Affiliations 

  • 1 Department of Quality Improvement, Nationwide Quality of Care Network, New Delhi, Delhi, India drmahtab2013@gmail.com
  • 2 Department of Pediatrics, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
  • 3 Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
  • 4 Nationwide Quality of Care Network, New Delhi, Delhi, India
  • 5 Department of Neonatology, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
  • 6 Faculty of Medicine, University of Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
  • 7 National Health Mission, Government of Madhya Pradesh, Bhopal, India
  • 8 - Independant Consultant, Nairobi, Kenia
BMJ Open Qual, 2021 11;10(4).
PMID: 34759034 DOI: 10.1136/bmjoq-2020-001131

Abstract

OBJECTIVE: The purpose was to increase use of alcoholic hand rub (AHR) in specialised newborn care unit (SNCU) to improve hand hygiene in order to reduce neonatal sepsis and mortality at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur.

DESIGN: A prospective interventional and observational study.

METHODOLOGY: We formed a quality improvement (QI) team in our SNCU consisting of doctors, nurses, auxiliary staff and parents (a floating member) to improve proper use of AHR. To identify the barriers to the problem, we used fishbone analysis tool. The barriers which were not allowing the health providers to use AHR properly identified were amount of AHR in millilitres to be used per day per baby, how much and when the amount of AHR to be indented from the main store and what is the proper site to place the bottle. We used plan-do-study-act cycles to test and adapt solutions to these problems. Within 5-6 weeks of starting our project, AHR use increased from 44 mL to 92 mL per baby per day and this is sustained around 100 mL per baby per day for over 2 years now.

RESULTS: Significant decrease in neonatal mortality was observed (reduced from median of 41.0 between August 2016 and April 2018 to 24.0 between May 2018 and December 2019). The neonates discharged alive improved from 41.2 to 52.3 as a median percentage value. The percentage of babies who were referred out and went Left Against Medical Advice (LAMA) deceased too.

CONCLUSION: Multiple factors can lead to neonatal deaths, but the important factors are always contextual to facilities. QI methodology provides health workers with the skills to identify the major factors contributing to mortality and develop strategies to deal with them. Improving processes of care can lead to improved hand hygiene and saves lives.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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