Healthcare-acquired Infections Research Paper

Introduction 

Healthcare-acquired infections (HCAIs) present a serious risk for the safety of patients, staff members and visitors. These infections can prolong patient hospitalizations, incur direct economic costs and cause significant morbidity or mortality to those infected (Jia et al., 2019). For this reason, infection control and management are key indicators in providing quality patient care and minimizing the spread of infections to ensure a safe health care setting. In the height of the COVID-19 pandemic, Windsor Regional Hospital (WRH) has implemented stringent infection control guidelines as a part of its quality improvement initiative (WRH, 2020). These efforts include increasing personal protective equipment (PPE) compliance, conducting routine infection control audits, screening protocols upon entry to the hospital and limiting patient visitors (WRH, 2022). To implement this initiative, McKinsey’s 7S Framework will be discussed as a strategic tool for quality improvement. This change management framework tool consists of seven elements: strategy, structure, systems, style, staff, skills and shared values (Perveen & Habib 2018). The purpose of this paper is to discuss infection control as a quality improvement initiative to reduce HCAIs using the components of McKinsey’s 7S framework. 

Forming the Team 

Stakeholders involved in the quality improvement of infection control include the hospital employees, infection control coordinators, the executive committee, as well as public health sectors. The hospital staff such as nurses, physicians and managers are the key stakeholders in supporting and meeting the objectives of quality initiatives (Chmielewska et al., 2022). Through the participation in leadership rounding on infection control measures, staff members will engage in education and training to safeguard quality control efforts and improve system performance (WRH, 2022). Infection control coordinators such as Karen Riddell leads the Hospital Acquired Infection and Hand Hygiene Corporate indicator (WRH, 2022). She oversees reportable HCAIs data, performance indicators, and manages quarterly hand hygiene audits. The executive committee includes David Musyj, the President and Chief Executive Officer at WRH who is involved in quality improvement discussions, implementing clinical standards and policies as well as communicating improvement goals and performance (WRH, 2022a). Public health sectors including the Windsor-Essex County Health Unit and the World Health Organization provide current data on infectious diseases as well as partnerships in evidenced-informed policy options and best practice standards for HCAIs (WHO, 2022). For the quality initiative to be a successful collaboration between these stakeholders are essential in quality improvement integration. 

McKinsey’s 7S Framework

McKinsey’s 7S Framework is a value-based model that incorporates the multiple dimensions of a quality improvement initiative (Perveen & Habib 2018). The framework is divided into two parts. The technical elements consist of strategy, structure and system; the social aspects represent style, staff, skills, and shared beliefs (Chmielewska et al., 2022). ‘Strategy’ outlines the interventions taken by the hospital towards achieving the quality improvement objectives. WRH defines its initiatives in a document titled Improvement Targets and Initiatives. These initiatives to reduce HCAIs include a designated ‘Monday Morning Huddle’ with weekly HCAIs data, written action plans on targeting root causes of infections, and charting on the Report and Learn risk reporting software to identify trends and causes of HCAIs (WRH, 2022). Structure defines the hierarchies and responsibilities within the hospital (Chmielewska et al., 2022). WRH outlines its organizational structure by delegating roles as defined by its board of directors, executive committee, and medical leaders (WRH, 2022). Systems involve hospital processes that coordinate and manage initiatives. Erika Vitale, the director of Infection Prevention and Control serves in communications of updates and changes to infection protocols and guidelines (WRH, 2022). Style represents the hospital’s culture and leadership style. WRH demonstrates a just culture of patient safety and a transformational leadership style through supporting quality initiatives and empowering change (WRH, 2022). Staff members include nurses, physicians and infection control staff with different knowledge and training towards implementing change (Chmielewska et al., 2022). Skills define the competencies of trained staff members. WRH ensures infection control staff are qualified to perform audits while being certified to provide education and training on infection prevention and management (WRH, 2022). The Shared Values component defines the guiding principle that drives employees to support a change. WRH’s mission statement is to provide quality person-centred health care. This statement aligns with the quality improvement’s objective: to provide quality patient care through reducing the spread of infections. The interactions among these elements of McKinsey’s 7S Framework build the quality improvement initiative. 

