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  • Quality Improvement Article
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Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India

Journal of Perinatology volume 41, pages 2834–2839 (2021)Cite this article

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A Correction to this article was published on 13 October 2021

This article has been updated

Abstract

Objective

We evaluated effect of sequentially introducing four WHO-recommended interventions to promote hand-hygiene compliance in tertiary-care NICU.

Study design

Four dedicated research nurses directly observed doctors and nurses to record success in hand-hygiene opportunities at randomly selected NICU beds and randomly sampled time-slots in four phases (of 4-weeks each): I-Baseline, II-Self-directed learning; III-Participatory learning; IV-Closed-Circuit Television (CCTV); and V-CCTV-plus (with feedback).

Findings

Hand-hygiene compliance changed from 61.8% (baseline) to 77% (end) with overall relative change: 24.6% (95% CI 18, 32; p value= 0.003); compared with preceding phase, relative changes of 21% (15, 28; <0.001), 4% (0, 8; 0.008), −10% (−13, −6; <0.001), and 10% (5, 15; <0.001) during phases II, III, IV, and V, respectively were observed. Rise in hand-hygiene compliance was higher for after-WHO-moments (12.7%; upto 2.5-folds for moment 5, <0.001) compared to before-WHO-moments (5.2%). Educational interventions, feedback and monitoring WHO moments can improve hand-hygiene compliance significantly among health-care providers in NICU.

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Fig. 1: Study flow.

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Acknowledgements

We are grateful to the dedicated team of research nurses- (in alphabetical order) Anjali Thareja, Annie George, Joshmi and Sreemol Sarasan—for providing immense support in collecting the hand hygeine compliance data. We are thankful to NHKC and DeNIS teams under Division of Neonatology including Mr SS Suresh for assistance in designing the datasheets for the study, and Mr Sant Lal for CCTV camera installation and its smooth functioning. We are obliged to Indian Council of Medical Research (ICMR) led by Dr Reeta Rasaily who allowed us to conduct the study on the Centre for Advanced Research (CAR) platform and guided the study implementation. We are thankful also to the team of resident doctors, and staff nurses who participated in the study.

Funding

Indian Council of Medical Research.

Author information

Author notes

  1. These authors contributed equally: Shridhar Gopalakrishnan, Suman Chaurasia.

Authors and Affiliations

  1. Department of Pediatrics, Armed Forces Medical College (AFMC), Pune, 411040, India

    Shridhar Gopalakrishnan

  2. Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Dehradun, 249203, Uttarakhand, India

    Suman Chaurasia

  3. Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    M. J. Sankar & R. Agarwal

  4. Department of Pediatrics, AIIMS, New Delhi, India

    V. K. Paul

  5. WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    A. K. Deorari & M. Joshi

Authors
  1. Shridhar Gopalakrishnan
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  2. Suman Chaurasia
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  3. M. J. Sankar
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  4. V. K. Paul
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  5. A. K. Deorari
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  6. M. Joshi
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  7. R. Agarwal
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Contributions

RA, SG, MJS, and SC conceptualized, designed and implemented the study with critical intellectual inputs from AKD, MJ and VKP. MJS, SG, and SC acquired and analyzed the data and all authors reviewed the results, participating extensively in interpretation of data. SG and SC wrote the first draft of the study; all authors were involved in revising the manuscript and gave vital inputs to complete the final version. All authors approve the final manuscript and confirm accuracy and integrity of its contents.

Corresponding authors

Correspondence to Suman Chaurasia or M. J. Sankar.

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Competing interests

The authors declare no competing interests.

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The original online version of this article was revised: The specification "These authors contributed equally" was corrected.

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Gopalakrishnan, S., Chaurasia, S., Sankar, M.J. et al. Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol 41, 2834–2839 (2021). https://doi.org/10.1038/s41372-021-01141-3

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  • DOI: https://doi.org/10.1038/s41372-021-01141-3

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