scholarly journals Implementation of the Comprehensive Unit-Based Safety Program to Improve Hand Hygiene in Four NICUs in Pune, India

2020 ◽  
Vol 41 (S1) ◽  
pp. s8-s10
Author(s):  
Julia Johnson ◽  
Asad Latif ◽  
Bharat Randive ◽  
Abhay Kadam ◽  
Uday Rajput ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Improvement Strategy ◽  
Implementation Phase ◽  
Healthcare Facilities ◽  
Safety Program

Background: In low- and middle-income country (LMIC) healthcare facilities, gaps in infection prevention and control (IPC) practices increase risk of healthcare-associated infections (HAIs) and mortality among hospitalized neonates. Method: In this quasi-experimental study, we implemented the Comprehensive Unit-based Safety Program (CUSP) to improve adherence to evidence-based IPC practices in neonatal intensive care units (NICUs) in 4 tertiary-care facilities in Pune, India. CUSP is a validated strategy to empower staff to improve unit-level patient safety. Baseline safety culture was measured using the Hospital Survey on Patient Safety Culture (HSOPS). Baseline IPC assessments using the Infection Control Assessment Tool (ICAT) were completed to describe existing IPC practices to identify focus areas, the first of which was hand hygiene (HH). Sites received training in CUSP methodology and formed multidisciplinary CUSP teams, which met monthly and were supported by monthly coaching calls. Staff safety assessments (SSAs) guided selection of multimodal interventions. HH compliance was measured by direct observation using trained external observers. The primary outcome was HH compliance, evaluated monthly during the implementation and maintenance phases. Secondary outcomes included CUSP meeting frequency and HH compliance by healthcare worker (HCW) role. Result: In March 2018, 144 HCWs and administrators participated in CUSP training. Site meetings occurred monthly. During the implementation phase (June 2018–January 2019), HH monitoring commenced, sites formed their teams, completed the SSA, and selected interventions to improve HH based on the WHO’s IPC multimodal improvement strategy: (1) system change; (2) training and education; (3) monitoring and feedback; (4) reminders and communication; and (5) a culture of safety (Fig. 1). During the maintenance phase (February–September 2019), HH was monitored monthly and sites adapted interventions as needed. HH compliance improved from 58% to 70% at participant sites from implementation to maintenance phases (Fig. 2), with an odds ratio (OR) of 1.66 (95% CI, 1.50–1.84; P < .001). HH compliance improved across all HCW roles: (1) physician compliance improved from 55% to 67% (OR, 1.69; 95% CI, 1.42–2.01; P < .001); (2) nurse compliance from 61% to 73% (OR, 1.68; 95% CI, 1.46–1.93; P < .001); and (3) other HCW compliance from 52% to 62% (OR, 1.48; 95% CI, 1.10–1.99; P = .010). Conclusion: CUSP was successfully adapted by 4 diverse tertiary-care NICUs in Pune, India, and it resulted in increased HH compliance at all sites. This multimodal strategy is a promising framework for LMIC healthcare facilities to sustainably address IPC gaps and reduce HAI and mortality in neonates.Funding: NoneDisclosures: Aaron Milstone, Johns Hopkins University, BD (consulting)

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

2022 ◽  
Vol 9 ◽  
Author(s):  
Julia Johnson ◽  
Asad Latif ◽  
Bharat Randive ◽  
Abhay Kadam ◽  
Uday Rajput ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Neonatal Intensive Care ◽  
Hand Hygiene Compliance ◽  
Patient Safety Culture ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Central Line Insertion ◽  
Hygiene Compliance

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 &lt; 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.

Patient Safety Culture and the Ability to Improve: A Proof of Concept Study on Hand Hygiene

2017 ◽  
Vol 38 (11) ◽  
pp. 1277-1283 ◽  
Author(s):  
Martine G. Caris ◽  
Pim G. A. Kamphuis ◽  
Mireille Dekker ◽  
Martine C. de Bruijne ◽  
Michiel A. van Agtmael ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Tertiary Care ◽  
Patient Safety Culture ◽  
Care Hospital ◽  
Independent Observer ◽  
Hospital Unit ◽  
High Performing ◽  
Low Levels

