Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India

Julia Johnson, Asad Latif, Bharat Randive, Abhay Kadam, Uday Rajput, Aarti Kinikar, Nandini Malshe, Sanjay Lalwani, Tushar B. Parikh, Umesh Vaidya, Sudhir Malwade, Sharad Agarkhedkar, Melanie S. Curless, Susan E. Coffin, Rachel M. Smith, Matthew Westercamp, Elizabeth Colantuoni, Matthew L. Robinson, Vidya Mave, Amita GuptaYukari C. Manabe, Aaron M. Milstone

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices. Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload. Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001). Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

Original languageEnglish
Article number794637
JournalFrontiers in Pediatrics
Publication statusPublished - 6 Jan 2022
Externally publishedYes


  • aseptic technique
  • bloodstream infection
  • hand hygiene
  • healthcare-associated infection
  • multimodal strategy
  • neonate
  • patient safety
  • patient safety culture


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