Using quality improvement to reduce hospital-acquired infections: Evaluation of the USAID ASSIST Project in the West Bank

The project was launched in 2017, in partnership with the Ministry of Health (MOH) officials, infection and prevention control specialists, and infectious disease specialists. The collaborative involved 22 participating hospitals and experts, with the goal of establishing reliable processes for infection control and prevention. The project focused on improving transmission-based precautions, hand hygiene, environmental cleaning, and screening processes. The collaborative activities included training programs, workshops, and regular meetings to share best practices and lessons learned. The participating hospitals and experts also used quality improvement methods and tools, such as the Model for Understanding Success in Quality (MUSIQ) and the Plan-Do-Study-Act (PDSA) cycle, to identify and address gaps in their infection control processes. The results of the project showed significant improvements in process and outcome measures. The transmission-based precautions improved from 60% to 90% compliance, and hand hygiene compliance increased from 70% to 95%. The environmental cleaning process also showed significant improvements, with a 30% reduction in environmental cleaning errors. The screening process for HAIs also improved, with a 25% increase in the number of patients screened. The project also evaluated the improvement capability of the participating hospitals and experts. The results showed that the improvement capability increased significantly over the 9-month collaborative, with a 50% increase in the number of hospitals that reported using quality improvement methods and tools. The participants also reported a significant increase in their confidence in their ability to identify and address gaps in their infection control processes. The project faced several barriers and enablers to progress, including the lack of standardized infection prevention and control processes and systems, limited resources, and competing priorities. However, the collaborative activities and quality improvement methods and tools helped to overcome these barriers and enable the participating hospitals and experts to make significant improvements in their infection control processes. The project's findings and recommendations are relevant to the Palestinian Territories and other countries facing similar challenges in reducing HAIs. The project's success demonstrates the importance of a collaborative approach to quality improvement, with a focus on building the capacity of healthcare providers to identify and address gaps in their infection control processes. The project's results are presented in several figures and tables, including Figure 1, which shows the primary drivers of reducing HAIs, and Figure 2, which shows the timeline of project events. The results also include data on the improvement in transmission-based precautions, hand hygiene compliance, environmental cleaning process, and screening process for HAIs. The project's evaluation aimed to assess the impact of the quality improvement collaborative on process and outcome measures, improvement capability, and participant experience. The evaluation used a mixed-methods approach, combining quantitative and qualitative data collection and analysis methods. The results of the evaluation provide valuable insights into the effectiveness of the quality improvement collaborative and the factors that contributed to its success. The project's findings and recommendations have implications for the development of a long-term strategy for reducing HAIs in the Palestinian Territories. The project's success demonstrates the importance of a collaborative approach to quality improvement, with a focus on building the capacity of healthcare providers to identify and address gaps in their infection control processes.