Continuous Quality Improvement Regarding Infections


Reducing the prevalence of nosocomial infections can greatly improve patient and practitioner outcomes within a medical setting. Nosocomial infections are a major predictor of increased COVId-19 rates translating to higher mortality rates. The current report presents a continuous quality improvement (CQI) plan for We Care Hospital to reduce the prevalence of nosocomial COVID-19. Several measures, including using personal protective equipment (PPE), isolation, and effective sterilization strategies, are proposed as interventions while adhering to ethical considerations in patient-doctor interactions. Success is established when the recommendations of the CQI plan are implemented in daily practices with positive results.


Nosocomial infections remain an unaddressed issue in many hospitals around the world. These infections can increase mortality rates and affect healthcare practices to challenge how the healthcare system works. Establishing an effective approach to monitoring nosocomial infection rates can yield positive results in assessing the impacts of healthcare processes, identifying nosocomial infection risk factors, and monitoring trends in pathogen resistance. With a continuous quality improvement (CQI) project, these observations will be addressed so that healthcare practitioners can determine the patient outcome and system performance and maintain professional development for increased positive outcomes. As the COVID-19 pandemic continues to cripple the healthcare sector, it becomes an even more important consideration to control the prevalence of nosocomial infections, starting from personnel protection with personal protective equipment (PPE) when caring for patients to minimize COVID-19 exposure (Graham & Woodhead, 2021). This means that patients seeking services apart from COVID-19 are at a higher risk of contracting nosocomial infections, especially COVID-19 if preventive measures are not observed.

Current approaches meant to reduce nosocomial infections are not very effective or are applied wrongly, leading to a surge in hospital-acquired COVID-19. Research shows that many cases and mortality rates due to COVID-19 are caused by nosocomial infections (Abbas et al., 2021a; 2021b; Falcone et al., 2021). PPEs are an effective measure that can significantly reduce these cases since research reveals that patients who acquire such infections were exposed to other infections or developed antibiotic resistance, which leads to increased severity and complications (Johnson & Sollecito, 2020). This illustrates how important the CQI is in reducing these rates.


Proposed improvement approaches are tailored towards the objectives and goals of a healthcare facility, meaning that a proposal may not address challenges faced in another facility if they were not created with the said facility in mind. Johnson and Sollecito (2020) argue that healthcare organizations develop personal performance improvement approaches to be the center stage of decision-making processes. The reasons for CQI vary but largely concentrate on achieving accreditation needs, cost control, customer competition, and employer and payer pressure (Johnson & Sollecito, 2020, p.5). Reducing the rate of nosocomial infections and increasing COVID-19 mortality rates is an example of a CQI approach. In this case, the problem is increased COVID-19 cases acquired by patients after visiting a facility.

The CQI strategy should ensure process improvement where We Care Hospital records reduced nosocomial COVID-19 cases. Additionally, it needs to illustrate a competitive advantage where the facility uses more effective measures to reduce these rates than other facilities. Finally, it should conform to requirements where the proposed approaches do not go against the budget and resources the facility can afford. Therefore, for We Care Hospital to experience a change, the nosocomial infections will be lower than in the previous year. For instance, if the nosocomial infections reported in 2021 accounted for increased COVID-19 cases, the rate should be lower in 2022.

Therefore, the main aim of this CQI is to reduce the prevalence of nosocomial infections to ensure both patient and practitioner safety. Another aim is to promote a safe healthcare environment where practitioners frequently use PPEs. Generally, these aims maximize the quality of care offered to patients without posing additional dangers that would see them contract other infections. At We Care Hospital, the focus is on improving procedures to excel in the healthcare market by giving patients the quality care they need. This form of dedication shows that the hospital is patient-oriented instead of others who may be in the business for the money or increase their market share. These aims can be generalized into the facility, illustrating effective management and leadership in offering quality service, which suggests that the facility also seeks to:

  1. Understand and adapt to the external environment to offer quality patient care.
  2. Empower practitioners to analyze and improve healthcare processes.
  3. Adopt a culture that recognizes the needs of patients and providers and uses customer preferences as predictors of quality improvement plans.
  4. Develop an elaborate approach that traverses both traditional and modern professional avenues.

The proposed approach is to establish continuous surveillance and PPE implementation to prevent the prevalence of nosocomial infections. The above aims and objectives are key performance metrics that determine whether We Care Hospital has realized its goals through precise and procedural changes in its service delivery.


The CQI is designed to help healthcare workers understand effective protective measures and implement them when caring for patients with COVID-19 to reduce virus exposure. This will include physicians, nurses, and volunteers working to help patients. Other participants selected for the project include an information specialist, health care epidemiologist, infection control specialist, clinical microbiologist, and hospital administration.

Structural Elements

Johnson and Sollecito (2020) provide a checklist of structural elements to consider when implementing a CQI in healthcare. To ensure maximum application, these elements are adapted to align with the aims of this project.

Process improvement teams

We Care Hospital needs to establish a team and empower it to implement effective measures to reduce nosocomial infections. Empowering such teams is important as it enables the practitioners to understand the purpose of their work and ensure that they give it their all to give patients quality care.

