Evaluation of the Safe Care, Saving Lives (SCSL) quality improvement collaborative for neonatal health in Telangana and Andhra Pradesh, India: a study protocol

Hanson, Claudia; Zamboni, Karen; Prabhakar, Vikrant; Sudke, Ajit Kisanrao; Shukla, Rajan; Tyagi, Mukta; Singh, Samiksha; Schellenberg, Joanna

doi:10.1080/16549716.2019.1581466

Cited by 7 publications

(14 citation statements)

References 41 publications

(45 reference statements)

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“…In a 2016 study from Rajasthan where primary health care facilities were also included, the hand hygiene compliance during childbirth was 2% in 240 observed cases at baseline [25] which is very low in comparison to our study (34%) that included only secondary and tertiary level facilities. Poor hand hygiene adherence has long been a concern not only in low [17,20,21,25] but also in high resource settings across the globe [8,26] . Hand hygiene compliance is reported as ranging from 8 to 39% in Sub-Saharan African countries [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

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Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

et al. 2018

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BackgroundHand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems.MethodsWe conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization’s concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate.ResultsWe included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility.ConclusionObserved compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units.Trial registrationRetrospectively registered with Clinical Trials Registry- India (CTRI/2018/04/013014).Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6219-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Low load newborn care units have < 35 average admissions per month, medium between 36 and 110 and high load being > 110 admissions per month. Low load labour room facilities have < 67 deliveries per month, medium 67-167 and high load > 167 average deliveries per month [17].…”

Section: Types Of Facilitiesmentioning

confidence: 99%

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

et al. 2018

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“…We used a quasi-experimental plausibility design with a nested process evaluation, details of which are presented elsewhere [ 12 ]. The intervention targeted all 85 hospitals that were empanelled in the health insurance schemes, through a phased intervention roll-out organised in three waves (see Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…In this approach, teams from multiple hospitals work together to improve implementation of evidence-based practices (EBPs), in this case EBPs for intrapartum and newborn care. Twenty EBPs were identified by neonatologists and obstetricians, addressing the three main drivers of neonatal survival through: (1) neonatal sepsis prevention and management, (2) prevention and management of complications from prematurity and (3) reliable intrapartum care and newborn resuscitation [ 12 ]. Teams were supported by quality improvement coaches to use rapid cycle tests of change to achieve a given improvement aim and attend “learning sessions” to share improvement ideas, experience and data on performance [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

et al. 2021

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Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

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“…The evaluation protocol is described in detail elsewhere [35]. Here, we use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting (S1 STROBE Checklist).…”

Section: Methodsmentioning

confidence: 99%

Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

et al. 2019

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Background The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh—2 Indian states with a respective population of 35 and 50 million. Methods and findings We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%–62%, p -value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%–8%), 15% (9%–24%), 4% (2%–8%) and 2% (1%–5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%–18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. Conclusions Our findings suggest differences in quality of neonatal intensive care and 28-day su...

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Evaluation of the Safe Care, Saving Lives (SCSL) quality improvement collaborative for neonatal health in Telangana and Andhra Pradesh, India: a study protocol

Cited by 7 publications

References 41 publications

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

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