Infection Prevention Succeeds When Hospital Management’s Involved

Frank Diamond

Frank Diamond has been with Infection Control Today since November 2019. He has more than 30 years of experience working for magazines, newspapers, and television news.

An actively engaged hospital management team can make the difference between success or failure when it comes to managing health care-acquired infections, a study states.

The effectiveness of infection prevention and control programs on hospital units depends on the oversight of an engaged management team. While the data gathering by investigators with Ohio State University occurred before the COVID-19 pandemic, the lessons learned about better control of health care-acquired infections (HAIs) such as catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) can be applied to other pathogenic outbreaks, states their study in the American Journal of Infection Control.

“As clinical practices continue to evolve during the COVID-19 pandemic, hospitals should not lose sight of the importance of management practices in the context of infection prevention,” the study states “Adapting these management strategies for leaders to accommodate the restrictions of hospital environments during the COVID-19 pandemic can ensure that focus on HAI prevention is maintained.”

Investigators interviewed 420 managers and frontline staff in 18 hospitals across the United States from September 2017 to November 2019 to better understand management’s role in preventing and controlling CAUTIs and CLABSIs.

“Interviews were held during normal work hours in hospital conference rooms and unit break rooms and were either one-on-one or group interviews, depending on staff availability,” the study states. “Interview length ranged from 15-60 minutes with an average of 28 minutes. All inter- views were audio-recorded, transcribed verbatim, and de-identified.”

The transcripts of the interviews were coded using a deductive dominant thematic analysis. Investigators first developed a preliminary coding method based on goal setting and support, leadership, strategic alignment and communication, and information sharing. The coding system was revised as new themes were located in the transcripts.

“Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching,” the study states. “We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts.”

Because publicly available HAI data are available at the hospital level, not the hospital unit level, the investigators were not able to judge the variable performance of the units and hence the management techniques involved.

The study includes excerpts from interviewees, all of whom testified to the importance of an engaged management. One interviewee said that that was “really demonstrated by the commitment that leadership showed with a complete re-vamp of our hand hygiene program.... When we collected our baseline data, we were about in the 50% in terms of hand hygiene compliance, and we have been reliably like 89%, 90% now. We’ve come a long, long way but with a lot of work.”

Another interviewee said: “We have strong leadership support. And by the support I don’t mean permission, I mean active involvement. And I think that makes a huge difference. Well, for example, if we have a CAUTI or a CLABSI, and we’ll talk about that, leadership, first of all, wants the details. They want to know what’s going on. They work with our team.”

The three successful management practices might have had to be changed somewhat during the COVID-19 pandemic: for instance, obviously, fewer face-to-face meetings. Nonetheless, an active management improves the oversite of all HAIs as well as COVID-19 (which can also become an HAI).

“In the context of the COVID-19 pandemic, leaders may have to think creatively to adjust their methods of engaging with hospital staff to respect the current rules and recommendations for maintaining physical distance,” the study states. “Leadership rounds, frontline staff huddles, and providing recognition to staff may look different in the present crisis, but the importance of maintaining leadership engagement cannot be underemphasized.”

In fact, communication was more important during COVID-19 given the fluidity of the situation and changing guidelines.

“In this situation, sharing information via electronic medical record alerts, targeted emails, town halls, or webinars, rather than through face-to-face interactions, may be valuable approaches to communicate clinical practice changes while taking precautions to reduce in-person interactions,” the study states. “However, in choosing their communication strategies, hospital leaders should also be sensitive to the risk of information overload, especially given the volume and frequency of communications that have been necessary as the COVID-19 pandemic has evolved.”