Clean Care is Safer Care

Case study

Indira Gandhi ESI Hospital, Delhi, India

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Submitted by:

Dr Madhurika Agrawal
Indira Gandhi ESI Hospital,

What type of health-care facility or organization are you?

Indira Gandhi Employees’ State Insurance Hospital is a 250 bedded Secondary level health care facility in Delhi, catering to insured laborers and their dependent families under the ESI Act under the Ministry of Labor. It is well equipped and staffed with qualified faculty to run the out patient and in-patient facilities for multiple specialties. There is good diagnostic, including laboratory, services. Support services such as waste management, laundry etc also function well. Ayurveda and yoga services are also provided.

What was the situation at your facility with respect to hand hygiene and HAI before you initiated the hand hygiene initiatives?

Almost 3 years ago, it was noticed that the HAI rates in post operative patients had increased. Cultures taken from various environmental areas related to patient care were positive for nosocomial pathogens. This led us to reform our strategy for HAI and universal precautions. An infection control committee and a biomedical waste management committee were constituted consisting of relevant clinical, para clinical, administrative and other support staff. Guidelines, general and specific to various areas of the hospital were designed and reviewed regularly along with strict compliance to personal protective equipment and pre and post exposure prophylaxis for all staff. Many educational and hands on training workshops were conducted to emphasize these issues and its bearing on the over all expenses to our organization. Hand hygiene was stressed upon in each training as well as routine monitoring of health care workers compliance with recommendations. Alcohol hand rubs was made available.

What were the goals of your initiative?

  • To reduce the rate of preventable Hospital Acquired Infections and associated morbidity.
  • To minimize the average length of hospital stay and bed cost incurred per patient
  • To improve compliance with hand hygiene practices among health care workers
  • To educate patients

What actions have you planned or already put in place to improve hand hygiene at your facility?

  • Reeducating health care workers by demonstrations and corrections by observers.
  • Display of WHO posters on the technique for performing hand hygiene and 'my 5 moments' of hand hygiene at all work stations
  • Minimizing the use of all types of catheters and IV cannula

Did you encounter any particular problems while planning and implementing your strategy?

The first and foremost barrier is the cost of procurement of alcohol based rubs for every key area and also continuous water supply. After initial resistance we were able to procure hand rubs for most of the key areas and also apply for additional water supply connections. But the toughest task is to bring about the attitudinal change in every body, which we are working on still. This is the real test for us.

What were the outcomes of your initiatives?

Changes in hand hygiene practices will be quantified soon. There are fewer post operative infections as indicated by the fewer cultures being sent from the post operative wards. Minimizing the use of all types of catheters has reduced opportunities to err. Reduced cost and quantity of procurement of higher antibiotics is observed. Reduced hospital stay is also evident. Reviews of patient satisfaction reports show that our initiatives are appreciated.

What were your key learning points?

Once we start quantifying our results, we could share this with all. At present, HCW who practice hand hygiene are ill at ease while performing it since they are uncertain of their peers approval and are concerned whether they will be blamed for wasting time performing hand hygiene as recommended The store manager has started questioning the increased demand for alcohol based hand rubs from various departments especially from the Department of Emergency Medicine. Comments such as 'we have started teaching our family members the right technique to hand wash' from the health care providers, is really motivating.

What are your future directions?

Our future plan is to continue the practice in a more methodical and stepwise way as proposed by WHO and quantify our results. We intend to share our experiences with WHO and other health bodies. We aspire to get a 'hand hygiene compliant hospital' accreditation too.

Additional comments

We wish to get all the notifications related to this subject along with the print and electronic instruments from WHO.