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

Arunava Biswas1, Sangeeta Das Bhattacharya1, Arun Kumarendu Singh2

  • 1School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India.

Journal of the Pediatric Infectious Diseases Society
|September 7, 2018
PubMed

Insights

Healthcare provider hand hygiene compliance was suboptimal, especially during resuscitation and between patient contacts in a low-resource NICU. A root-cause analysis identified barriers and solutions to improve adherence to protocols.

Area of Science:

  • Healthcare quality improvement
  • Infection control
  • Neonatal intensive care

Background:

  • Hand hygiene is critical for preventing infections in neonatal intensive care units (NICUs).
  • Compliance with hand hygiene protocols remains a challenge, particularly in resource-limited settings.

Purpose of the Study:

  • To quantify healthcare provider adherence to hand hygiene protocols.
  • To develop a conceptual framework for enhancing hand hygiene compliance in a low-resource NICU.

Main Methods:

  • A 3-phase intervention involving discussion, audit, and action was implemented.
  • A 4-month unobtrusive audit assessed hand hygiene opportunities and compliance.
  • Root-cause analysis involving the NICU team identified barriers and solutions.

Main Results:

  • Overall hand hygiene compliance was suboptimal, with missed opportunities during resuscitation (20%) and between patient contacts.
  • Missed hand hygiene was significantly higher during resuscitation and when providers moved between patients.
  • Deficiencies included inadequate hand-washing duration, neglected drying, recontamination, and improper washing technique.

Conclusions:

  • Hand hygiene compliance was inadequate during critical procedures and transitions.
  • A collaborative root-cause analysis facilitated the development of a framework to improve hand hygiene practices.
Abstract

Keywords:
conceptual frameworkhand hygienehand-washing complianceinfection controlneonatal care unit

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