Alleviating the Prevalence of Hospital Acquired Infections by Implementing Design Strategies in the United Kingdom

INTRODUCTION 

Hospital Acquired Infections or Nosocomial Infections can develop either due to medical or surgical intervention or from direct or indirect contact with a setting involving healthcare. It usually affects 1 in 10 patients admitted to the United Kingdom hospitals (Carter et al., 2020). 

The National Health Service (NHS), England reported that the infection leads to the emergence of 300,000 patients in the UK, resulting in 5000 deaths per year, costing up to 1 billion pounds to National Health Service as a financial impact (National Health Service (NHS England), 2011). These severe problems are critically monitored by the healthcare agencies, including National Health Service, Centre for Disease Control and Prevention (CDC) et al (Danna, 2018). Infections like Central line-associated bloodstream infections (CLABSI), Catheter-associated urinary tract infections (CAUTI), Pneumonia acquired from the hospital, Ventilator-associated pneumonia, Surgical site infections (SSI) and Clostridium difficile colitis infections (CDI) are some of the major hospital-acquired infections predominantly infecting the patients (Boev & Kiss, 2017).

 Multiple researchers have reported that hospital-acquired infections are found at the patient level and transmitted to the community level. It can be linked to multidrug-resistant conditions observed at the community level (Habboush et al., 2020). It has been devised that a patient suffering from Hospital Acquired Infections spends 2.5 times more time than others, which further increases extra expenses of more than 3000 pounds (Harding and Campbell, 2020). Furthermore, this results in additional usage of NHS resources, discomfort to the patient and a decline in the patient’s safety (Metersky & Kalil, 2017). 

The current research will illustrate that the built environment, about the prevalence of Hospital Acquired Infections, can be dramatically reduced with a consideration on routes of transmission involving air, water and surface – in the course of designing and functioning facilities for healthcare.

PROJECT INITIATION 

With an increased prevalence of Hospital Acquired Infections in the United Kingdom, it has become crucial to implement strategies to alleviate the infection amongst the patients. Having a complete understanding of the disease, the alleviating strategies are quite important for patients to recover from diseases. Poor design inculcates complications, giving rise to hospital-acquired infections and associated risks. Thus, implementing the design strategies to alleviate the prevalence of hospital Acquired Infections has become a necessity.

Before implementing the desired change, it is essential to understand the root cause, principles and necessity of change. To bring out a change, it is vital to let go of the previous trends and practices. Therefore, it invites a significant investment of time, people, resources, facilities, equipment, and economy. These factors are considered as significant challenges and prerequisites of success as well. 

Lewin’s Three Stage Model For Change

Organizational development relies on effective change management processes at the individual and organizational levels. Lewin’s Three Stage Model describes the status-quo as the current scenario, a change process involving a proposed change evolves into a future state which is the final destined stage (Figure 1 below  Before selecting the team and other requisites, it is vital to have a clear vision, i.e. goals and objectives of Change. The succeeding section will discuss the goals and objectives of the current project. 

The vision of Change: Goals and Objectives 

The main goal of the project is to implement design strategies to alleviate Hospital Acquired Infections. As we have already discussed the prevalence of Hospital Acquired Infections, it is necessary to examine factors involved in disseminating disease before implementing the design strategies. Various factors that influence risk for HAI are immunosuppression, age factor, staying period in hospital, frequency of visits in hospitals, current invasive procedures, devices involving indwelling, prolonged stay in ICU et al (Miller et al., 2012). One of the significant factors influencing risk for HAI and antimicrobial resistance to drugs is intravenous antibiotic receipt between three months (Sydnor & Pearl, 2011). As hospitalizations are responsible for treating minor and major illnesses, it also contributes to increased chances of hospital-acquired infections and multidrug antimicrobial resistance.

The microorganisms causing HAI are acquired from the hospital staff, other patients, and premises. The patients admitted to the ICU are more prone to Hospital Acquired Infections. A recent study has reported that amongst 231,459 patients in 947 hospitals, 19.5% of ICU patients contain one nosocomial infected patient (Stiller et al., 2017). The most common HAI- Clostridium difficile colitis (CDI) is caused by Clostridium difficile. The Central Line-Associated Blood Stream Infection is primarily caused by Candida spp. which is prevalent in ICU, Enterobacter species prevalent inwards, pediatric units and ICU wards, and Staphylococcus aureus (Flores et al., 2019).

