Modern Maternity Hospital, Petlaburj is the largest maternity hospital in Telangana, with an average of twelve hundred deliveries every month. The Special Newborn Care Unit in the hospital has more than two hundred admissions in a month, most of whom are babies who are delivered in the hospital labor ward.
Dr. Anitha Sethi is head of the Special Newborn Care Unit in the hospital. Recently, she became worried about a rising number of cases of sepsis in the unit. Sepsis is a life threatening infection that is one of the leading causes of neonatal death. Despite limitations prevalent in the unit like shortage of staff and irregular supply of resources, she and her team wanted to figure out how to reduce cases of sepsis. When Safe Care, Saving Lives introduced the concept of quality improvement to Dr. Sethi, she was eager to take advantage of the opportunity to improve aseptic practices through quality improvement. The team was enthusiastic about using a Model for Improvement designed by Institute for Healthcare Improvement, which is part of the Safe Care, Saving Lives program.
Poor hand hygiene is a common cause of sepsis among newborns, as babies become infected when staff don’t use proper hand hygiene protocol. With the help of ACCESS Health, the newborn care unit staff set a goal of improving hand hygiene to reduce cases of sepsis. ACCESS Health helped the hospital audit their current hand hygiene practices. The data showed that there was only four percent compliance to proper hand hygiene. Dr. Sethi and her team set a goal of eighty percent compliance within the first six months of initiating the project. The team decided to start improving the practice in morning shift initially and then scale it up to the other shifts.
Mentors from ACCESS Health helped the staff brainstorm and develop ideas that could improve compliance, called “change ideas”. Once they had determined a set of new change ideas, they tested the impact the ideas could have.
While testing change ideas, Dr. Sethi and her team made sure all Special Newborn Care Unit staff understood the importance of hand hygiene There were workshops on hand hygiene led by Dr. Sethi and others, video demonstrations, and a poster campaign. The responsibility of auditing hand hygiene in the unit was taken up by the doctors and the nurses on the morning shift. They were regularly motivated and monitored by Dr. Sethi. The lab technicians, transporters and cleaning staff were given information about the importance of maintaining a hygienic environment in the unit. Wall mounted liquid soap solution dispensers were installed in the handwashing area and alcoholic rub solutions for hands were placed beside each newborn warmer. The team also came up with the idea of having fragmented newspaper sheets autoclaved and making them available at the handwashing area for easy wiping of wet hands.
The improvement process and output of each change idea being tested was closely observed by the team and was supervised by Dr. Sethi. The practices that proved successful were scaled up to the other shifts. Not all change ideas led to improvements in reducing cases of sepsis, but testing them before implementation enabled staff to study the feasibility of the idea and to understand the bottlenecks in implementation. In a span of three months, compliance to hand hygiene increased from four percent to fifty three percent.
In this journey of improvement, the mentoring team encouraged and motivated the quality improvement team by disclosing the percentage improvement in the process and by annotating interventions through statistical means and relating the improvement in process with the outcome of incidence of sepsis. A few nurses came forward and expressed their interest in interpreting data and displaying the improvement by means of charts in the unit to further inspire colleagues. The motivated staff trained other staff regarding the methodology of improvement and shared responsibility for the program with others to give newcomers to the program an increased sense of ownership of the program.
Dr. Sethi conveyed her sense of satisfaction and relief to the ACCESS Health team, not just for improving hand hygiene compliance, but also for changing the behavior of her staff. The quality improvement team at the Petlaburj Maternity Hospital strongly believes that the concept of quality is not extrinsic, in fact it is the most primary and integral component in every clinical practice. Despite inadequate resources and a heavy workload, the doctors and nurses have managed to inculcate quality in their daily clinical practices and today, just a few months on, the unit is already seeing success.