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Joseph J S. Quality Improvement Interventions to Sustain Hand Rub Compliance in Neonatal Care. JCCNC 2026; 12 (3) :297-306
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 newborns are highly vulnerable. Although hand rub is quick, easy to use, and requires minimal resources, many healthcare facilities still practice it inconsistently. The study aimed to improve and sustain hand hygiene compliance by enhancing AHR use through a multi-stakeholder quality improvement (QI) approach to reduce neonatal sepsis in a special neonatal care unit at a tertiary government children’s hospital in Chennai, India.
Methods: This prospective, interventional QI study used multi-stakeholder engagement and plan-do-study-act (PDSA) cycles. Using the WHO point-of-care QI (POCQI) model, a multi-stakeholder QI team, including doctors, nurses, health workers, and mothers, identified barriers to hand rub use. The study was conducted using fishbone analysis and 6 implemented weekly PDSA cycles in 2017. Contextual and low-cost interventions included fixing measuring tapes on AHR bottles to monitor use, placing fixed bedside holders for easy access, displaying IEC (information, education, and communication) posters and signboards in the 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, we developed a Pareto chart. Data were analyzed using SPSS software, 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 6 weeks (β=+7.44 mL/baby/d/wk; R²=0.983). The high F-statistic (288.4) and P<0.001 confirmed the improvement was statistically significant and aligned with the upward shift 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, contextually relevant interventions, when implemented through a participatory, multi-stakeholder approach, can sustain hand hygiene improvement in neonatal settings. This model shows that sustainability in infection prevention depends not on complex technology but on shared ownership, continuous feedback, and practical design.