Khurana Supreet, Saini Shiv Sajan, Sundaram Venkataseshan, Dutta Sourabh, Kumar Praveen
Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India Correspondence to: Dr Praveen Kumar, Professor, Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian Pediatr. 2018 Sep 15;55(9):748-752.
To standardize and improve compliance to Aseptic non-touch techniques (ANTT) for commonly performed procedures in Neonatal intensive care unit (NICU) through application of Model for improvement, and study its impact on Healthcare-associated infection (HCAI) rates.
Quality improvement project utilizing multiple Plan-Do-Study-Act (PDSA) cycles.
Tertiary-care neonatal unit.
All resident doctors and nurses working in neonatal unit were subjects for assessment of compliance to ANTT. All admitted neonates staying in hospital for more than 48 hours were subjects for HCAI data collection.
Most frequently performed procedures in NICU were identified and pictorial Standard Operating Procedures (SOP) were developed. Implementation and uptake was reinforced by means of PDSA cycles. Compliance to ANTT was assessed as proportion of components to which adherence was documented. Trend of HCAI rates in unit were analyzed using process control charts.
Change in compliance to ANTT for most frequently performed procedures.
Significant improvement in compliance to ANTT practices was observed, specifically in use of procedure tray/trolley (16% to 49%, P=0.001), iv hub scrubbing (0% to 60%, P=0.001), local skin cleaning (33% to 67%, P=0.004), personal protective equipment use (55% to 80%, P=0.02) and disposal (27% to 51%, P=0.03), use of non-touch technique (50% to 70%, P=0.001) and reduction in key part contamination (45% to 31%, P=0.03). A modest decrease in HCAI rates was seen in the short period of observation after implementation.
Substantial improvements in compliance to aseptic non-touch techniques can be ensured by adopting a combination of initial intensive teaching and sustaining through multiple PDSA cycles, targeting specific areas revealed by audits.
通过应用改进模型，规范并提高新生儿重症监护病房（NICU）常见操作的无菌非接触技术（ANTT）的依从性，并研究其对医疗相关感染（HCAI）发生率的影响。
利用多个计划-实施-研究-改进（PDSA）循环的质量改进项目。
三级护理新生儿病房。
新生儿病房的所有住院医生和护士均为评估ANTT依从性的对象。所有住院超过48小时的入院新生儿均为HCAI数据收集的对象。
确定NICU中最常执行的操作，并制定图片标准操作规程（SOP）。通过PDSA循环加强实施和采用。将ANTT的依从性评估为有记录显示依从的组件比例。使用过程控制图分析病房中HCAI发生率的趋势。
最常执行操作的ANTT依从性变化。
观察到ANTT操作的依从性有显著改善，特别是在使用操作托盘/推车方面（从16%提高到49%，P=0.001）、静脉输液接头擦洗方面（从0%提高到60%，P=0.001）、局部皮肤清洁方面（从33%提高到67%，P=0.004）、个人防护设备使用方面（从55%提高到80%，P=0.02）和处置方面（从27%提高到51%，P=0.03）、非接触技术的使用方面（从50%提高到70%，P=0.001）以及关键部位污染的减少方面（从45%降至31%，P=0.03）。实施后在短期观察中HCAI发生率略有下降。
通过采用初步强化教学并通过多个PDSA循环持续改进的组合方式，针对审核揭示的特定领域，可以确保无菌非接触技术的依从性得到实质性提高。
