Abstract
BackgroundEach year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal.MethodsA time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis.ResultsOne hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9–13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4–9.7).ConclusionsHealth workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing.Trial registrationISRCTN97846009. Date of Registration- 15 August 2012.
Highlights
Each year 700,000 infants die due to intrapartum-related complications
Health workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills
All 137 health workers included in this study participated in knowledge and skill evaluation before the Helping Babies Breathe (HBB) training, immediately after training and at 6 months after the training
Summary
We conducted this study in a tertiary hospital in Kathmandu, Nepal. In 2011, the hospital had around 22,000 deliveries, and an early neonatal mortality of nine per thousand live births [17]. The hospital has a system that rotates the staff of these units on a periodic basis This was a sub-set of a larger study conducted to evaluate the change in perinatal mortality before and after the implementation of a simplified neonatal resuscitation protocol, the HBB-QIC, in the hospital [18]. Successful completion of each OSCE required correct overall performance (≥80%), as well as the completion of key assessments and interventions such as “recognizes baby not breathing/crying” and “provides bag-and-mask ventilation” [9] Assessment using these tools was completed before the HBB training was provided, immediately after the training, and again at 6 months after completion of the training (Table 1). Information on each health worker’s daily routines, including daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation checklist usage, completion of the peer evaluation process, and attendance at the weekly review meetings was assessed using a direct observation checklist (Table 1)
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