Healthcare-Associated Infections and the Leadership style of head nurses: from organizational well-being to nursing Sensitive Outcomes. The variables of the organizational context, the mental processes, and team decision-making processes of the team involved in Infection Prevention Control.

Background Healthcare Associated Infections (HAIs) are a global challenge. Analyzing the influence of head nurse’s leadership style and the organizational well-being of healthcare staff on Nursing Sensitive Outcomes—such as Catheter-Associated Bloodstream Infections (CABSIs), Catheter-Associated Urinary Tract Infections (CAUTIs), Surgical Site Infections (SSIs), and Multi-Drug Resistant Organism (MDRO) infections—is crucial. The study of these clinical and organizational aspects enables managers and educators to identify critical issues in care practices and promote targeted strategies that incorporate the contributions of those directly involved. Objectives During the doctoral program, a research study was designed and conducted to investigate how head nurses’ leadership and organizational context variables impact the spread of HAIs. The main objectives of the research were: • To explore the relationship between HAIs, nurses' organizational well-being, and the head nurse leadership style. • To conduct a survey using validated scales on a sample of nurses and head nurses to assess the association between organizational well-being, leadership style, and incidence of HAIs. • Test a model analyzing the relationship between organizational context variables—such as staffing, stress related to demands, and workloads—and the occurrence of specific HAIs, such as SSIs. • To examine how mental processes, behaviors, and actions promoted by head nurse and health care workers in the Intensive Care Unit (ICU) can promote adherence to Infection Prevention Control programs, contributing to the reduction of MDRO infections. Method To achieve the overarching goal of the doctoral program, the research designs were structured to align with the four previously outlined objectives. A review based on the JBI Manual was conducted to address the first objective. The second and third objectives were examined through a single-center observational study, while 11 the final objective was explored using a qualitative multicenter study guided by the Grounded Theory approach. Each research design employed validated tools, such as the Quantitative Work Index (QWI) and the Health Safety Executive Indicator Tool (HSE-IT), to measure workload and the perceived stress of healthcare professionals. Additionally, a custom Outcomes Form was developed and implemented over 30 days, following specific training for nurse coordinators. This form was tailored to capture staffing levels and the prevalence of HAIs, adhering to the classification provided by the European Centre for Disease Prevention and Control (ECDC). Following collection, these data were analysed using a structural equation model. Finally, in order to explore the mental and decision-making processes of the healthcare team, the technique of free non-participant observation was used first and then semi-structured single and/or focus group interviews with the entire team. Results The literature shows that an authentic head nurse leadership style can “inspire a shared vision” and “challenge the process” and have a significant impact on the reduction of HAIs (β = 0.07; p = 0.024), reducing the rates of Catheter-Associated Urinary Tract Infections (CAUTIs) and Catheter Associated Blood Stream Infections (CABSIs) by 6% and 17% respectively (objective 1). The survey conducted on a sample of 133 nurses from the medical, surgical, and oncology wards of a large hospital in central Italy explored the relationship between organisational well-being and the incidence of HAIs (objective 2). From this sample, data collected through the QWI, the HSE-IT, and the outcome form showed that the inadequacy of the nursing staff (β = -0.39), the imbalance of the nurses' workload between the needs of the organisation, the needs of the patients and the work organisation (β = 0.24) contributed to the stress-related demands on nurses (β = 0.27) with an increase in the number of SSIs (objective 3). Through a phenomenological interpretative analysis of the data collected at the first research center, four themes emerged that favor the management of MDRO-associated HAIs: a) attention to the infectious problem, b) supervision by the head nurse, c) sharing of information, and d) distribution of responsibilities (objective 4). Conclusions The research conducted over the three years has highlighted how the leadership of the head nurse represents a crucial strategic lever for change and more sustainable management of infectious risks in different healthcare settings, including medical, surgical, oncology, and intensive care. However, addressing HAIs requires targeted actions and integrated strategies involving healthcare organizations, management, and both academic and ongoing professional education. The synergistic integration of organizational and clinical variables can serve as a foundational step toward reconstructing a care system oriented toward quality service. In this redefinition, the organizational well-being of staff and the quality of patient care take on a central role, contributing to a healthcare system that is both more effective and sustainable.