CQI tools

CQI tools are effective in helping We Care Hospital understand which measures have been achieved and which ones are yet to be realized. There are different tools recommended by Johnson and Sollecito (2020), although the most effective one, in this case, is checklists. These tools highlight the details of a CQI, allowing the facility to be organized in achieving each measure. They work as visual reminders where tasks are prioritized and scheduled to meet deadlines. They are also simple and easy to create and help the facility persevere to complete all steps in the CQI.

Parallel organization

As the pandemic rages on, We Care Hospital realizes its priorities are divided based on the surge of cases and patients who need treatment for other conditions. Therefore, there is a need to develop a separate organization structure focused on setting priorities and monitoring the CQI approach to reduce nosocomial infections. This team (quality control) focuses on finding effective measures to handle nosocomial infections and works only to achieve goals within this area.

Organizational leadership

Effective leadership within all levels of the organization, including the parallel organization in We Care Hospital needs to be united. This ensures unity in resource allocation to make the processes effective and adopted into the organizational culture so that they are maintained across other departments.

Statistical thinking and analysis

Another key recommendation is statistical process control that will allow We Care Hospital to determine common and special causes of variation in the proposed approaches.

Customer satisfaction measures

We Care Hospital also needs to know the importance of measuring customer satisfaction in working towards reducing nosocomial infections. In this regard, patients will not be satisfied if the hospital is not dedicated to reducing the prevalence of these diseases. Therefore, the facility needs to use appropriate surveys and methodologies to provide effective customer satisfaction results.


Benchmarking approaches, such as using a benchmark table, can present We Care Hospital with an overview of the best practices within a healthcare situation to simulate how processes may occur and the potential outcomes to expect. See Appendix 1 for a benchmark table developed to guide CQI implementation.

Redesign of processes from scratch

Ensure that the end product conforms to customer requirements by using techniques of quality function deployment and process reengineering.


Nosocomial infections affect different parties in various ways. The main stakeholder is the patient, whose safety remains paramount. Additionally, healthcare professionals are also key stakeholders who need to protect themselves. Caregivers, including nurses, are essential stakeholders whose role ensures that recommended measures are effective in helping promote patient safety. Community collaboration is also an important factor in preventing nosocomial infections. It will allow We Care Hospital and the community to establish a shared community health improvement program assessing community needs such as social determinants of health. Such programs will also introduce community members to nosocomial infections and inform them how they occur, helping them understand how to protect themselves.


We Care Hospital needs to adopt a proper leadership framework to implement the project and achieve its goals of reducing the rate of nosocomial infections. Effective clinical leadership is an important predictor of quality of care since compassionate leaders make decisions that ensure high care standards and encourage positiveness, compassion, and openness within the team (Graham & Woodhead, 2021). Compassionate leadership in realizing the success of the CQI would entail solid clinical management practices since the focus is on PPEs and high-risk patient groups. For instance, the leadership needs to balance procedure standardization and staff flexibility to ensure the positive adoption and implementation of PPEs.


The proposed interventions to reduce the spread of nosocomial infections for We Care Hospital include implementing a hand hygiene policy, using PPEs, mandatory isolation with limited interaction, and implementing proper aseptic and sterilization techniques. An effective hand hygiene policy is an important intervention as it focuses on reducing pathogen transmission likely to occur during patient and practitioner interactions. This intervention applies to all departments and personnel working in We Care Hospital. Additionally, patients will also be required to observe the measure to limit pathogen spread. PPE implementation is concerned with pathogen spread, especially during interactions with patients with severe infections such as COVID-19 (Singh et al., 2021). A PPE implementation policy would protect practitioners and other patients from contracting such diseases.

The severity of the disease also prompts the facility to implement additional measures limiting patients’ exposure to nosocomial infections. Mandatory isolation with limited interaction for patients diagnosed with a high-risk condition can reduce pathogen exposure as only limited staff will have access to a patient. Finally, during disinfection and waste management, the facility can implement proper aseptic or sterile handling strategies during the insertion or maintenance of indwelling devices. The Chief Physician will oversee, train, and collect data and follow up with every team to assert the impact of the CQI project. They will establish a separate team composed of physicians and nurse leaders to monitor how each individual is working to achieve the project’s goals. Appendix 2 illustrates the proposed interventions, their risk level, and implementation timeframe.

Study of the Intervention

Various approaches can be used to study the proposed interventions and make amendments. For instance, COVID-19 has proven to affect patients differently, categorizing patients into high-risk and regular patients. Therefore, studying their laboratory and clinical history will help group them based on the possibility of contracting the virus. Therefore, a scoring tool will be developed to provide details of patients and their likelihood of contracting COVID-19. Patients who score high will be placed in the high-risk category and later treated in separate rooms than low-risk patients to contain the virus in a single place.


A prevalence survey among healthcare professionals is an important measure for the intervention. This is because it will place the practitioners in the position of patients to understand them better and determine whether the proposed measures are effective in reducing the prevalence of nosocomial COVID-19. Before implementation, an initial measure identifies the confirmed cases and groups them based on symptom risk. The goal is to ensure that patients are grouped based on their risk levels. The sorting tool developed in the initial phase will be important in this step. Currently, the facility is engaged in grouping measures where patients are grouped based on their symptom levels. However, this approach is ineffective as it is characterized by several challenges, such as improper sorting. For instance, low-risk patients are often grouped alongside high-risk patients. Provisions of this prevalence survey are illustrated in Appendix 3.

