Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India.

Julia Johnson,Aaron M Milstone,Elizabeth Colantuoni,Uday Rajput,Nandini Malshe,Asad Latif,Sanjay Lalwani,Yukari C Manabe,Aarti Kinikar,Umesh Vaidya,Bharat Randive,Melanie S Curless,Abhay Kadam,Vidya Mave,Sharad Agarkhedkar,Matthew L Robinson,Matthew Westercamp,Amita Gupta,Sudhir Malwade,Rachel M Smith,Tushar Parikh ,Susan Coffin

doi:10.3389/fped.2021.794637

Abstract

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

Highlights

METHODSAs facility-based births increase worldwide, low- and middleincome countries (LMIC) increasingly provide care for premature and sick neonates in neonatal intensive care units (NICUs) and special care nurseries [1]
Our objective was to assess the performance of Comprehensive Unit-based Safety Program (CUSP) in NICUs in an LMIC setting to guide infection prevention and control (IPC) improvement strategies, reduce healthcare-associated infections (HAI) risk in hospitalized neonates, and improve patient safety culture
We supplemented the Infection Control Assessment Tool (ICAT) with questions specific to neonatal care, such as the storage and preparation of breast milk and formula feeds, umbilical catheter insertion and maintenance, and isolette and radiant warmer cleaning and disinfection. After review of these assessments and discussions with key local stakeholders, we identified three focus areas for CUSP: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous (IV) fluid preparation and administration

Summary

Introduction

METHODSAs facility-based births increase worldwide, low- and middleincome countries (LMIC) increasingly provide care for premature and sick neonates in neonatal intensive care units (NICUs) and special care nurseries [1]. Poor infection prevention and control (IPC) practices augment this risk in many LMIC healthcare facilities [4]. The burden of HAI in hospitalized neonates in LMICs exceeds that of facilities in high-income settings [5]. The Comprehensive Unit-based Safety Program (CUSP) is a multimodal improvement strategy that has been successfully implemented to improve IPC practices. CUSP has been used to reduce risk of central line-associated bloodstream infections (CLABSIs) and other HAIs in a variety of healthcare settings and populations [11,12,13,14,15,16,17]. Our objective was to assess the performance of CUSP in NICUs in an LMIC setting to guide IPC improvement strategies, reduce HAI risk in hospitalized neonates, and improve patient safety culture

Methods

Results

Conclusion