The Catheter-Associated Urinary Tract Infections are caused by staphylococcus sp., Enterococcus, Pseudomonas, Klebsiella, Proteus, and candida. Thus, National Healthcare Safety Network has included staphylococcus aureus, Enterobacter, Klebsiella, pneumonia, E.Coli, Pseudomonas as the causal organisms for Surgical Site Infections (Flores et al., 2019).

Vision of Organization

• Improving the awareness amongst the medical staff and patients.
• Developing a team responsible for handling hygienic aspects.
• Identifying the possible areas for improvement in patient care and reducing nosocomial infections. 

VISION OF SERVICE

Establishment of effective training programs at primary health care and advanced health care levels regarding Hospital Acquired Infections.

PRIMARY OBJECTIVES OF THE PROJECT CHANGE

• To Alleviate the prevalence of Nosocomial Infections by implementing design strategies 
• To identify the causes and mode of transmission of Nosocomial Infections
• To elucidate the preventive measures and implement environmental-based design strategies. 

Different Stakeholders for the Project 

To move the project forward, it is essential to have a list of stakeholders ranging from patients to families and health care professionals involving policymakers. Estimating power and interest emphasized the senior doctors, senior executive managers, and the Ministry of Health. However, the later analysis supported that patients, doctors, junior health workers and junior residents are few of the less powerful but highly supportive stakeholders. Senior doctors, administrative managers and other health workers were observed as highly powerful but less interested. Other patients, nurses, health care workers and junior medical staff can be categorized as low power and low-interest people.

PROJECT PLANNING AND FEASIBILITY PHASE

Project Goal Statement

To alleviate the Hospital Acquired Infections in the community to prevent the complications in diseases and recovery rate while reducing the economic burden on the patients and National Health Care Facilities. The Project change would focus on reducing the hospitalization rates and Relieving the burden on doctorsThe project initiation phase subjects towards the project planning and feasibility strategies that identify the major activities relevant to move forward the project with the incorporation of training programs. It involves a phased approach to implementation, along with trial programs during the initial phase. The primary activities involved are:

• Identification of Managing Team 

It is the critical step in the entire plan of change. The team selection process is the most vital as the whole project relies on the contribution of selected personnel and their team effort. While implementing the design strategies, it is crucial to choose an experienced team with expertise in hygiene and develop environmental design strategies in the hospital to alleviate hospital-acquired infections.

Thus, the group involves senior doctors, junior doctors, senior executive managers, patients and nurses. Management involvement is for funds approval and project approval. The senior doctors are well experienced and would deliver the training programs to the junior staff and patients regarding design strategies. 

• Development of Curriculum 

Curriculum development and organizing process are essential steps in any change management. It involves schedule management strategies so that step by step design strategies can take place. 

• Funds Approval and Attraction 

Any change is not feasible without the availability of funds. Thus, the project plan, including the aim and scope of implementation of design strategies, should be discussed with senior management to be convinced and approve the funds for requisite resources. 

• Executive Team Identification 

Highly experienced team executives are required to streamline the processes and schedule the training. Maintaining documentation and records related to finances and operations is their core responsibility. The executive team would comprise four senior doctors and two assistants for their help. 

• Selecting the project coordinators 

The executive Team would further investigate the project and choose project coordinators who would directly report the daily project status. Maintaining daily project records is their core responsibility. Project coordinators would review the status of project and report to the executive team about each and every activity related to the project.

• Initiating the Trial Programs 

Post identification of the executive team and project coordinators, project trials would be initiated. The entire process would take 15 days and each day trial record would be maintained and sent for approval post quality checking. These trial programs would be based on the design strategies and role and responsibilities of every individual towards the project and its success. 

• Maintaining the Records and Follow-ups

The core responsibility of every individual involved in the project. The records would help in evaluating the exact status of the project. Also, the expenditure and use of resources can be monitored easily through the proper records. 

• Launching Wide Programs

Post-approval of trial programs, comprehensive programs concerning the design strategies would be launched.

• Periodic Training for staff and Patients 

It is essential to train both patients and staff about the design strategies to alleviate hospital-acquired infections. Thus, a weekly schedule would be made where training sessions would be given. 

