Addis Ababa university, school of medicine, Addis Ababa, Ethiopia
Title: Improvement of infection prevention standards compliance at Tikur Anbessa Hospital- a quality improvement project [Type the document subtitle]
Aklilu Azazh MD
11 Introduction
Addis Ababa university has a university hospital, namely Tikur Anbessa, where emergency department was established 2 years ago for service delivery and academic programmes.The university specifically the medical school has partnership with American international health alliance/HIV- AIDS Twining center on capacity building of staff to support HIV-AIDS patients through USAID and CDC support. Through the twining center the emergency department is twinned with university of Wisconsin emergency department.
Tikur Anbessa hospital has IP policy and there is infection prevention committee which plays advisory role in where department of sanitation and health promotion follows day to day activities. In the quarterly surveillance an emergency department(ED) scored 33% which was alarmingly low level figure.
Therefore in a quality improvement project supported by university of Wisconsin and the twining center this area was selected as key and important area to reduce transmission of both HIV AIDS and other communicable problems.
Objective
To improve infection prevention standard compliance from the existing 33% to 70% within 6 months period.
Indicators
General indicator is the hospital IP score.Specific indicators were derived from scores in the following areas: Hand hygiene set up, ED Environment setup, Waste disposal systems, Sharps care systems, equipment Decontamination, equipment sterilization and linen care.
Methodologies and strategies
After the problem of low compliance in infection prevention standards was identified the root cause analysis was performed using the fish bone method. Among the main causes of the problems priority was set for
2 feasible elements and discussion was made with stakeholders to build awareness. After incorporating opinions of stakeholders strategy was redesigned and surveillance questioners validated. Surveillance was done by the infection prevention team of the hospital in July 2010 as a baseline and September and December, 2010 and March 2011 in the implementation phase. The technique of surveillance is mostly observational on the infection prevention setup of the emergency department while there are also interview questions to the head nurse. Then all points scored were added and changed in to percentage in line with federal ministry of health reporting standard.
Hand hygiene set up(8 points), Environment/House keeping(19) , Waste disposal(3), Waste disposal(6), Sharps care(3), Decontamination(3), Sterilization(3),Linen(Laundry)(3points) all scores being 45.
Key strategies
1. Stakeholders meeting and awareness creation
We selected all important stakeholders like the hospital leadership,
emergency department staff nurses, the hospital Infection Prevention
committee, the hospital Quality Assurance staff, the hospital finance
and property departiment,the Guards and cleaners.
2. Leadership and commitment
The head nurse made responsible as a focal person for infection
prevention in the ED. One motivated cleaner was also assigned to undertake some activities which are crucial like decontamination of equipments, sharp safety box allocation, and distribution of hand antiseptics. The cleaners and clean team activities were harmonized and there was a daily morning round of ED environment to see any unsafe situation was started.
3. Resources and Environment
Stakeholders have worked together in improving the environment and resources of ED.The hospital had set the hand washing sinks and
3 designed additional windows for ventilation while AIHA /Twining center supplied with liquid soaps and antiseptic hand rubs.
4. Periodic surveillance was conducted by the hospital Infection prevention team and the feedback was given to the ED staff.
The Results
1. Pre Quality improvement project implementation period
The first infection prevention surveillance was done at October 2009, in which the score obtained was 33%. There were two other surveillances done in February 2010 which was 57% and in August 2010, just before implementation and the score was 37 %( figure 1)
2. After implementation was started surveillance was done at september2010, December 2010, and March 2011 and the results were 57%, 69% and 89% respectively.(Figure 2)
Figure 1-Pre implementation graph showing the IP standard compliance.
4 Figure 2-Implimentation period graph.(The July preimplimentation baseline is included for comparison).
3. Results on specific domains infection prevention settings (Table 1)
IP standard compliance Surveillance 1 Surveillance 2 Surveillance 3 Surveillance 4 of ED. (July 2010) (September 2010) (December 2010) (March 2011)
Hand hygiene set up 12.5(1/8) 37.5(3/8) 12.5(1/8) 87(7/8)
Environment/House 26(5/19) 58(11/19) 31.5(6/19) 89(17/19) keeping
Waste disposal 0(0/3) (0/3) 0(0/3) 66(2/3)
Sharps care 50(3/6) 83(5/6) 50(3/6) 100(6/6)
Decontamination 66(2/3) 100(3/3) 66(2/3) 100(3/3)
Sterilization 0(0/3) 100(3/3) 66(2/3) 100(3/3)
Linen(Laundry) 66(2/3) 33(1/3) 100(3/3) 66(2/3)
5 The impact
Quality improvement and infection prevention are new concepts in Ethiopia. These approaches can be replicated in other important fields for problem solving. The improvement of infection prevention setup in emergency department has been exemplary in the hospital and the lesson is being used by other department and units. Moreover in the same way attempts for change can be done in other hospitals in Ethiopia.
The way foreword
The way forward is bringing behavioral change among staff. There is better setup and awareness creation in infection prevention the staff shall be motivated to practice standard precaution principles. This could not be done in this quality improvement projects in the six months period as the setup was not ideal.
Acknowledgements
1. The CDC Ethiopia for the financial support
2. American international health Alliance/Twining center for the partnership
works.
3. The University of Wisconsin, particularly, Lori DiPrete-Brown, Roman Aydiko
for their mentorship on the quality improvement course and tool development.
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