In everyday medical practice, nurses face numerous healthcare issues that need careful consideration, comprehensive knowledge, and a solid skill set to be adequately addressed. These skills are generally related to effective leadership, management, collaboration, problem identification, and strategic planning and implementation. This paper aims to examine the population health problem, namely, nosocomial infections, and provide evidence from peer-reviewed literature that guides nurses’ actions towards its resolution. The paper will also explain the impact of state board nursing practice standards and governmental policies on the concern and offer leadership strategies that improve patient outcomes, experience, and patient-centered care.
Nosocomial infections, better known as Healthcare-associated infections (HCAIs), have become a severe public health problem globally because of their adverse effect on mortality and morbidity among hospitalized patients. HCAIs are infections that individuals acquire while obtaining care in medical facilities and that develop 48 hours after hospital admission or within 30 days after having been taken care of. According to the Centers for Disease Control and Prevention (CDC), approximately 1.7 million cases of nosocomial infections occur in the USA, which totally results in more than 98,000 deaths each year (Haque, 2018). Besides, patients who become infected through surgery spend an average of 6.5 additional days in the hospital (“Healthcare-Acquired Infections,” n.d.). HCAIs primarily include Catheter-associated Urinary Tract Infections (CAUTI) (32%), surgical site infections (22%), lung infections (15%), and Central Line-Associated Blood Stream Infections (CLABSI) (14%) (“Healthcare-Acquired Infections,” n.d.). Thus, the most vulnerable patients are those who undergo surgery, use indwelling urinary or bloodstream catheters, and have prolonged hospital stays.
One of the most critical concerns caused by infection is that many germs can be resilient to most antibiotics. For example, approximately 50 percent of surgical-associated infections, especially Staphylococcus aureus and gram-negative bacilli, are antibiotic-resistant (“Infection prevention and control,” n.d.). Moreover, the CDC calculated that, in 2017, Clostridium difficile, the most prevalent bacterium in healthcare facilities and particularly resilient to antibiotic medication, comprised approximately half a million infections (“Clostridioides difficile,” 2019). It was also the guilt of almost 13 thousand deaths in the United States (“Clostridioides difficile,” 2019). Being at the forefront of delivering care for patients, nursing staff directly contribute to reducing infection transmission by carefully following essential prevention procedures and tightly communicating with patients.
Recent studies have demonstrated that many HCAIs can be averted via strict compliance with evidence-based best practices. Frequent handwashing is the primary preventive action to diminish the hazard of transmitting skin microbes from one individual to another. Washing hands as thoroughly as possible after contact with patients, equipment, blood, secretions, body fluids, or excretions is a fundamental quality healthcare principle. For example, Fernando et al. (2017) indicate that between 2002–2013, due to Australian hand hygiene compliance programs, the annual incidence of S. aureus bacteremia (SAB) reduced by 63 percent. Another study showed that patients’ adherence to hand washing also considerably decreases nosocomial infection rate, especially among Staphylococcus aureus and enterococci (Haverstick et al., 2017). The elimination of the transient flora by proper handwashing can be achieved using various normal and antiseptic soaps and alcohol-based liquids. In this regard, the major problems that cause inadequate hand hygiene are mostly associated with the time-consuming performance of the procedure and the lack of available sinks and detergents.
Another efficient approach is hospital cleaning or sanitation, which implies ensuring the safety of clinical rooms, uniforms, and equipment for patients. The central problem is that many infections, including C. difficile, Staphylococcus aureus (MRSA), and vancomycin‐resistant Enterococcus (VRE), can live on dry surfaces for nearly four-five months. Therefore, the use of alcohol or antibiotic-based rubs by all medical staff and careful disinfection of frequently touched areas are the most appropriate means to destroy nosocomial infections. Advanced technologies, such as ultraviolet light devices (UV), no-touch equipment, and hydrogen peroxide vapor (HPV), can also significantly reduce infection risk. As the study exhibited, patients who live in rooms with HPV were over 60 percent less probably contract HCAIs (Fernando et al., 2017). Additional practices that prove its effectiveness are wearing gloves, masks, and other protective personnel outfits and isolation.
