Monika Kaushal
Emirates Specialty Hospital, UAE
Title: A quality improvement approach to reduce infections in neonatal intensive care
Biography
Biography: Monika Kaushal
Abstract
Outcomes in neonatology has improved dramatically in the last 3 decades
Improved survival- associated with increasing short term and long term morbidity
Infections- important cause of morbidity and mortality
Majority of infections are potentially preventable
Early onset sepsis related to maternal and perinatal factors
NICU professionals have little control!
Late- 72 hrs / 7 days
Late onset usually HAI and linked to infection control measures
Controllable and potentially preventable
Reported Incidence – 15-50% depending on location and gestation
25% of VLBW in the NICHD network
Incidence falling in developed economies- eg:15% in Canada (2010/11) and drop from 38/1000 admissions to
20/1000 admissions in the UK 2006-2014
Gulf region – (2013-15) 56/1000 admissions
Seasonal variations have been described
To reduce the infection, we need to have policies in place.
• Hand hygiene policy
• Central line policy and bundles
• Isolation policies
• Antibiotic policies
• Cleaning and waste
We might have Disjoint between policy and care delivery
The metrics being used were nor accurate/fit for purpose
If we look at hand hygiene policy , it may happen:
• Policy in place
• IC team audits showing high compliance
• But fly on the wall observation revealed a different story
• Non-compliance widespread
• Accessibility of hand gel at bedside was an issue
• Turnover of new staff – eg . Residents who were poorly
Oriented
• Hand hygiene of parents not monitored or enforced
• Mobile phone use in the clinical area
• Publicity poor
So we need to work on the missing gap and improve the compliance.
Similarly, for central line bundle it may have issues in any of the following.
• Bundles in place
• IC team reporting high compliance- Wrong metric being used
• Was a tick box exercise with no empowerment of nurses
• No standardisation
• Application of antiseptic and adherence to aseptic technique suspect
• Type of antiseptic used
• Multiple breaks in to the line
• Indefinite line duration
When we do quality improvement then we can have infection free NICU.