Setting Aims

Hospital-acquired infections are the second most prevalent cause of death globally, thus, it is crucial to ensure goals are being set to decrease the infection rate (Haque et al., 2020). Strategies as simple as ensuring proper hand hygiene techniques can play a primary role in preventing these HAIs from spreading especially during the COVID-19 pandemic (Haque et al., 2020). Therefore, to decrease HAIs hospitals must have quality initiatives to work towards these goals. Over the past years, WRH’s vision is to provide outstanding care with no exceptions, therefore, it has set improvement targets to help with the rising HAIs (Windsor Regional Hospital, n.d.). In 2018 – 2019, WRH set a target to decrease the rate of HAI per 1,000 patient days from 3.14 to 3. When applying this quality improvement goal to the 7s framework, it is implemented through the ‘Shared Values’ element since it is essential for healthcare workers to have the same values and strive to achieve the organization’s goals to make a change to the rate of HAIs (Perveen & Habib, 2018).

Perceived facilitators and barriers to change

Quality improvement initiatives often have many barriers that affect the ability of change to be made. A barrier to decreasing HAIs is the finite availability of resources. There is a limited number of hospital beds making it hard to cohort patients based on their conditions and level of infectiousness (Haque et al., 2020). Additionally, with the COVID-19 pandemic, PPE shortages have been affecting hospitals, for example, at the beginning of the pandemic, there was a shortage in masks and respirators leading to improper PPE usage (Cohen & Rodgers, 2020). Although the disinfection and usage of PPE were seen as a solution during COVID-19, it caused surges in illnesses amongst patients and nurses (Cohen & Rodgers, 2020). This put patients’ safety at risk and increased healthcare workers’ workload which reduced the quality of care provided (Cohen & Rodgers, 2020). Another barrier to change is the decreased compliance with hand hygiene and PPE usage amongst healthcare workers (Haque et al., 2020). To improve upon this barrier, making PPE easily accessible and more efficient to use can increase compliance and decrease HAI rates. It is also important to ensure appropriate training involving infection control for healthcare workers and other hospital staff, along with completing regular audits as needed (Haque et al., 2020). Altogether, these factors affect the rate of HAIs. 

Planning for Change 

It is important to provide routine training on the prevention of HCAIs to increase compliance. The first step would be to gather all the relevant information. In this case, the focus will be on proper hand hygiene and correct donning and doffing PPE techniques. The information must be up to date and based on the best practice guidelines for preventing HCAIs. This will then be presented during mandatory educational sessions as well as included in written materials (Jeyasheelan et al., 2020). Additionally, having adequate funding is essential in reducing HCAIs. Some of the funding needs to be allocated to obtaining enough supplies including PPE, precaution signs, disinfectant wipes, etc. Furthermore, funding needs to be put into an infection prevention and control program (Vokes et al., 2018). This program will provide health care professionals with resources, support, as well as expertise on infection control and prevention (Public Health Ontario, 2021).

Establishing Measures to Evaluate Change

The implementation of the HCAI tracking and surveillance system will be a good method of tracking progress. Monegro (2021) revealed that the implementation of robust surveillance along with prevention practices has success in preventing HCAIs. The health care team will initiate mandatory monthly meetings to assess the progress of prevention practices as well as discuss ways to maintain improvement. Gathering as a team while giving a space for people to discuss their ideas will help to increase morale and interprofessional collaboration. Additionally, there will be monthly audits performed by hospitals infection prevention programs to assess the health care team’s compliance with infection prevention practices (Centers for Disease Control and Prevention, 2019). For those who are having difficulty following proper procedures, additional education training will be provided.