Decreasing Central Line-associated Bloodstream Infections through Quality Improvement Initiative

Objectives: To study the impact of a quality improvement (QI)initiative using care bundle approach on Central-line associatedbloodstream infections (CLABSI) rates.Methods: A QI team for infection control in NICU was formed in atertiary-care neonatal intensive care unit (NICU) from June 2015to August 2016. Baseline data were collected over first 3 monthsfollowed by the intervention period of 1 year. Measures withrespect to strengthening hand hygiene and central line bundlecare were implemented during the intervention period. Auditsassessing the compliance to hand hygiene and CLABSI bundleprotocols were used as process indicators. Multiple PDSA cycleswere used to strengthen the practices of proposed interventions,documentation of data and audits of the processes during thestudy period.Results: The QI initiative achieved a 89% reduction in CLABSIfrom the baseline rate of 31.7 to 3.5 per 1000 line-days. The bloodstream Infections reduced from 7.3 to 2.3 per 1000 patient-days.The overall mortality showed a reduction from 2.9% to 1.7 %during the intervention period. There was a significantimprovement in compliance with hand hygiene protocol andcompliance with CLABSI protocols.Conclusion: This study demonstrated that simple measuresinvolving hand hygiene and strengthening of the care bundleapproach through quality improvement could significantly reducethe blood stream Infections and CLABSI rates

novel single-stage procedure for increasing the width of attached gingival and eliminating the aberrant frenal attachment

Common treatment for buccal gingival recession caused by an aberrant frenal attachment includes elimination of the frenum and treatment of the gingival recession by soft tissue graft to increase the width of the attached gingiva that in turn results in root coverage. Keratinised gingival, if present in adequate amount, maintains the gingival health by protecting the marginal gingiva. This not only considers the desires of the patient but also explores the potential regenerative capacity of the tissues. This report describes a novel single-stage procedure for increasing the width of the attached gingiva and eliminating the aberrant frenal attachment