TY - JOUR
T1 - Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India
AU - Johnson, Julia
AU - Latif, Asad
AU - Randive, Bharat
AU - Kadam, Abhay
AU - Rajput, Uday
AU - Kinikar, Aarti
AU - Malshe, Nandini
AU - Lalwani, Sanjay
AU - Parikh, Tushar B.
AU - Vaidya, Umesh
AU - Malwade, Sudhir
AU - Agarkhedkar, Sharad
AU - Curless, Melanie S.
AU - Coffin, Susan E.
AU - Smith, Rachel M.
AU - Westercamp, Matthew
AU - Colantuoni, Elizabeth
AU - Robinson, Matthew L.
AU - Mave, Vidya
AU - Gupta, Amita
AU - Manabe, Yukari C.
AU - Milstone, Aaron M.
N1 - Publisher Copyright:
Copyright © 2022 Johnson, Latif, Randive, Kadam, Rajput, Kinikar, Malshe, Lalwani, Parikh, Vaidya, Malwade, Agarkhedkar, Curless, Coffin, Smith, Westercamp, Colantuoni, Robinson, Mave, Gupta, Manabe and Milstone.
PY - 2022/1/6
Y1 - 2022/1/6
N2 - 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.
AB - 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.
KW - aseptic technique
KW - bloodstream infection
KW - hand hygiene
KW - healthcare-associated infection
KW - multimodal strategy
KW - neonate
KW - patient safety
KW - patient safety culture
UR - http://www.scopus.com/inward/record.url?scp=85123082253&partnerID=8YFLogxK
U2 - 10.3389/fped.2021.794637
DO - 10.3389/fped.2021.794637
M3 - Article
AN - SCOPUS:85123082253
SN - 2296-2360
VL - 9
JO - Frontiers in Pediatrics
JF - Frontiers in Pediatrics
M1 - 794637
ER -