Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach

Abstract

BackgroundLack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months.MethodsAll nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded.ResultsSignificant improvement was seen in compliance to various components—use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate’s sickness level.ConclusionsUsing a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.

Reducción de las infecciones del torrente sanguíneo asociadas a catéter: efectividad del método de mejora continua de la calidad en un hospital universitario en Colombia

“…Beyond showing a reduction in clinical outcomes, which is consistent with similar projects in other geographies (13)(14)(15)(16), this study is intended to show practical details that facilitate the implementation of strategies designed for a swift and efficient achievement of the goals, particularly with regards to strengthening the patient safety culture, focusing mainly on events associated with intravascular devices and others routinely used as a patient monitoring strategy.…”

Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units

“…In turn, in a study carried out in a Neonatal Intensive Care Unit, before adopting and implementing and operational protocol for the maintenance of intravenous catheters, an alarming result was identified in relation to the disinfection of devices before administering medications, as disinfection of the devices was not performed by any professional (Shettigar et al, 2021).…”

“…CABSI is defined as a bloodstream infection due to the use of PIVCs or central vascular access devices (CVADs) (Gorski et al, 2021). CABSI is associated with an increase in hospitalization times and with worsening of children’s health status, even with a potential evolution to death (Berger et al, 2021; Shettigar et al, 2021).…”

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

“…Our analysis of the platform's impact on various QI initiatives revealed several notable successes. These include reduced late-onset neonatal sepsis rates, 15 improved adherence to infection control practices 16 and enhanced team communication and collaboration across various health facilities. Other outcomes which have been reported and published in contemporary literature by members of the CoP are increasing adherence to the use of e-partograph, 17 improving donor human milk collection, 18 development of an antibiotic stewardship programme, 19 use of sucrose analgesia in NICU 20 and pre-identification of high-risk pregnancies.…”

“…Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach 16 Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital 18 Quality improvement in Kangaroo Mother Care: learning from a teaching hospital 26 Implementing use of sucrose analgesia in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology 20…”