Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch Techniques: A Quality Improvement Approach

Khurana, Supreet; Saini, Sushma Kumari; Sundaram, Venkataseshan; Dutta, Sourabh; Kumar, Praveen

doi:10.1007/s13312-018-1373-6

Cited by 10 publications

(11 citation statements)

References 7 publications

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“…4. Compliance to ANTT procedures: Two studies 24,27 reported this outcome, one from neonates and another…”

Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 88%

“…1. Hospital-acquired infection rates: One study in NICU 24 has measured infection rates. The infection rates decreased from 19.9 episodes per 1000 patient days to 15.3 episodes per 1000 patient days.…”

Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 99%

“…Table 8 details the following outcomes. Hospital-acquired infections: In total, 12 studies 9, 12, 14, 24, 31-38 reported the effect of health education on hospital-acquired infections. In total, 10 studies showed reduction of HAI with use of various health education techniques.…”

Section: Questions Evidence Summary and Recommendationsmentioning

confidence: 99%

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Prevention and Surveillance of Healthcare Associated Infections

Kaur

Arora

Anne

et al. 2020

Journal of Neonatology

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Neonatal sepsis is an important cause of morbidity and mortality, especially in low-and middle-income countries. Infections contribute to 20.8% of neonatal mortality in India. 1 The morbidities related to neonatal infections include prolonged hospital stay, increased cost of care, retinopathy of prematurity, periventricular leukomalacia, and abnormal neurodevelopment. Neonatal sepsis is classified as early onset sepsis (EOS) for symptom onset before 72 hours of birth, and as late onset sepsis (LOS) for symptoms beginning 72 hours after birth. EOS is related to maternal infection and LOS is often hospital acquired. Hospital/healthcare associated infections (HAIs) are potentially preventable. Various principles underline formulation of infection prevention and control strategies. These include, but not limited to improving hand hygiene practices, good housekeeping practices, improving nurse to patient ratio, human milk usage, probiotics, kangaroo mother care, decreasing use of invasive devices and antibiotic prophylaxis, The objective of this guideline is to improve the quality of care and outcomes for preterm and term infants by providing recommendations on infection prevention and control strategies. The guideline development group short-listed 12 research questions to be of the highest priority for development of recommendations. A separate search strategy was used for each of the priority questions to identify studies for inclusion in this review. At least two or more databases were searched to identify eligible studies. Search was restricted to studies in English language. A standardized form was used to extract relevant information from studies. Systematically extracted data included study identifiers, setting, design, participants, sample size, intervention or exposure, control or comparison group, outcome measures, and

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“…4. Compliance to ANTT procedures: Two studies 24,27 reported this outcome, one from neonates and another…”

Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 88%

Section: Strong Recommendation Moderate Quality Evidencementioning

confidence: 99%

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Prevention and Surveillance of Healthcare Associated Infections

Kaur

Arora

Anne

et al. 2020

Journal of Neonatology

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“…The solutions must come from the ground level. This is emphasized in the articles by Balla, et al [6] and Khurana, et al [7] who have demonstrated the use of QI methods to decrease infection-related morbidity and optimize resource utilization.…”

Section: Examples Of Qi Methods Addressing the Six Dimensions Of Qualitymentioning

confidence: 99%

Delivering Quality Healthcare in India: Beginning of Improvement Journey

Deorari

Livesley

2018

Indian Pediatr

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“…1 2 Previous studies have demonstrated that these invasive procedures are not carried with high standards. [3][4][5] There has been practice variability, inadequate risk assessment, and thus causing uncontrolled standards of practice. A multimodal approach is required to reduce the burden of HCAI, mainly involving the healthcare professionals' education, implementing evidence-based care bundles with attention to aseptic techniques, standardisation of procedures, and identifying local determinants of infection and improvement in reporting and surveillance for infections.…”

Section: Introduction Problem Descriptionmentioning

confidence: 99%

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

Shettigar¹,

Aradhya²,

Ramappa³

et al. 2021

BMJ Open Qual

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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.

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Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch Techniques: A Quality Improvement Approach

Cited by 10 publications

References 7 publications

Prevention and Surveillance of Healthcare Associated Infections

Prevention and Surveillance of Healthcare Associated Infections

Delivering Quality Healthcare in India: Beginning of Improvement Journey

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

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