Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Chow SM (1), Lam SC (1), Chan HL (2), Leung LM (2), Shum, Rocky (3)
Affiliation :
(1)Infection Control Team, HHH (2) Nursing Services Division, HHH (3) Clinical Laboratory Department, HHH
Introduction :
After combating with COVID-19, the Centers for Disease Control and Prevention (CDC) in 2022 reported antimicrobial resistance (AMR) has continued to grow due to inappropriate antibiotic consumption by COVID-19 patients. Thus, there has been a substantial increase in the number of MDROs. HHH data by CICO from 2021 to 2022, new cases among VRE increase from 0.006 to 0.005 while MDRA from 0.089 to 0.098 and MRSA from 1.699 to 1.924 respectively. Therefore, MDROs admission screening was implemented in HHH for early detection and isolation and Hand Hygiene Enhancement Program was introduced for prevent cross transmission.
Objectives :
(1) To reduce hospital acquired MDROs transmission
(2) To enhance hand hygiene compliance
Methodology :
For MDROs admission screening among newly admitted patients, rectal swab for VRE screening since 2021, combine swabs (nasal, axilla and groin) and/or wound swab (s) for MDRA screening since 2022 and combine swabs (nasal, axilla and groin) for MRSA screening in specific wards since 2023.
For Hand Hygiene Enhancement Program, two training talks were hold in 2023 for infection control linked nurse/person (ICLN/P) for aligning World Health Organization (WHO) 5 moment hand hygiene observation methods. ICT provided the most updated knowledge about hand hygiene to ICLN/P and offered hand hygiene demonstration. ICLN/P used an updated e-form for hand hygiene compliance audit at workplace. Moreover, ward environment was inspected by ICNs and enhanced by placing alcohol hand rubs on trolleys in addition to bedsides to facilitate staff hand hygiene.
Result & Outcome :
After MDROs admission screening program was implemented, among newly identified hospital associated MDROs, 70.45-100% of VRE, 55.56-76.92% of MDRA and 33.33-100% of MRSA new cases were identified during admission screening.
New hospital acquired VRE, MDRA and MRSA rates are decreased with implementing MDROs admission screening and hand hygiene enhancement program in 2023.
For Hand Hygiene Enhancement Program, hand hygiene compliance rate increased from 87.61% (Q12023) to 93.06% (Q32023).
MDROs admission screening is effectively reduced hospital acquired MDROs transmission and have early detection and isolation. Preemptive contact precautions are reinforced till the result is negative to prevent local transmission.
Hand Hygiene Enhancement Program boosts hand hygiene compliance rate, which thus reduce hospital acquired MDROs rate. The Hand Hygiene Enhancement Program could also involve ICLN/P, which could increase their alertness of hand hygiene compliance among their wards and units.
