A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti

2020 ◽  
Author(s):  
Theony Deshommes ◽  
Christian Nagel ◽  
Richard Tucker ◽  
Lindsay Dorcélus ◽  
Jacqueline Gautier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Educational Interventions ◽  
World Health ◽  
Quality Improvement Initiative ◽  
Patient Contact ◽  
Post Intervention

Abstract Introduction Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children’s hospital neonatal intensive care unit (NICU) in Haiti. Methods A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization ‘5 Moments for HH’. Data were analyzed using standard statistical analysis. Results HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. Conclusion This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.

scholarly journals Project Console: a quality improvement initiative for neonatal abstinence syndrome in a children’s hospital level IV neonatal intensive care unit

2021 ◽  
Vol 10 (2) ◽  
pp. e001079
Author(s):  
Kathryn L Ponder ◽  
Charles Egesdal ◽  
Joanne Kuller ◽  
Priscilla Joe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Quality Improvement Initiative ◽  
Abstinence Syndrome ◽  
Post Intervention ◽  
High Acuity

ObjectiveTo improve care for infants with neonatal abstinence syndrome.DesignInfants with a gestational age of ≥35 weeks with prenatal opioid exposure were eligible for our quality improvement initiative. Interventions in our Plan–Do–Study–Act cycles included physician consensus, re-emphasis on non-pharmacological treatment, the Eat Sleep Console method to measure functional impairment, morphine as needed, clonidine and alternative soothing methods for parental unavailability (volunteer cuddlers and automated sleeper beds). Pre-intervention and post-intervention outcomes were compared.ResultsLength of stay decreased from 31.8 to 10.5 days (p<0.0001) without an increase in readmissions. Composite pharmacotherapy exposure days decreased from 28.7 to 5.5 (p<0.0001). This included reductions in both morphine exposure days (p<0.0001) and clonidine exposure days (p=0.01). Fewer infants required pharmacotherapy (p=0.02).ConclusionsOur study demonstrates how a comprehensive initiative can improve care for infants with neonatal abstinence syndrome in an open-bay or a high-acuity neonatal intensive care unit when rooming-in is not available or other comorbidities are present.

scholarly journals Hand hygiene adherence according to World Health Organization Recommendations in a Neonatal Intensive Care Unit

2017 ◽  
Vol 17 (3) ◽  
pp. 551-559 ◽  
Author(s):  
Daiane Santos Silva ◽  
Ana Amelia G. Dourado ◽  
Caroline Ramos Eustaquio Cerqueira ◽  
Fernando Hernandez Romero ◽  
Nair Almeida Amaral ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
World Health Organization ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
World Health ◽  
Cross Sectional ◽  
Health Organization

Abstract Objectives: to evaluate the application of hand hygiene technique, according to the World Health Organization (WHO) recommendations, in the neonatal intensive care unit, at a Maternity in Salvador de Bahia, Brazil. Methods: cross-sectional study. Hand hygiene technique by professional category and alcohol solution consumption were systematically registered. For this task an adapted instrument created by the WHO was used and applied using factsheets. The sample was taken from medical physicians, physiotherapists, nurses and nursing technicians. Results: hand hygiene adherence regarding WHO recommendations was deficient in terms of technique and in terms of frequency (adequate technique ranged from 0% to 13.3% between professional categories). Hand hygiene was frequently ignored (27% between physicians and 51.8% between nursing technicians). The moment right after touching surfaces next to patients was the most ignored one. Alcohol gel solution monthly use was only 35% of the expected value for the unit. Conclusions: despite the international investigations and efforts for better results, the adherence and compliance to the hand hygiene guidelines is still deficient and continues to be a major problem.

scholarly journals Handwashing Practices in Neonatal Intensive Care Unit, Paediatric Intensive Care Unit and Neonatal Nurseries in Patan Hospital

2017 ◽  
Vol 15 (1) ◽  
pp. 56-60
Author(s):  
Suchita Joshi ◽  
Puja Amatya ◽  
Bibek Poudel ◽  
Saroj Adhikari Yadav
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
World Health ◽  
Neonatal Intensive Care Units ◽  
Post Intervention ◽  
Health Organization ◽  
Hospital Acquired

