Affiliations: [a] Upper GI Surgery, Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK E-mail: [email protected] | [b] University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), UK E-mail: [email protected] | [c] Head of Healthcare Quality and Medical Procurement, General Authority of Health Insurance, Alexandria, Egypt E-mail: [email protected] | [d] Head of ITU Department, Consultant Intensivist, King Hamad University Hospital, Bahrain E-mail: [email protected] | [e] Sunderland, United Kingdom of Great Britain and Northern Ireland E-mail: [email protected] | [f] Head of Healthcare Quality and Medical Procurement , General Authority of Health Insurance, Alexandria, Egypt E-mail: [email protected] | [g] Barrow-in-Furness, United Kingdom of Great Britain and Northern Ireland E-mail: [email protected] | [h] Bahrain E-mail: [email protected] | [i] Head of ITU Department - Consultant Intensivist, King Hamad University Hospital, Bahrain
Correspondence:
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Corresponding author: Islam Omar. E-mail: [email protected]
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.
