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

2021

794637

2021

2296-2360

<p>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. 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. 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 ( &lt; 0.0001). 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.</p>

10.3389/fped.2021.794637

Front Pediatr

35071137

Saving neonatal lives by improving infection prevention in low-resource units: tools are needed.

2019

010319

2019 Jun

2047-2986

<p>Globally, neonatal mortality rates remain relatively stagnant despite overall progress in reducing under-5 mortality. In regions with highest mortality for neonates, infections account for up to 30%-50% of deaths. In many low and middle income countries (LMICs), births within health care facilities are encouraged as a mechanism to reduce both maternal and neonatal mortality. However, the resulting increased demand for facility births has not been accompanied by comparable increases in capacity for delivering quality care and enhancing the safety of maternal and neonatal patients. Shortages in space, trained staff, and consumable resources have frayed many maternal-neonatal health care settings. To date, there have been limited systematic efforts to improve quality of care, while demands on facilities expand.</p>

10.7189/jogh.09.010319

J Glob Health

31217955