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A Structured Quality Improvement Framework for Managing Serratia marcescens Outbreaks in a Resource-Limited Neonatal
Mahmoud Khaild1, Nasser Al Shafouri1, Amna Al Nassri2
1Pediatrics and Neonatology, Ibri Hospital, Ibri, OMN.
Background:
Neonatal intensive care units (NICUs) in resource-limited settings face major infection-control challenges due to patient vulnerability, high device use, and limited staffing. Serratia marcescens is a well-recognized cause of recurrent NICU outbreaks, however structured quality-improvement (QI) frameworks for outbreak management in low-resource settings remain insufficiently described.
Objective:
To evaluate whether implementation of a structured, multimodal, Plan-Do-Study-Act (PDSA)-based QI framework was associated with improved outbreak containment and infection-control process measures in a resource-limited NICU.
Methods:
We conducted a single-centre, retrospective pre-post quality improvement evaluation comparing two Serratia marcescens outbreaks (2022 and 2023) in the neonatal intensive care unit of Ibri Hospital, Oman. The 2023 event implemented a structured Plan-Do-Study-Act (PDSA) framework featuring early-warning triggers, multidisciplinary task-force activation, enhanced staffing, environmental decontamination, and real-time auditing. Primary outcomes were outbreak duration and incidence density (cases per 1,000 patient-days). Secondary measures included compliance with hand hygiene, personal protective equipment (PPE), and environmental hygiene.
Results:
Outbreak incidence was observed to decrease from 8.9 to 2.5 cases per 1,000 patient-days, and outbreak duration was shorter, declining from 53 to 14 days. Hand-hygiene compliance improved from 78.9% to 92.0%, environmental-cleaning scores from 78% to 96%, and PPE compliance reached 100%.
Conclusion:
Implementation of a structured, PDSA-based outbreak-management framework was temporally associated with improvements in infection-control process measures in a resource-limited NICU. Despite a limited sample size and an uncontrolled pre-post design, this model supports feasibility and measurable benefit in low-resource NICUs.
Insights
A structured quality improvement framework significantly reduced Serratia marcescens outbreaks in a resource-limited neonatal intensive care unit (NICU). This approach improved infection control measures, demonstrating feasibility and benefit in low-resource settings.
Area of Science:
- Healthcare Management
- Infectious Disease Control
- Quality Improvement Science
Background:
- Neonatal intensive care units (NICUs) in resource-limited settings face significant infection control challenges.
- Serratia marcescens outbreaks pose recurrent threats in NICUs, yet effective management frameworks for low-resource environments are scarce.
Purpose of the Study:
- To assess the impact of a structured, multimodal Plan-Do-Study-Act (PDSA)-based quality improvement (QI) framework on NICU outbreak containment.
- To evaluate improvements in infection control process measures following the QI framework implementation.
Main Methods:
- A single-centre, retrospective pre-post study compared two Serratia marcescens outbreaks (2022 and 2023) in a resource-limited NICU.
- The 2023 outbreak utilized a PDSA framework including early-warning triggers, a multidisciplinary task force, enhanced staffing, environmental decontamination, and real-time auditing.
Main Results:
- Outbreak incidence density decreased from 8.9 to 2.5 cases per 1,000 patient-days.
- Outbreak duration shortened from 53 to 14 days.
- Compliance with hand hygiene, environmental cleaning, and personal protective equipment (PPE) significantly improved.
Conclusions:
- A structured, PDSA-based outbreak management framework was associated with improved infection control in a resource-limited NICU.
- This model demonstrates feasibility and measurable benefits for managing outbreaks in similar settings.
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