Ethical Considerations

The most important ethical consideration that may arise from implementing the plan is a doctor and patient confidentiality. Patients may have underlying medical conditions they may not want to disclose to others. As doctors bound by this issue, their responsibility will entail ensuring that they protect a patient’s medical records (Saleem et al., 2022; Shekhawat et al., 2020). Therefore, patient confidentiality should be paramount in the implementation of this project.

Discussion and Conclusion

Patients will have improved health outcomes evident through reduced nosocomial infections. Healthcare professionals will also have a reduced nosocomial infection rate. The project will be implemented across all departments in the facility, which will be successful if all individuals adhere to the recommendations. Communicating clear objectives will also allow professionals more freedom in doing their work. Community collaboration will also record positive outcomes, especially in understanding social determinants of health. The sustainability of the CQI will be achieved once the metrics are aligned with the plan. In other words, the performance of the recommendations and interventions proposed should be aligned.

Additionally, We Care Hospital will have to establish leadership commitment and engagement to achieve the project’s goals. The leadership will also be responsible for managing the change across the facility, including implementing training excursions. It is also recommended that the facility maintain the plan’s measures in its future processes and make amendments where necessary to contain different healthcare situations that may not be incorporated in this plan.


Abbas, M., Nunes, T. R., Martischang, R., Zingg, W., Iten, A., Pittet, D., & Harbarth, S. (2021a). Nosocomial transmission and outbreaks of coronavirus disease 2019: The need to protect both patients and healthcare workers. Antimicrobial Resistance & Infection Control, 10(1), 1-13. Web.

Abbas, M., Nunes, T. R., Cori, A., Cordey, S., Laubscher, F., Baggio, S., Jombart, T., Iten, A., Vieux, L., Teixeira, D., Perez, M., Pittet, D., Frangos, E., Graf, C. E., Zingg, W., & Harbarth, S. (2021b). Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction. Journal of Hospital Infection, 117, 124-134. Web.

Falcone, M., Tiseo, G., Giordano, C., Leonildi, A., Menichini, M., Vecchione, A., Pistello, M., Guarracino, F., Ghiadoni, L., Forfori, F., Barnini, S., & Menichetti, F. (2021). Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study. Journal of Antimicrobial Chemotherapy, 76(4), 1078-1084. Web.

Graham, R. N. J., & Woodhead, T. (2021). Leadership for continuous improvement in healthcare during the time of COVID-19. Clinical Radiology, 76(1), 67-72. Web.

Saleem, S. G., Ali, S., Ghouri, N., Maroof, Q., Jamal, M. I., Aziz, T., Shapiro, D., & Rybarczyk, M. (2022). Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan. Pakistan Journal of Medical Sciences, 38(ICON-2022). Web.

Shekhawat, R. S., Meshram, V. P., Kanchan, T., & Misra, S. (2020). Privacy and patient confidentiality in times of Covid-19. Medico-Legal Journal, 88(4), 229-230. Web.

Singh, S. K., Khawale, R. P., Chen, H., Zhang, H., & Rai, R. (2021). Personal protective equipments (PPEs) for COVID-19: A product lifecycle perspective. International Journal of Production Research, 1-22. Web.

Sollecito, W., & Johnson, J. (2020). McLaughlin and Kaluzny’s continuous quality improvement in health care (5th ed.). Jones & Bartlett Publishers.


Appendix 1: A sample benchmark table to guide CQI implementation

Benchmark table Far away from benchmark Close to benchmark Achieved
National Quality Standards “Adult hospital patients who strongly disagree or disagree that staff took their preferences and those of their family and caregiver into account when deciding what the patients discharge health care would be” (Agency for Healthcare Research and Quality [AHRQ], 2022) Adult hospital patients who sometimes or never had good communication about medications they received in the hospital“ (AHRQ, 2022) Deaths per 1,000 adult hospital admissions with pneumonia” (AHRQ, 2022)
National Benchmark Benchmark = 3.2 Benchmark = 7.8 Benchmark = 21.6
Current Standards Benchmark = 4.9 Benchmark = 7.5 Benchmark = 22

Appendix 2: An overview of proposed interventions

Intervention Risk Timeframe
Hand hygiene Very High Two weeks
Use of PPE High One week
Mandatory isolation with limited interaction High One week
Proper aseptic or sterile techniques High One week

Appendix 3: Provisions of a prevalence survey

# Measure Check
1 Protective gear
2 Patients with physical injuries or surgical wounds: identification, caution, and monitoring
3 Patients at risk of ventilator-associated pneumonia: identification, caution, and monitoring
4 Patients at risk of bloodstream infections: identification, caution, and monitoring
5 Patients at risk of urinary tract infections: identification, caution, and monitoring
6 Patients at risk of surgical wound infections: identification, caution, and monitoring
7 Nature of infection: bacterial, viral, or fungal check

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