Background: Hand hygiene has been identified as the single most important factor in minimising hospital acquired infections. However, compliance of handwashing guidelines has remained low. The aim of this study was to study the handwashing practices in the Paediatric and Neonatal intensive care units and Neonatal nurseries in Patan Hospital, and secondly to re-evaluate the improvement on compliance of handwashing guidelines after intervention.Methods: Pre-intervention study was conducted by covertly observing the handwashing practices by the healthcare workers. The healthcare workers were then shown the video demonstrating correct methods of handwashing as recommended by World health organization. The cycle was completed by discretely re-observing the handwashing practices following intervention.Results: Sixty five samples were collected initially. Only 6 (9.2%) had completed all steps of handwashing correctly. Post- intervention, 51 samples were collected, out of which 35 (68.6%) had correctly completed all the steps. Following audio-visual demonstration, 100% correctly completed 8/10 steps of handwashing with soap and water. 8 (16%) failed to dry hands using a single use towel and 14 (28%) failed to turn off the tap using elbow. Postintervention, 100% correctly completed 4/7 steps of handwashing using chlorhexidine. Four (15%) still failed to rub backs of fingers to opposite palm, eight (30%) failed to palm to palm with fingers interlaced, and rub thumb to opposite palm.Conclusions: Compliance in hand hygiene is low despite the known fact that it reduces nosocomial infections. However, a simple intervention like video demonstration can improve the compliance among healthcare workers.

scholarly journals IMPACT OF A QUALITY IMPROVEMENT INITIATIVE ON UNPLANNED EXTUBATION (UE) RATE IN THE NEONATAL INTENSIVE CARE UNIT (NICU)

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e16-e16
Author(s):  
Mark Hewitt ◽  
Erin Sproul ◽  
Jo-Anna Hudson ◽  
Julie Emberley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
High Risk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Quality Improvement Initiative ◽  
Care Providers ◽  
Post Intervention ◽  
Level Ii

Abstract BACKGROUND Unplanned extubations (UEs) refer to any removal of an endotracheal tube not directly ordered or intended by the medical team. It is the fourth most common adverse event in the neonatal intensive care unit (NICU) and can lead to significant morbidity in this vulnerable population. A large proportion of UEs in the NICU are deemed preventable and UE rates are increasingly being recognized as an important quality of care metric. OBJECTIVES To examine the effectiveness of an education-based quality improvement initiative to decrease UE rate in a level II/III NICU with a high rate of UEs DESIGN/METHODS Pre-intervention UE rate was determined by retrospective chart review for all intubated neonates admitted to a 25 bed level II/III NICU from January 2013 until December 2013. UEs were recorded along with demographic information including reason for extubation. UE rate was calculated by number of UEs/100 ventilator days and the data was analyzed to determine any significantly associated risk factors. The UE quality improvement initiative included: multi-disciplinary NICU staff education sessions, placement of educational posters in the NICU and identification of high risk neonates as defined by the pre-intervention study. High risk neonates were given additional signage to alert care providers. Standardized documentation was implemented to track and record UEs prospectively. Six months post-implementation, all UE events were reviewed from December 2015 until May 2016 and the post-intervention UE rate was calculated. RESULTS The UE rate was 3.28 UEs/100 ventilator days in the pre-intervention cohort with neonatal movement and adhesive failure accounting for over 50% of the documented UEs. Regression analysis revealed total ventilation time to be the only significant (p<0.05) risk factor for an UE. In the post-intervention cohort the UE rate was 1.45 UEs/100 ventilator days, a 56% decrease from the pre-intervention rate. Rates of re-intubation following an UE were 78.3% and 50% for the pre- and post-implementation cohorts respectively. CONCLUSION Reduction in UE rate from 3.28 to 1.45 was achieved with an education-based multi-disciplinary quality improvement initiative. Rates of re-intubation following an UE were similar between cohorts. Further study is necessary to evaluate whether the effectiveness of this intervention will persist over time and whether results are generalizable to other NICUs.

Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project

2018 ◽  
Vol 8 (5) ◽  
pp. 408-413 ◽  
Author(s):  
Arunava Biswas ◽  
Sangeeta Das Bhattacharya ◽  
Arun Kumarendu Singh ◽  
Mallika Saha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Conceptual Framework ◽  
Neonatal Intensive Care ◽  
Hand Hygiene Compliance ◽  
Hand Washing ◽  
Root Cause ◽  
Hygiene Compliance

Abstract Objective Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. Materials and Methods We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. Results A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. Conclusions Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.

A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kimberly Kristoff ◽  
Rui Wang ◽  
David Munson ◽  
Kevin Dysart ◽  
Stracuzzi Lauren ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Vascular Access ◽  
Neonatal Intensive Care ◽  
Quality Improvement Initiative
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