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JOSEPH J S. Quality Improvement Interventions to Sustain Hand Rub Compliance in Neonatal Care. JCCNC 2026; 12 (3)
URL: http://jccnc.iums.ac.ir/article-1-1018-en.html

Background: Hand hygiene using alcohol-based hand rub (AHR) is one of the simplest, most cost-effective interventions for preventing healthcare-associated infections, especially in neonatal intensive care settings where new-borns are highly vulnerable. Although hand rub is quick, easy to use, and requires minimal resources, its optimal and consistent practice remains suboptimal in many healthcare facilities. The study aimed to improve and sustain hand hygiene compliance through enhanced use of alcohol-based hand rub (AHR) using a multi-stakeholder quality improvement approach to reduce neonatal sepsis in a special neonatal care unit at a tertiary government children's hospital in Chennai India.
Methods: It was a prospective, interventional quality improvement (QI) study employing multi-stakeholder engagement and Plan–Do–Study–Act (PDSA) cycles. Using the WHO Point-of-Care Quality Improvement (POCQI) Model, a multi-stakeholder QI team including doctors, nurses, health workers, and mothers identified barriers to hand rub. The study was conducted using fishbone analysis and six implemented weekly PDSA cycles in 2017. Contextual and low-cost interventions included: fixing measuring tapes on AHR bottles to monitor usage, placing fixed bedside holders for easy access, displaying IEC (Information Education Communication) posters and sign boards in regional language to reinforce awareness and involving mothers in daily practice reinforcement. A run chart tracked average AHR use per baby per day. To prioritize the most influential contributors, a Pareto chart was developed. Data were analyzed using SPSS version 23. Regression analysis assessed trends in AHR use, the F-statistic evaluated intervention effects, and descriptive statistics were used to generate Pareto charts.
Results: Regression analysis showed a significant upward trend in AHR use over six weeks (β = +7.44 mL/baby/day per week; R² = 0.983). The high F-statistic (288.4) and p < 0.001 confirmed that the observed improvement was statistically significant and aligned with the upward shift seen in the run chart toward the target level. Simplified SOPs (Standard Operating Procedures), defined staff responsibilities, and periodic recognition ensured continued adherence and ownership.
Conclusion: Simple, low-cost, and contextually relevant interventions when implemented through a participatory, multi-stakeholder approach can sustain hand hygiene improvement in neonatal settings. This model demonstrates that sustainability in infection prevention does not depend on complex technology but on shared ownership, continuous feedback, and practical design.