OBJECTIVETo investigate whether the safety culture of a hospital unit is associated with the ability to improve.DESIGNQualitative investigation of safety culture on hospital units following a before-and-after trial on hand hygiene.SETTINGVU University Medical Center, a tertiary-care hospital in the Netherlands.METHODSWith support from hospital management, we implemented a hospital-wide program to improve compliance. Over 2 years, compliance was measured through direct observation, twice before, and 4 times after interventions. We analyzed changes in compliance from baseline, and selected units to evaluate safety culture using a positive deviance approach: the hospital unit with the highest hand hygiene compliance and 2 units that showed significant improvement (21% and 16%, respectively) were selected as high performing. Another 2 units showed no improvement and were selected as low performing. A blinded, independent observer conducted interviews with unit management, physicians, and nurses, based on the Hospital Survey on Patient Safety Culture. Safety culture was categorized as pathological (lowest level), reactive, bureaucratic, proactive, or generative (highest level).RESULTSOverall, 3 units showed a proactive or generative safety culture and 2 units had bureaucratic or pathological safety cultures. When comparing compliance and interview results, high-performing units showed high levels of safety culture, while low-performing units showed low levels of safety culture.CONCLUSIONSSafety culture is associated with the ability to improve hand hygiene. Interventions may not be effective when applied in units with low levels of safety culture. Although additional research is needed to corroborate our findings, the safety culture on a unit can benefit from enhancement strategies such as team-building exercises. Strengthening the safety culture before implementing interventions could aid improvement and prevent nonproductive interventions.Infect Control Hosp Epidemiol 2017;38:1277–1283

Risk Factors for Central Venous Catheter–Associated Bloodstream Infection in Pediatric Patients: A Cohort Study

2016 ◽  
Vol 37 (8) ◽  
pp. 939-945 ◽  
Author(s):  
Jillian Hansen Carter ◽  
Joanne Marie Langley ◽  
Stefan Kuhle ◽  
Susan Kirkland
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hand Hygiene ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Cox Proportional Hazards ◽  
Infection Prevention And Control ◽  
Temporal Association ◽  
Central Venous ◽  
Over Time

OBJECTIVETo examine the incidence of central-line–associated bloodstream infection (CLABSI) over time and to determine risk factors for CLABSI in hospitalized children.DESIGNProspective cohort study.SETTINGPediatric tertiary care referral center in Halifax, Nova Scotia, serving a population of 2.3 million.PARTICIPANTSPatients ages 0–18 years with central venous catheters (CVCs) inserted at this facility between 1995 and 2013.METHODSParticipants were followed from CVC insertion to CLABSI event or until CVC removal. Data were prospectively collected by clinicians, infection prevention and control staff, and nursing staff for the purposes of patient care, surveillance, and quality improvement. Cox proportional hazards regression was used to identify risk factors for CLABSI.RESULTSAmong 5,648 patients, 385 developed CLABSI (0.74 CLABSI per 1,000 line days; or 3.87 per 1,000 in-hospital line days). Most infections occurred within 60 days of insertion. CLABSI rates decreased from 4.87 per 1,000 in-hospital line days in 1995 to 0.78 per 1,000 in-hospital line days in 2013, corresponding to an 84% reduction. A temporal association of CLABSI reduction with a hand hygiene promotion campaign was identified. CVC type, number of lumens, dressing type, insertion vein, and being in the critical care unit were statistically significantly associated with CLABSI.CONCLUSIONSHospital-wide surveillance over an 18-year period identified children at highest risk for CLABSI and decreasing risk over time; this decrease was temporally associated with a hand hygiene campaign.Infect Control Hosp Epidemiol 2016;37:939–945

scholarly journals Impact of the Norwegian National Patient Safety Program on implementation of the WHO Surgical Safety Checklist and on perioperative safety culture

2020 ◽  
Vol 9 (3) ◽  
pp. e000966
Author(s):  
Arvid Steinar Haugen ◽  
Eirik Søfteland ◽  
Nick Sevdalis ◽  
Geir Egil Eide ◽  
Monica Wammen Nortvedt ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
Operating Theatre ◽  
Secondary Outcome ◽  
Safety Program ◽  
Surgical Safety ◽  
Hospital Managers ◽  
Culture Dimensions ◽  
National Patient

