Impact of quality improvement process on healthcare-associated infection in the ICU in a tertiary care hospital in India

Introduction

Healthcare-associated infection (HCAI) has a significant contribution to mortality, morbidity and cost of treatment in critically ill patients. The objective of this study was to conduct a process (quality improvement) and outcome (pre and post implementation) surveillance, HCAI being taken as the major variable.

Methods

This was a prospective observational study carried out from June 2005 to September 2009. Process implementation was started from May 2006 and included compliance with hand hygiene, urinary catheter care, central line care and VAP bundle. HCAI rates were recorded prospectively every month from June 2005. We recorded the rates of central line-related bloodstream infection (CLI), catheter-associated urinary tract infection (UTI), hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) per 1,000 device-days as per CDC-NNIS definition [1, 2].

Results

Various infection rates showed numerical improvement after the implementation of the quality improvement (QI) process (Figure 1). The differences were statistically significant for two of these four endpoints (P for HAP = 0.029 and for UTI = 0.013) and in others there was a trend towards improvement. Device utilization rates associated with these endpoints before and after the implementation remained unchanged, confirming that the drop of infection rates was not influenced by any reduction/increase of respective device utilizations (Figure 1). The average compliance rate during the study period for hand hygiene was 77.92, for urinary catheter care 98.24, for central line care 96.62 and for VAP bundle 91.54.

Figure 1

Comparing mean infection rates before and after the quality improvement process.

Conclusions

Implementation and continuous surveillance of the QI process improved nosocomial HCAI in our hospital.