Reducing the rate of central line-associated bloodstream infections; a quality improvement project.

BACKGROUND: The burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital. METHODS: This was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions. RESULTS: There were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252). CONCLUSIONS: Improvement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.

Role of hospital leadership in pandemic preparedness: experience at a tertiary hospital in Kenya during the COVID-19 pandemic.

INTRODUCTION: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis. OBJECTIVES AND METHODS: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-for-profit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, protocols, brochures and flyers. We evaluated and described pandemic preparedness at the hospital under four main themes: (a) leadership, governance and incident management structures; (b) coordination and partnerships; (c) communication strategies; and (d) framework to resolve ethical dilemmas. RESULTS: The hospital expeditiously established three emergency governance structures, namely a task force, an operations team and an implementation team, to direct and implement evidence-based preparedness strategies. Leveraging on partners, the hospital ensured that risk analyses and decisions made: (1) were based on evidence and in line with the national and global guidelines, (2) were supported by community leaders and (3) expedite financing for urgent hospital activities. Communication strategies were put in place to ensure harmonised COVID-19 messaging to the hospital staff, patients, visitors and the public to minimise misinformation or disinformation. An ethical framework was also established to build trust and transparency among the hospital leadership, staff and patients. CONCLUSION: The establishment of a hospital leadership structure is crucial for efficient and effective implementation of pandemic preparedness and response strategies which are evidence based, well resourced and ethical. The role of leadership discussed is applicable to healthcare facilities across low and middle-income countries to develop contextualised pandemic preparedness plans.

Informing healthcare operations with integrated pathology, clinical, and epidemiology data: Lessons from a single institution in Kenya during COVID-19 waves.

Pathology, clinical care teams, and public health experts often operate in silos. We hypothesized that large data sets from laboratories when integrated with other healthcare data can provide evidence that can be used to optimize planning for healthcare needs, often driven by health-seeking or delivery behavior. From the hospital information system, we extracted raw data from tests performed from 2019 to 2021, prescription drug usage, and admission patterns from pharmacy and nursing departments during the COVID-19 pandemic in Kenya (March 2020 to December 2021). Proportions and rates were calculated. Regression models were created, and a t-test for differences between means was applied for monthly or yearly clustered data compared to pre-COVID-19 data. Tests for malaria parasite, Mycobacterium tuberculosis, rifampicin resistance, blood group, blood count, and histology showed a statistically significant decrease in 2020, followed by a partial recovery in 2021. This pattern was attributed to restrictions implemented to control the spread of COVID-19. On the contrary, D-dimer, fibrinogen, CRP, and HbA1c showed a statistically significant increase (p-value <0.001). This pattern was attributed to increased utilization related to the clinical management of COVID-19. Prescription drug utilization revealed a non-linear relationship to the COVID-19 positivity rate. The results from this study reveal the expected scenario in the event of similar outbreaks. They also reveal the need for increased efforts at diabetes and cancer screening, follow-up of HIV, and tuberculosis patients. To realize a broader healthcare impact, pathology departments in Africa should invest in integrated data analytics, for non-communicable diseases as well.

Preadmission testing for COVID-19 as a screening strategy: a retrospective chart review from a tertiary hospital in Kenya.

Background: Since COVID-19 was declared a pandemic in March 2020, hospitals and patient care facilities have faced challenges in protecting healthcare workers and patients from being exposed to the infection. The main challenge has been how exposure to COVID-19 can be controlled when asymptomatic patientscan transmit the infection. This study aims to evaluate pre-admission testing of COVID-19 in patients at the Aga Khan University Hospital, Nairobi as a screening strategy for understanding, preventing and controlling exposure to COVID-19. Methods: This was a descriptive retrospective chart review study that analysed the incidence of COVID-19, incidental detection of laboratory-confirmed COVID-19 and effects on plan of care in patients prior to admission at the Aga Khan University Hospital from April to December 31, 2020. Demographic data, clinical characteristics, COVID-19 test report and plan of care were retrieved from patients medical records review. Results: A total of 8837 pre-admission tests were done between April 2020 and December 2020, with a COVID-19 prevalence rate of 10.9% (961/8837). Among the positive pre-admission tests, 14.3% were incidental positive results (138/961). Among the 138 incidental positive tests 21% (30) had their plan of care affected, 14.5% [20] had their care interventions delayed, 4.3% [6] had their hospital stay shortened, 1.4% [2] their hospital stay prolonged and 0.7% [1] had their care diagnostics delayed. Conclusion: While community spread of COVID-19 fluctuated during this period; depending on the level of compliance to infection control measures, pre-admission prevalence rates were increasing as the year progressed. Mandatory testing of COVID-19 in hospital facilities remains an important admission requirement in controlling asymptomatic transmission of the virus. COVID-19 health burden justifies resource allocation for universal screening of all patients before hospital admission.