2015) and teaching is preferred as a facilitator.
An learning approach called blended learning where a combination of online components
teaching along with offline teaching can be used as an effective teaching approach is
preferred in biomedical education. High scorers or performers will be asked then to explain
the reason for their high compliance and themes will be determined. Generally, there are
certain facilitators to this such as internalized precautions, previous exposure and repetitive
experiences, financial factors like bonuses, pay raises and other perks linked with
compliances there are certain barriers as well like the nursing students who did not value
teaching on HH or who do not find these workshops interesting are likely to acts as barriers
to the hand hygiene practice. Professional modeling, molding, assessment tasks and treatment
feedback from the patients and the colleagues are the facilitators which can be used to
enhance hand hygiene practices and its practice compliance. Regular but small and group
based, hands-on activity sessions can also act as enhancers. Culture change is vital to foster a
sustainable hand hygiene practice change amongst nursing students and new nurses.
Quality standards and important principles formulation are important tools of a
clinical governance framework in maintenance of hand hygiene. Quality standards (de Araújo
et al., 2016) from an outside perspective - is important to the immediate team. Independent

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reward to organizations assures confidence building and level of performance. Aspirations to
achieve external quality factors and standards are huge psychosocial motivators that
excellently encourages a medical or nursing manager to be extremely hard working, for if the
task or the hand hygiene practice (that is in this case) is established successfully - he or she
will be paid off. Observational audit tool can be used (in this hand hygiene practice change)
in healthcare facilities which did not submit any of the compliance data till date to the Hand
Hygiene, Australia. The tool can be very critical to estimation of hand cleaning and washing
compliances and in keeping up with the five moments and movements of hand hygiene. A
competency tool can be used to examine staff competency to carry out the effective hand
washing. Sampling matrix sheets are helpful in assisting the health care managers to decide
the suitable areas of hand hygiene data for compliance with the national program
recommendations.
These above mentioned guidelines as well as written documents for clinicians can be
used to promote evidence-based practices in prevention of the hospital inflicted infections.
Hospital acquired infections is a leading cause of morbidity and mortality that provide a huge
challenge to the clinicians. The measures of the infection controls including identification of
patients who are at risk of infections are to be done initially. Then, observing the compliance
to hand hygiene, the following of the standard national precautions in reduction of
transmission of bacteria is to be done. Environmental factors, architectural factors should be
followed closely to improved safety care. Infection prevention of burns patients, for example
requires identifying the sources of the organism, then identification of the vector organisms
and then preventive measures are to be applied by the clinicians. Surveillance is critical.
Opportunistic infections in immune-deficient and transplant patients should be preveted with
safety measures. Room ventilation, proper cleaning and clear decontamination along with
protective clothing is vital. Monitoring, surveillance, adherence to national safety guidelines

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should be prioritized then depending on requirements. Designating and categorizing the
infection and control teams would help in reducing the incidences and prevalence of hospital
induced and acquired infections in an effective and muchbetter way.

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