A Quality Improvement Initiative to Control a Gram-negative Sepsis Outbreak in a Resource-limited Neonatal Intensive...

Area of Science:

• Neonatal Intensive Care
• Infectious Disease Control
• Patient Safety

Background:

• Neonatal mortality remains a critical global health issue, particularly in low- and middle-income countries, with healthcare-associated infections (HCAIs) contributing significantly to neonatal sepsis.
• Incidence rates of HCAIs in neonatal intensive care units (NICUs) are high, ranging from 15.2 to 62.0 per 1,000 patient-days, leading to substantial morbidity and mortality.
• A simplified and scalable framework is essential to mitigate neonatal mortality stemming from sepsis.

Purpose of the Study:

• To describe the successful containment of a Gram-negative sepsis outbreak in a NICU.
• To evaluate the effectiveness of a combined Modified Donabedian approach and the Systems Engineering Initiative for Patient Safety (SEIPS) model in controlling HCAIs and reducing sepsis-related mortality.
• To highlight the importance of a holistic, structured approach in improving patient safety and outcomes in NICUs.

Main Methods:

• Implementation of a strategic combination of the Modified Donabedian approach and the SEIPS model to address a Gram-negative sepsis outbreak.
• Monitoring of HCAI incidence rates and case fatality rates during the outbreak.
• Assessment of changes in antibiotic use and sepsis-related mortality following the intervention.

Main Results:

• Healthcare-associated infections (HCAIs) decreased from a mean of 14 and a peak of 38.7 per 1,000 patient-days to a sustained mean of 2.9.
• Antibiotic use was reduced by 50%.
• Late-onset sepsis-related mortality significantly decreased from 27.3% in 2021 and 40% in 2022 to 12% in 2023 and 0% in 2024.

Conclusions:

• Effective control of HCAI outbreaks in NICUs necessitates a holistic and structured approach, integrating work system components (structure, processes, outcomes) as outlined by the SEIPS model.
• Empowering healthcare workers and fostering psychological safety are crucial for successful implementation of patient safety initiatives.
• Strong leadership is vital for uniting teams, overcoming challenges, and driving improvements in neonatal care and patient safety.