Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch...

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.