Institution of an antibiotic stewardship programme for rationalising antibiotic usage: a quality improvement project in the NICU of a public teaching hospital in rural central India

Abstract

Antibiotic misuse is the most common cause of antimicrobial resistance—a globally declared emergency. This necessitates the introduction of rational antibiotic usage management policy. The paediatrics department of a public teaching hospital with around 500 neonatal intensive care unit (NICU) admissions annually revealed 75% of NICU admission exposure to any antibiotics. The aim was to institute antibiotic stewardship programme (ASP) to optimise antibiotic usage from existing 75% to 40% in a 6-month period through a quality improvement (QI) project.A root cause analysis using fishbone diagram was performed to identify the possible reasons for the high antibiotic usage. Six Plan-Do-Study-Act cycles were conducted to implement the protocols for usage of antibiotics for well-defined indications; active laboratory engagement to decrease the turnaround time for blood culture results; a hard stop to all antibiotic orders after 72 hours; streamlining of antibiotic usage; strengthening universal aseptic practices; and confidence building of staff. The outcomes monitored were antibiotic exposure rates, average number of antibiotic days in all NICU admissions, sepsis rates and mortality.Institution of ASP had significantly reduced antibiotic exposure in NICU admissions, that is, from 75% in March to 41% in August 2018. Median (IQR) antibiotic days per infant in NICU went down from 3 to 0 (0–6). The per cent of NICU admission with culture-positive sepsis and all-cause mortality rate in NICU declined from 18% to 11.56% and 25% to 16%, respectively, over these 6 months.Thus, ASP for rationalising antibiotic usage was successfully instituted in NICU of a rural medical college in central India through QI, without any adverse effect on sepsis and mortality.

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

“…These include reduced late-onset neonatal sepsis rates, 15 improved adherence to infection control practices 16 and enhanced team communication and collaboration across various health facilities. Other outcomes which have been reported and published in contemporary literature by members of the CoP are increasing adherence to the use of e-partograph, 17 improving donor human milk collection, 18 development of an antibiotic stewardship programme, 19 use of sucrose analgesia in NICU 20 and pre-identification of high-risk pregnancies. 21 These outcomes not only demonstrate the potential of the dCoP platform to drive meaningful change in clinical practice but also highlight the importance of nurturing a culture of continuous learning and improvement among healthcare professionals.…”

“…Pre-identification of high-risk pregnancies to improve triaging at the time of admission and management of complications in labour room: a quality improvement initiative 21 Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India 17 Paediatrics Institution of an antibiotic stewardship programme for rationalizing antibiotic usage: a quality improvement project in the NICU of a public teaching hospital in rural central India 19 Zero neonatal hypothermia around birth…”

Nosocomial Infections in Surgical Patients at a Central Academic Hospital in South Africa

“…The patients who are admitted to an ICU are also at heightened risk of development of nosocomial infection [9,10,16]. However, what influence the rate of occurrence of nosocomial infections the most is the overall length of hospital stay of the patients [12,17,18] and the effectiveness of antimicrobial stewardship program at a facility [9,[18][19][20].…”