• Periodic Training to Doctors 

Doctors involving seniors and juniors must be trained about the new strategies to alleviate the HAI to further instruct the staff under them.

• Implementation of Design Strategies 

After the entire process is scheduled and trial programs are approved. Finally, the design strategies to alleviate the HAI would be implemented by the whole project team. 

Risk Assessment 

There are several possible risks and problems associated with the change plan. Poor Trainee Performance can be observed as the most prominent risk that seems to be highly problematic. The primary reasons behind it can be lack of knowledge, lack of encouragement, lack of interest amongst the participants. It can be regulated through an accurate selection of participants and choosing reward and recognition programs. The subject associate with the risk should be re-trained. 

STEPS TAKEN TO MOVE FROM PLANNING PHASE TO IMPLEMENTATION PHASE

The implementation phase turns the plans into action. 

1. Formulating the tasks and organizing the workflow
2. Training Team Members
3. Providing updates regarding training and project to the stakeholders. 
4. Monitoring work quality
5. Budget Management
6. Documentation: Proper documentation makes the implementation process easier. 

PROJECT COMMUNICATION PLAN 

Project Communication Plan involves project team meetings, trial program meetings, Monthly Project Meetings, Training sessions, project status reports to introduce the project and review the status of the project. The below table has illustrated the communication plan in which format for meetings including face to face, via emails, presentations et al have been demonstra

PROJECT IMPLEMENTATION AND MONITORING PHASE

The following phases determine the process of assessing the work against planned performance

Phase1

Formal formulation of novel processes involving increased hand-washing compliance via environmental design strategies. It introduces the start-up to new facilities. 

An infinite number of infections are carried in the hospital through the pathway of contact. The most common reservoirs of microorganisms are contaminated surfaces. Although the infected surfaces are not linked with direct transmission, the hands of the patients and staff cause the transmission. Poor compliance to hand-washing by healthcare faculty poses a challenging problem (Cilloniz et al., 2019). Educational programs regarding Good Hygiene Practices illustrating the frequency of handwashing to staff must be conducted in this regard.

Environmental design strategies proffering environmental support with the help of pictures, posters and visuals can remind the team of hand-washing. Also, the placement of sinks and hand-washing dispensers and alcohol sanitisers can increase the rates of hand-washing. Combining both the posters, as well as bedside alcohol sanitisers and dispensers, can improve compliance. The frequency of hand-washing increases with the increase in the ratio of sinks to patients. 

Phase 2

Opening new purpose-built emergency single rooms to alleviate nosocomial infections. Novel clinical assessment and management workflow pathways are in place, along with conveniently located sinks to prevent infections. 

New Purpose-Built Emergency Rooms is a critical strategy that helps in reducing nosocomial infections. It has been supported by various studies that single rooms along with conveniently placed sinks in each room alleviate the rates of nosocomial infections in ICUs and other units. Multi-bedrooms increases the infection and transmission of pathogens to other patients. Also, it is easy to decontaminate a single room as compared to a multi-bedroom. 

Phase3

Incorporation of HEPA Filters to alleviate the airborne infections in the patient’s room. Air quality can be maintained by providing clean filtered air while controlling indoor air pollution via ventilation. 

Airborne infections in the form of droplets are transmitted into the environment and then to persons (Eze et al., 2017). Water, dust, soil and air are reservoirs of pathogens. Thus, excellent air quality is a must to prevent airborne infection. Thus, clean and filtered air through the ventilation facility is much required to maintain ideal air quality. High-Efficiency Particulate Air Filters (HEPA) are the best solution that removes the minute microbes of 0.3 micro-meter responsible for the airborne infection. A study had reported a ten-fold increase in the incidence of HAI in bone marrow transplant patients compared to others when they were admitted outside the environment of HEPA filters.

It is vital to understand how stakeholders and the project team can be motivated to make an appropriate evaluation. Thus, knowing their temperament, personality and needs is a crucial strategy. Therefore, to streamline the project, motivational theories can be implemented to help them eliminate the fears of loss associated with change. 

MOTIVATION THEORIES

Herzberg, Maslow and McClelland can be implemented. 

