Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
Leung SY
Affiliation :
Lai King Building, Princess Margaret Hospital
Introduction :
In May 2022, there was a clustering Candida Auris outbreak in R4N, total 50 positive HAI cases were identified. Apart from R5N ward, R4NA was converted to designated Candida Auris ward. 5 – 16% contamination rate of R4NA environmental samplings were being isolated.
Objectives :
1. To standardize and strengthen infection control workflow in LKB
2. To increase staff engagement
3. To monitor staff competent and evaluate the outcome
Methodology :
A. Minimize the risk of environmental contamination
1. Surveillance & Cohort:
˗ Segregate R4N into clean & cohort zone
- Designated team approach
2. Designated equipment, Colour coding and labelling
3. Enhance environmental cleansing efficacy
˗ Upgrade common used item
• Disposable bed cover and waterproof pillow
• Antimicrobial curtain – Fantex
- Enhance equipment & environmental cleansing schedule
• Improve ward environment by 5S
• Increase cleaning frequency to three times per day
• Perform weekly self UV florescent stain audit
• Use UVDI sanitizer by ward staff
- Installation of ceiling mount UV-C lighting to draw in and treat environmental air
B. Revamp 6 high risk high volume nursing procedures to align & adopt infection control practices in LKB
˗ Shower bath
˗ Napkin round
˗ NG tube feeding
˗ Open suctioning
˗ Wound dressing
˗ Empty urine bag
C. Enhance staff compliance on infection control measures
1. To ensure good personal hygiene of staff
˗ Change to working clothes to all LKB nursing staff
˗ Bare below elbow culture
˗ Keep staff changing room tidy and clean
2. Enhance daily patient care
˗ Group nursing tasks
- Buddy system among nurses / PCAs
- Perform cross ward audit on the 6 revamped nursing procedures
3. Staff engagement
˗ Designated Infection control patrol nurse to increase staff alertness and awareness
˗ Mutual reminding on hand hygiene and revised workflow
D. Patient management
˗ Regular patients screening and ward environmental sampling
˗ Decolonization program in R5N and R4NA
˗ Manuka Honey bath with oral Probiotic to R4NA patients
Result & Outcome :
Monitor Staff compliance and Evaluate outcome
1. HAI MDRO rate in LKB is improving
- HAI MDRO rate in LKB is on downwards trend from 3.45 (1Q 2021) to 1.96 (3Q 2022).
2. Candida Auris Environmental sampling by ICN in R4NA– Results were dramatically improved.
- R4NA environmental contamination rate was improving from over 15% in Mar 2022 to 0% in July 2022.
- From 26/7/2022 till now, 0% of contaminated rate are detected.
3. LKB Environmental Sampling result is improving from 23.49% in 1Q 2022 to 6.17% in 3Q 2022
4.Hand Hygiene Audit by ICT
- LKB staff hand hygiene compliance rate is improving from
88.96% in 3Q 2020 to 93.05% in 3Q 2022.
Outcome:
- From 05/07/2022, No HAI Candida Auris patient detected in LKB
- From 31/1/2023 onwards, total R4NA 28 candida auris patient are cleared
- LKB R5N ward support KWC Candida Auris patient management
