Audits and educational interventions improve endotracheal suctioning practices in the paediatric intensive care unit

Background Artificial airway suctioning can cause transient adverse events such as desaturation, bleeding, and hemodynamic changes, as well as longer-term consequences, such as mucosal injury and hospital-acquired infections. Practicing safe suctioning is therefore essential to optimise therapeutic outcomes. Methods This prospective quality improvement project was conducted in the Paediatric Intensive Care Unit of a tertiary care hospital in South India, using the clinical audit framework. The aim was to assess and enhance compliance with evidence-based guidelines for endotracheal suctioning. Ten parameters essential for safe endotracheal suctioning were identified based on American Association of Respiratory Care (2022) guidelines and taking into consideration the departmental guidelines. A pro forma was used to document the suctioning practices as observed by visiting at different hours. The percentage compliance to set standards was calculated for each parameter. Post the first audit cycle, targeted interventions were implemented including sharing of structured learning modules with the critical care therapists, emphasising the importance of safe suctioning, as well as involving the Medical Gas Engineering Department to repair or replace the suction apparatus and pressure gauges found to be malfunctioning. A second audit cycle was conducted post-intervention and the results compared. Results Re-audit showed an increase in the compliance with use of appropriate negative pressure (<120 mmHg) during suctioning from 13% to 56%, and use of thumb control from 61% to 80%. There was a marginal increase in the number of beds with safe suction depth displayed at the bedside (70% to 72%). Conclusion The re-audit demonstrated an improvement in compliance with guidelines for safe suctioning, thus demonstrating that regular audits and educational interventions can positively influence clinical practice and contribute to improved patient care and safety. Sustaining these improvements may require periodic re-audits, continued on-boarding training for new staff and systemic support including timely maintenance of equipment.