# Assessing and Enhancing Adherence to the Standard Aseptic Non-touch Technique in Peripheral Intravenous Cannulation: A Quality Improvement Project in a Resource-Constrained Neonatal Intensive Care Unit

## TL;DR

This study shows that training and education significantly improve adherence to aseptic techniques during IV cannulation in a neonatal ICU in Pakistan.

## Contribution

The study demonstrates the effectiveness of structured educational interventions in improving aseptic technique compliance in a resource-limited setting.

## Key findings

- Compliance with aseptic non-touch technique increased from 66% to 94% after two educational intervention cycles.
- Hand hygiene adherence improved from 50% to 84%, and tray cleaning practices increased from 64% to 87%.
- Targeted training and frequent assessments led to a substantial and sustained improvement in aseptic practices.

## Abstract

Background

Neonatal sepsis remains a critical concern in neonatal care, contributing significantly to morbidity and mortality. Aseptic techniques prevent infections during invasive procedures such as peripheral intravenous (IV) cannulation, particularly the aseptic non-touch technique (ANTT). The purpose of this study was to assess the baseline level of ANTT adherence among medical personnel and to analyze the effect of a structured educational intervention on compliance rates. The implementation of ANTT is based on the premise that having a standard framework and ensuring its compliance will decrease infection rates and consequently improve health care, especially in the resource-constrained setups of low- and middle-income countries (LMICs)

Objectives

The primary goal of this quality improvement project (QIP) is to assess baseline adherence to the ANTT during peripheral IV cannulation and evaluate improvement following a structured educational intervention using two Plan-Do-Study-Act (PDSA) cycles in the Neonatal Intensive Care Unit (NICU) at the Combined Military Hospital, Multan, Pakistan.

Methods

This QIP comprised two PDSA cycles to improve compliance with ANTT guidelines. Baseline data on adherence to aseptic practices were collected using a QI Surveillance Proforma to measure compliance. A structured educational intervention, which included presentations, video demonstrations, hands-on training, and competency assessments, was implemented over four months to improve compliance. The target audience included the NICU staff and nursing cadets. Compliance rates were measured post-intervention in both cycles using the same standardized checklist evaluating key aseptic practices.

Results

The compliance rates for peripheral IV cannulation were initially 66%. However, the analysis post-intervention showed a significant increase in compliance, with 89% median compliance after the first PDSA cycle and 94% after the second cycle. We saw that hand hygiene improved its adherence rates from 50% to 84%, while tray cleaning practices also improved from 64% to 87%. The overall adherence rate for peripheral IV cannulation showed an increase in rates to 92%. That is a huge improvement and shows targeted educational strategies can have a substantial impact.

Conclusion

This QIP highlights that carefully planned educational interventions, training, and hands-on practice can have on NICU healthcare providers' adherence to aseptic procedures. We found that frequent skills assessments with uncomplicated, easy-to-remember procedures can ensure that our system operates near maximum efficiency.