Healthcare Associated Infections Management inside Intensive Care Units: “What do nurses think about their head nurses?” A qualitative pilot study

Introduction. Preventing and controlling Healthcare Associated Infections (HAIs) caused by Multi Drug Resistant Organisms (MDROs) is one of the primary goals in high-risk settings like Intensive Care Units (ICUs). The leadership style of the head nurse can result in a reduction of infection rates, such as bloodstream and urinary tract infections; however, it is unclear how leadership can encourage nurses to adhere to Infection Prevention Control (IPC) programs. This study aims to explore the role of the head nurse in encouraging the clinical care team to adhere to IPC practices for preventing and controlling MDRO infections in the ICU. Methods. In 2024, a single-centre interpretative phenomenological study was conducted following the Consolidated Criteria for Reporting Qualitative (COREQ). Nurses and head nurses from three ICUs were recruited. Data were collected through semi-structured interviews and analysed thematically. Results. Eleven nurses and two head nurses were recruited. The results identified four themes that facilitate the management of HAIs by MDROs: a) awareness of the infection problem, b) head nurse supervision, c) information sharing, and d) distribution of responsibilities. The involvement of leadership and learning through feedback from head nurses are perceived not as barriers but as added value that promotes the dissemination of best practices. Conclusions. Recognising the role of the head nurse in the management of HAIs by MDRO would represent an important driver for change in high-risk infection settings. It would enable healthcare organisations to intervene not only with nurses directly involved in patient care but also with middle managers who implement the hospital's directives and produce nursing sensitive outcomes.