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

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.