Newborns in resource-constrained developing countries are 3 to 20 times more likely to acquire Healthcare-associated infections (HCAIs) than those in developed countries. The major methods to reduce the burden of HCAIs include improvements in reporting and surveillance systems, identification of local determinants of infection, implementation of standard precautions and use of care bundles, with particular attention to aseptic techniques, and improving staff education, competency and skills.
Sick and preterm neonates undergo significant instrumentation during their hospital stay, which predisposes them to acquire HCAIs. Failure to use fastidious aseptic techniques during instrumentation and procedures, which involve breaches in skin and mucosal barriers leads to HCAIs. Devices and procedures are considered two of the most important risk factors for HCAIs. Aseptic Non-Touch Technique (ANTT) based on a set of well-defined principles, aims to standardize common procedures by maintaining an aseptic field and protecting Key parts and Key sites from touch with potentially contaminated hands and items. Although evidence based interventions to decrease HCAIs are well described, there exists a significant gap between theory and practices. This results in wide variations in patient care practices with regard to aseptic techniques.
In this quality improvement project, we aimed to standardize and improve compliance to aseptic non-touch techniques by developing and implementing SOPs for the most frequently performed invasive procedures in neonates and to study the change in incidence of HCAIs with improvement in compliance.
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This special issue of Indian Pediatrics (September 2018; Volume 55: Number 9) highlights mechanisms that can support health care providers in using various quality improvement (QI) approaches and showcases some of the improvement projects undertaken in India by different teams.
The USAID ASSIST Project started working in India in September 2013; initially working directly with districts and facilities to help them learn how to use QI approaches to save lives. This work went well and the staff in these facilities were able to reduce perinatal mortality by 15% over 18 months. During this time, we met great partners from important organizations and institutions across India.
These institutions are now leading a growing movement to help more people apply QI methods to deliver care that prevents harm, improves outcomes, and meets the needs of the people receiving it through their own networks using domestic funding; continuing these lifesaving efforts after ASSIST technical support has ended.
The supplement shows important results of the ongoing QI work in these networks and shows how domestic QI networks, earlier supported by ASSIST, are now independently supporting and spreading the use of QI methods to provide better care.