State Board Nursing Practice Standards and Governmental Policies
In the US, every state and territory possesses a specific regulatory body titled a Board of Nursing (BON) that supervises and observes nursing practice through established nursing standards within assigned jurisdiction. Presently, 59 BONs exist, forming the National Council of State Boards of Nursing (NCSBN), a not-for-profit organization where governmental agencies counsel together on the issues concerning safety and welfare, public health, and nursing licensure examinations. Nursing boards focus on four main areas such as practice, education, licensure, and discipline. Regarding the effectiveness of these agencies, the findings of the study by Winstead and Moore (2020), for instance, examined The North Carolina Board of Nursing (NCBON) and supported its activities in implementing regulatory workshops. Overall, these regulatory bodies empowered by the Nursing Practice Act (NPA) aim at protecting public health and welfare by guaranteeing that only competent care is delivered by licensed nurses.
In addition to state boards of nursing practice, the US Department of Health and Human Services (HHS) also determined prevention initiatives on HCAIs as one of the top priorities. In particular, its Steering Committee, together with scientists and other leading national organizations, realized the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan). This plan provides a cohesive, consistent outline for preventing nosocomial infections in ambulatory surgical centers, hospitals, and other facilities and adopting antibiotic stewardship efforts. In this respect, the study by Gribble et al. (2017) indicated that a significant reduction in 6 of the seven most prevalent HCAIs occurred in acute care facilities since the plans’ implementation. Overall, the HAI Action Plan resulted in considerably improved coordination of federal attempts to prevent HAIs by sharing resources, best practices, and lessons retrieved from collective clinical experience.
Nurses’ Role in Policy Making
Since registered nurses (RNs) represent the most significant group of medical professionals, they are directly accountable for promoting conducive changes in public health policy at local, state, and national levels. Besides delivering effective clinical care, their role also encompasses healthcare policy advocacy, development, implementation, and review. This role is executed through the work for healthcare companies, at elected and appointed posts, and volunteering on committees and boards overseeing political and regulatory decision-making. According to Patton et al. (2018), nurses substantially impact health outcomes, the availability and provision of care for the population, health equity, and the socio-economic and environmental contexts of healthcare providers. However, this influence’s scope depends on nurses’ political knowledge, cooperation with communities and other health team members, and effective communication. Thus, nurses should participate in different training programs that improve their leadership skills, enrich knowledge, and lift their educational level.
Leadership commitment plays a critical role in creating patient-centered care teams or organizations. In this regard, leaders should manifest frequent and consistent assistance for the cultural transformation and individual initiatives to achieve successful changes. They should also encourage staff to learn and adopt new ideas, especially those that gain evidence-based support. One of the practical leadership styles which have already received widespread recognition is transformational leadership (TL). This style stimulates employees to assume responsibility for their functions and strive to transcend the defined expectations. The study by Boamah et al. (2018) demonstrates that TL has a noticeable impact on workplace empowerment, ultimately enhancing nurses’ job satisfaction and patient outcomes and safety. TL requires managers to serve as a moral and ethical model, encourage individuals to be loyal to shared vision and goals, and delegate duties to followers. Furthermore, to be a transformational leader and implement change in organizations, people should develop a clear plan or road map for change, communicate tasks and missions to staff, provide their training, and invite their initiatives.
In summary, the paper has analyzed the issue of nosocomial infections and provided evidence from peer-reviewed literature on nurses’ necessary actions toward its resolution. Specifically, HCAIs still represent a severe public health problem that tremendously complicates the nursing workflow, prolongs hospital stays, and causes increased mortality. Herewith, the most critical concern induced by infection is that many bacteria can be resilient to most antibiotics, including Clostridioides difficile, Staphylococcus aureus, and gram-negative bacilli. Nurses’ actions include proper and frequent handwashing, hospital sanitation, and the application of advanced technologies, such as UV, HPV, and no-touch equipment. The highest regulatory bodies that regulate nursing practice and education and protect public health are the Boards of Nursing. The most appropriate leadership style can be transformational leadership requiring employee empowerment and effective communication to alleviate the problem’s effect.
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