Unsatisfactory performance is one of the potential risks associated with the project plan. This, however, can be managed through implementing the above motivational theories. The reward and Recognition approach is another perfect approach to motivate the team and mitigate the risks. Further, Proper documentation and training record is essential to meet the proposed objectives of the project. 

PROJECT EVALUATION 

Project Evaluation phase will evaluate the objectives of the project. It will elucidate that if the built environment can properly alleviate the nosocomial infections routes of transmission involving air, water and surface – in the course of designing and functioning facilities for healthcare

PRIMARY OBJECTIVES OF THE PROJECT CHANGE

• To Alleviate the prevalence of Nosocomial Infections by implementing design strategies. 
• To identify the causes and mode of transmission of Nosocomial Infections. 
• To elucidate the preventive measures and implement environmental-based design strategies.

The primary objectives of the project have been very well elucidated as per the schedule. The design strategy has been discussed in the project implementation phase. The mode of transmission has also been very well addressed in the above sections. Moreover, preventive measures based on the environmental design strategies have been discussed in detail too.

Purpose of the Project 

To alleviate the Hospital Acquired Infections in the community to prevent the complications in diseases and recovery rate while reducing the economic burden on the patients and National Health Care Facilities. 

The Project change would focus on reducing the hospitalization rates and Relieving the burden on doctors.

Assessment of Objectives

• To Alleviate the prevalence of Nosocomial Infections by implementing design strategies 
• To identify the causes and mode of transmission of Nosocomial Infections
• To elucidate the preventive measures and implement environmental-based design strategies.

The communications and leadership styles have been discussed thoroughly. Motivational Theories based on leadership and the Rewards and Recognition approach to encourage the team have been utilized. The most complex activity is to make the team members and stakeholders understand the importance of the proposed change and attract the funds. I, therefore, used the motivational theories and behavioural theories to make them understand the fear of loss while considering their personalities, temperament and needs. 

Trait Theory for effective Leadership is the perfect theory that can be adopted. It involves Intelligence, confidence, charisma, integrity, determination and sociability as the major attributes for effective leadership. The trait theory can hence be useful as an effective leadership theory to convince and motivate the employees. 

Further, Transformational theories can also be adopted for effective leadership. It aims at inspiring the team members to have the ability to perform exceptional achievements. The major key factors are inspiration, motivation, charisma and influence that nurture the relationships between leaders and subordinates. Four components of transformational leadership are Idealized influence, Inspirational motivation, Individualized consideration and intellectual stimulation. It aims at encouraging the creativity amongst the followers. 

Limitations of the Project 

The major limitation of the project is the collection of data. Showing the data collected from different hospitals would have enhanced the value of the project. Future studies can conduct quantitative and qualitative research based on primary data selection, further promoting awareness. 

CONCLUSION 

Hospital Acquired Infections or Nosocomial Infections can develop either due to medical or surgical intervention or from direct or indirect contact with a setting involving healthcare. Hospital-acquired Infections, also known as Healthcare-associated infections (HAI), are not present at the time of patient’s admission in the hospital. These infections are manifested after 48 hours of being hospitalized. It usually affects 1 in 10 patients admitted to UK hospitals. The most prevalent healthcare infections involve respiratory tract infections (22.8%), Urinary tract Infections (17.2%) and surgical site infections (15%) (Public Health England, 2014). 

Various factors that influence risk for HAI are immunosuppression, age factor, staying period in hospital, frequency of visits in hospitals, current invasive procedures, devices involving indwelling, prolonged stay in ICU et al. The microorganisms causing HAI are acquired from the staff of the hospital, other patients, as well as premises. National Healthcare Safety Network has included staphylococcus aureus, Enterobacter, Klebsiella, pneumonia, E.Coli, Pseudomonas et al. as the causal organisms for HAI. Hospital Acquired Infections can be controlled with the implementation of environment-based design strategies that have been discussed in this project.

The essential processes involve hand-washing compliance, single-room building strategies, and introducing HEPA filters to mitigate airborne transmission. Further, the project has discussed all the phases involved in the change process illustrating the schedule, plans and evaluation systematically. The project has also discussed the leadership and motivational theories effectively utilized to motivate the team members. Motivational Theories based on leadership and the Rewards and Recognition approach to encourage the team have also been utilized.

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