Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India

Frontiers in Pediatrics

Sharad Agarkhedkar¹  Sudhir Malwade¹  Melanie S. Curless²  Susan E. Coffin³  Matthew Westercamp⁴  Rachel M. Smith⁴  Elizabeth Colantuoni⁵  Yukari C. Manabe⁶  Matthew L. Robinson⁶  Vidya Mave⁶  Amita Gupta⁶  Aaron M. Milstone⁷  Asad Latif⁸  Bharat Randive⁹  Abhay Kadam⁹  Julia Johnson^1,11  Nandini Malshe^1,12  Sanjay Lalwani^1,13  Aarti Kinikar^1,14  Uday Rajput^1,14  Umesh Vaidya^1,15  Tushar B. Parikh^1,15 

[1] 0Department of Pediatrics, Dr. D. Y. Patil Medical College, Pune, India;1Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD, United States;2Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States;3Centers for Disease Control and Prevention, Atlanta, GA, United States;4Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States;5Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States;6Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States;Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States;Department of Neonatology, Bharati Vidyapeeth Deemed to Be University Medical College, Pune, India;Department of Pediatrics, Bharati Vidyapeeth Deemed to Be University Medical College, Pune, India;Department of Pediatrics, Byramjee-Jeejeebhoy Government Medical College, Pune, India;Department of Pediatrics, King Edward Memorial Hospital, Pune, India;Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States;

关键词: neonate;    healthcare-associated infection;    patient safety;    hand hygiene;    aseptic technique;    patient safety culture;   

DOI  :  10.3389/fped.2021.794637

来源: DOAJ

【 摘 要 】

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

【 授权许可】

Unknown