Perceptions of Leadership in Quality Culture for Infection Prevention Among Intensive Care Nurses and Unit-Based Assessment of Antimicrobial Resistance Indicators in Intensive Care Units

This study aims to examine intensive care nurses' perceptions of leadership in quality culture for infection prevention and to investigate antimicrobial resistance indicators at the intensive care unit level. Healthcare-associated infections (HAIs) remain a major global patient safety problem and are associated with prolonged hospital stays, increased healthcare costs, and higher mortality. The increasing prevalence of antimicrobial resistance (AMR) further complicates infection prevention and patient care. Intensive care units are particularly vulnerable to healthcare-associated infections and antimicrobial resistance because of the high frequency of invasive procedures, the vulnerability of critically ill patients, and the extensive use of broad-spectrum antibiotics. Nurses play a central role in infection prevention and antimicrobial stewardship because they are continuously involved in patient care. However, previous studies have reported a gap between nurses' knowledge of infection prevention and adherence to recommended practices in clinical settings. Organizational culture and leadership may contribute to this gap. Most previous studies have focused on healthcare professionals' self-reported perceptions of infection prevention. However, limited evidence is available regarding the relationship between nurses' perceptions of leadership and quality culture and objective antimicrobial resistance indicators at the intensive care unit level. Therefore, this study will assess nurses' perceptions using the Leadership in Quality Culture for Infection Prevention (LCQ-IP) instrument and examine their relationship with retrospective microbiological data from the participating intensive care units, including antimicrobial resistance rates and resistance profiles. The findings may provide evidence on the role of organizational leadership and quality culture in infection prevention and antimicrobial resistance management in intensive care settings.