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 ICU to the benchmark levels.

Method: An internal audit was conducted as a result of the high infection rates in the adult ICU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We opted to introduce a change in the staff uniform laundry in addition to 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 that 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 lower 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: A multimodal approach is necessary to improve hand hygiene adherence. In-hospital laundry is safer to control nosocomial infections. Quality improvement is a continuous process that guarantees a proper healthcare service as per the quality chasm.

Reference:

Omar, I., Shirazy, M., Omar, M. and Chaari, A. (2020) Controlling nosocomial infection in adult intensive treatment unit: A quality improvement project. The International Journal of Risk & Safety in Medicine. June 4th. https://doi.org/10.3233/JRS-190028. (epub ahead of print).