Quality improvement initiative to improve safe injection practices by nurses in labour room of a tertiary care centre, India

Safe injection practices (SIP) are a set of measures intended to prevent transmission of infectious disease between one patient and another, and between a patient and healthcare provider during the preparation and administration of injectable medications. Unsafe injection practices put both the patient and healthcare personnel at risk of infection.SIP involves administration of rational injection by a qualified and well-trained person using a sterile device (syringe, needle, etc), adopting sterile technique and discarding the used devices in a puncture-proof, specially designed container for appropriate disposal. Any breach in the process makes the injections unsafe and hazardous to patients and healthcare workers (HCWs).To implement SIP, the quality improvement team in the labour room initiated an improvement process with the aim of increasing the percentage of compliance with SIP from the existing 20%-80% within 6 weeks from 6 February to 21 March 2024. The team followed Point of Care Quality Improvement methodology to improve the compliance with SIP.The team developed a 15-point practice observation checklist aligned with WHO and Center for Disease Control (CDC) guidelines. This checklist outlined the steps involved in SIP and used to directly observe the process of preparing and administering injections for adherence to SIP. Each item was scored '1' if performed correctly and '0' if not in the checklist. The compliance was calculated in percentage for data analysis and plotted on a time series chart.The team tested a total of 12 plan-do-study-act to achieve the desired aim (80%). The median compliance rate rose to 87% in the first half of the sustenance phase, which came down to 67% in the later part highlighting the challenges in demand-supply chain of resources and attitude shift among HCWs in maintaining SIP. The lessons learnt are generalisable and can be replicated in similar settings.