Effect of intensive training and education of health care workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital

BACKGROUND

The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; hemodialysis ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analyzed the effect of intensive training and education of health care workers (HCWs) on maintenance bundles for venous access devices.

METHODS

The study period comprising of preintervention phase (3-months) included 25 random visits to the intensive care unit for point observations regarding maintenance of all venous access devices in-situ in all intensive care unit patients on the day of the visit. The observations were categorized as appropriate or inappropriate practices based on American Society of Anesthesiologists (ASA) guidelines for CVC 2020, INICC guidelines for PIVC 2017, and Australian Commission on Safety and Quality in Health Care (ACQHCS) for PIVC and hemodialysis ports, December 2019. While the intervention phase (1-month) comprised intensive training and education of HCWs, postintervention phase 3 (3-months) included similar visits and point observations as during the preintervention phase.

RESULTS

The maintenance of PIVC improved significantly in terms of the condition of site (from 82.7% appropriate observations to 97.8%, P < .05); condition of connectors (45.7%-56.8%, P < .05), and any attached unused IV sets (90.5%-98.56%, P < .05). For CVC, there was significant improvement in condition of insertion site (66%-94%, P < .01); condition of connectors (0%-44.37%, P < .01); fixation (91%-99.3%, P < .05); any attached unused IV sets (38.9%-97.3%, P < .01) and knowledge of HCW (96.52%-100%, P = .05). For hemodialysis ports, no significant improvement was observed.

CONCLUSIONS

Intensive training and education of HCWs led to significant improvement in the maintenance bundle of care for PIVC and CVC.

Positive deviance in child malnutrition of urban poor of Mumbai, India: A longitudinal analysis

Background

Maharashtra has the largest share of urban population in India (13.5%) and is home to the largest slums. Malnutrition rates in these settlements are very high due to insufficient feeding, poverty, poor water quality and sanitation. The Foundation for Mother and Child Health (FMCH) has been working on reducing malnutrition in the urban slums of Mumbai for about 14 years now. Longitudinal data (2014-2019) collected by them was used in this analysis.

Objectives

To analyze the nutritional status of children before and after the intervention of FMCH and identify underlying factors associated with positive deviance in them.

Methods

NFHS-4 urban data of the lowest wealth quintile was used to analyze nutritional status of urban poor in India. Primary data of 4634 children (age 0-5) from the slums of Mumbai was analyzed for nutritional status during baseline and end line using ENA software. Descriptive statistical methods and binary logistic regression model were applied on selected 1583 cases using SPSS.

Results

Malnutrition rates in these children were lesser than national averages until 2 years of age. From baseline to end line, 48% reduction was observed in wasting within the first 6 months of age. Binary logistic regression reveals that age at registration (Odds ratio, OR = 0.94, p-value=0.04) and area of residence (p-value=0.00) are two most significant factors contributing to positive deviance in the child's nutritional status. Another univariate logistic regression on categorized breastfeeding score reveals that a higher score results in higher odds (OR = 1.561, p-value=0.01) of positive deviance in nutritional status of the child.

Conclusions

Since the strategy in each area is different, the most successful strategy is thus identified. The importance of early identification and intervention for effective tackling of malnutrition is highlighted through this analysis. Also, the role of effective breastfeeding techniques has emerged to be extremely significant.

Key messages

Impacting over 4000 children, the right nutrition in the first 1000 days and regular monitoring resulted in almost 50% reduction in wasting. Effective breastfeeding techniques were found to be extremely significant in the improvement of child's nutritional status.