Improvement of infection prevention standards compliance at Tikur Anbessa Hospital- a quality improvement project

 

Problem: 
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.
Intervention: 
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 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.
 

 

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.

 

Lessons: 
  • Committed leadership is key for to enhance support and bring changes.
·         Even limited resources could be adequate for basic IP care  if used properly.
·         Training and awareness creation of employee is essential in change of practice.
  • IP management needs a plan and monitoring and supervision.

 

Countries: 
Report Author(s): 
aklilu azazh,Lori DiPrete-Brown, Roman Aydiko
Organization(s): 
Addis Ababa University in Ethiopia American international health alliance/Twining center University of Wisconsin
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