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): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lee SH(1), Ho LF(1), Au CP(1), Keung HH(1), Ho NY(1), Cheng YL(1), Lee WY(1)
Affiliation :
(1)Nephrology Unit, Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Catheter-related bloodstream infection (CRBSI) can cause high mortality, morbidity and serious complication especially MRSA CRBSI as well as increased length of stay in hospital. Significantly increased CRBSI in the past 12 months. 9 CRBSI cases were noted among haemodialysis (HD) patients in 2023. MRSA accounted for 2/3 of all CRBSIs. Make Catheter Safe project was organized with evidence-based strategies to reduce MRSA CRBSI in Renal Unit.
Objectives :
To reduce MRSA CRBSI rate among Renal Unit.
Methodology :
The 5-S preventive intervention strategies: 1)Snapshot MRSA surveillance: -A total 149 patients underwent MRSA screening during the period from 24/7/23 to 9/8/23. Provide early MRSA nasal and skin screening and timely decolonization. 2)Solution: -Trisodium citrate 4% as a catheter lock solution for CVC is more effective to prevent bacterial infection than heparin. 3)Standardize patient education on CVC care: -Education Videos and pamphlet created to enhance and standardize the knowledge of CVC daily care. 4)Surveillance and monitoring of CVC exit site: -Implement pilot CVC surveillance form and clinical photo to monitor the catheter exit site condition. 5)Superior flushing technique: -Implement evidence-based practice of the push/pause flush technique to minimize the ability of blood clot in or around the central catheter secondary to reduce formation of biofilms in the catheter lumen. The 3-R strategies to reduce the catheter use: -Reduce catheter use/early Removal/Early Referral.
Result & Outcome :
MRSA surveillance and decolonization: -A total 149 patients underwent MRSA screened. 19 patients (12.7%) screened with +ve result, 11 nos. (7.3%) are existing MRSA carrier under decolonization loop and 8 nos. (5.3%) are newly found MRSA carrier and started decolonization. Citrate lock: -Identified and prescribed 4% citrate lock to 12 high risk/Hx of CRBSI cases. Free of MRSA CRBSI when using its solution for locking catheter. CVC Education program: - Total 24 HD patients with CVC recruited in education program. Pre/Post-test showed significantly improved patients' knowledge of CVC care and CVC infection. CVC monitoring: -Total 64 CVC are monitoring. 12 cases with S/S of E.S.I identified and intervention given. Free of ESI induced MRSA CRBSI in the period. Catheter reduction: -Early removed 3 CVC after smooth cannulation. 3 high risk PD cases were identified and referred to arrange early vascular access creation to ensure smooth transition to HD with well-functioning.