ObjectivesOur primary objective was to study the impact of the Norwegian National Patient Safety Campaign and Program on Surgical Safety Checklist (SSC) implementation and on safety culture. Secondary objective was associations between SSC fidelity and safety culture. We hypothesised that the programme influenced on SSC use and operating theatre personnel’s safety culture perceptions.SettingA longitudinal cross-sectional study was conducted in a large Norwegian tertiary teaching hospital.ParticipantsWe invited 1754 operating theatre personnel to participate in the study, of which 920 responded to the surveys at three time points in 2009, 2010 and 2017.Primary and secondary outcome measuresPrimary outcome was the results of the patient safety culture measured by the culturally adapted Norwegian version of the Hospital Survey on Patient Safety Culture. Our previously published results from 2009/2010 were compared with new data collected in 2017. Secondary outcome was correlation between SSC fidelity and safety culture. Fidelity was electronically recorded.ResultsSurvey response rates were 61% (349/575), 51% (292/569) and 46% (279/610) in 2009, 2010 and 2017, respectively. Eight of the 12 safety culture dimensions significantly improved over time with the largest increase being ‘Hospital managers’ support to patient safety’ from a mean score of 2.82 at baseline in 2009 to 3.15 in 2017 (mean change: 0.33, 95% CI 0.21 to 0.44). Fidelity in use of the SSC averaged 88% (26 741/30 426) in 2017. Perceptions of safety culture dimensions in 2009 and in 2017 correlated significantly though weakly with fidelity (r=0.07–0.21).ConclusionThe National Patient Safety Program, fostering engagement from trust boards, hospital managers and frontline operating theatre personnel enabled effective implementation of the SSC. As part of a wider strategic safety initiative, implementation of SSC coincided with an improved safety culture.

scholarly journals Improvement in Infection Prevention and Control Measures at The Children Hospital, Lahore. A My Child Matters Collaborative Project

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 223s-223s
Author(s):  
M. Faizan ◽  
S. Anwar ◽  
R.U.A. Kashif ◽  
R. Saleem ◽  
H. Javed ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Pediatric Cancer ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Improvement Strategy ◽  
Targeted Interventions ◽  
Healthcare Associated ◽  
And Control

Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and our institution was established to address these issues. Aim: To describe the effect of a collaborative improvement strategy on the infection prevention and control (IPC) standards in a pediatric oncology unit in a resource-limited setting. Methods: Our study was a prospective before-and-after study. We compare the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and 4 modules of the St. Jude modified Infection Control Assessment Tool (ICAT) scores. Our strategy included: (1) creating a multidisciplinary team of pediatric hematology-oncology, infectious disease physicians, nurses, microbiologist, and a data manager, (2) engaging on monthly online IPC mentoring sessions with the SJ-GID and MCM mentors, (3) performing daily inpatient healthcare associated (HAI) surveillance rounds, and (4) providing regular hand hygiene training and compliance audits. Results: Our hand hygiene facility level per WHO scores increased from “Inadequate” during the baseline assessment to “Intermediate/Consolidation” by the end of 3-year implementation (122 vs 352 HHSAF scores). The sink: bed and hand sanitizer: bed ratios improved to 1:6 and 1:1 respectively. Six washrooms were added to our unit. ICAT general infection control module increased by 40% (45 vs 78 ICAT score) and hygiene compliance improved by 20% from baseline. Identification of HAI increased from baseline (4.07 vs 8.7 infections per 1000 patient days). A 25% of the isolates were multidrug-resistant microorganisms. Conclusion: Implementing a collaborative improvement strategy improved the IPC standards in our pediatric cancer center. The increase of HAI might be a result of a better surveillance and laboratory identification. Further targeted interventions should be develop to decrease HAI rates and infection-related morbidity and mortality in our population.

scholarly journals A study to assess knowledge and skill among doctors about hand hygiene, WHO five moments, personal protective equipment’s and assess the impact of educational intervention, in tertiary care hospital, Al Qassim provenance of Saudi Arabia

2018 ◽  
Vol 5 (9) ◽  
pp. 3796
Author(s):  
Sanjay Kumar Gupta ◽  
Fahd Khaleefah Al Khaleefah ◽  
Ibrahim Saifi Al Harbi ◽  
Sinimol Jabar ◽  
Marilou A. Torre ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Educational Intervention ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Effective Measure ◽  
Knowledge And Skills ◽  
Study Results ◽  
The Impact

Background: Hand hygiene (HH) is now to be considered as one of the most important effective measure of infection control activities. This is because enough scientific evidence suggested the observation that if properly implemented, hand hygiene alone can significantly reduce the risk of cross-transmission of infection in healthcare facilities.Methods: Hospital based educational intervention.Results: The study results showed the overall improvement pre and post educational intervention regarding hand hygiene skills, five moments and donning and doffing of PPE was significantly improved from 56.50% to 94.51%. If we see the knowledge and skills among doctors between department than we found significantly low knowledge and skills among (pre-interventional) doctors of radiology 23.33% followed by orthopedics 42.50%. The post educational interventions improvement in intensive care unit, laboratory, ENT and dental department were near 100% and lowest observed in departments in pediatrics (84%).Conclusions: The study shows that need for the doctors to increase their knowledge and skill related to infection prevention and control practice by assessing their existing knowledge and skills in small groups and according to observations intervention also plan and its improved knowledge and skill significantly.

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