Controlling nosocomial infection in adult intensive treatment unit: A quality improvement project

Article type: Research Article

Authors: Omar, Islam^{a; e;} | Shirazy, Mohamed^{b; g} | Omar, Mayar^{c; f} | Chaari, Anis^{d; h; i}

Affiliations: [a] Upper GI Surgery, Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK E-mail: islamfawzyomar@hotmail.com | [b] University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), UK E-mail: Mohamed_shirazy@yahoo.com | [c] Head of Healthcare Quality and Medical Procurement, General Authority of Health Insurance, Alexandria, Egypt E-mail: dr.mayar@yahoo.com | [d] Head of ITU Department, Consultant Intensivist, King Hamad University Hospital, Bahrain E-mail: Anis.chaar@khuh.org.bh | [e] Sunderland, United Kingdom of Great Britain and Northern Ireland E-mail: islamfawzyomar@hotmail.com | [f] Head of Healthcare Quality and Medical Procurement , General Authority of Health Insurance, Alexandria, Egypt E-mail: dr.mayar@yahoo.com | [g] Barrow-in-Furness, United Kingdom of Great Britain and Northern Ireland E-mail: Mohamed_shirazy@yahoo.com | [h] Bahrain E-mail: Anis.chaar@khuh.org.bh | [i] Head of ITU Department - Consultant Intensivist, King Hamad University Hospital, Bahrain

Correspondence: [*]  Corresponding author: Islam Omar. E-mail: islamfawzyomar@hotmail.com

Abstract: BACKGROUND:Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. OBJECTIVE:The aim of this project was to reduce the infection rates in the adult ITU to the benchmark levels. METHOD:We conducted an internal audit as a result of the high infection rates in the adult ITU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We introduced a change in the staff uniform laundry and organized a campaign to improve hand hygiene compliance using a multimodality approach. Moreover, we conducted training on aseptic techniques in ventilation, urinary catheter, and central lines insertion. Finally, we changed the ventilator filter to a higher quality brand which meets the standard specifications. Infection rates were monitored before and after the proposed changes. RESULTS:There was a marked reduction in ventilator-associated pneumonia; however, it did not reach the benchmark rates. Catheter line-associated bloodstream infection declined from above to below the benchmark. Catheter-associated urinary tract infection rates were below the benchmark; however, they showed a noticeable reduction. Hand hygiene adherence showed an improvement from 80% to 84%. However, this was below the predetermined target level of 90%. CONCLUSIONS:In-hospital laundry of staff uniforms is safer to control nosocomial infections. A multimodal approach is necessary to improve hand hygiene adherence and adoption of aseptic techniques. Quality improvement is a continuous process.

Keywords: Nosocomial, hospital-acquired, infections, intensive treatment unit, audit, healthcare quality, ventilator-associated pneumonia, central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI)

DOI: 10.3233/JRS-190028

Journal: International Journal of Risk & Safety in Medicine, vol. 31, no. 4, pp. 267-273, 2020