Authors (including presenting author) :
Chan YF(3), Chan HY(3), Siu TS(3), Po MY(2), Wong CW(1), Wan MC(1)
Affiliation :
(1) Division of Geriatrics, Department of Medicine & Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals (2) Community Healthcare Services, HKEC (3) Community Geriatric Assessment Team, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
One of the major responsibilities of Community Geriatric Assessment Team (CGAT) is to collaborate with staff of residential care home for the elderly (RCHE) to prevent and control infection & outbreak. Uptrend of no. of residents with contact with or confirmed MDRO in RCHEs increases the challenges for RCHEs staff and CGAT in care management and prevention of cross infection. Long-term care facilities are critical reservoirs for infectious disease, which significantly contributes to morbidity and mortality among the elderly. This imposes a heavy burden on the healthcare system (Choy et al., 2016). Effective infection prevention strategies, access to healthcare, vaccination, good hygiene practices, environmental cleaning, isolation and quarantine are essential in preventing the transmission of MDROs and controlling infections among elderly residents.
Objectives :
This article is to illustrate implementation and evaluation of management on MDROs in RCHEs of HKEC CGAT through bundle approach: - Early detection & isolation of MDROs cases - Provide ad hoc medical surveillance & onsite support - Enhance update knowledge of MDROs management in RCHEs to address significant disease issues.
Methodology :
Whenever RCHEs residents with contact / confirmed MDRO case during hospitalization was noted,
1. Early detection & isolation of MDROs cases by systematic monitoring and record CGAS nurses participate in subsequent screenings and empower RCHE staff for specimen collection (CPE & VRE). Due to frequent change of RCHE staff, a tailor-made instruction sheet for easy & accuracy reference for specimen collection conducted. A systematic record enhances monitoring MDRO progressing and result in RCHE, early detect outbreak occurrence. CGAS nurses proactively implement screening of high risk or close contact cases in the event of an outbreak in RCHE. 2. Ad hoc medical surveillance & onsite support in preventing the transmission of MDROs CGAS nurses participate in assessment of Isolation facilities and environmental hygiene, and provide update information to residents and staffs to comply infection control measures to reduce transmission risk. In the event of an outbreak in any elderly homes, CGAS offers ad hoc teleclinics to ensure continuous care for the elderly and minimize the ne
Result & Outcome :
Up to January 2025, over 7000 residents are under CGAS nursing support in HKEC. 1. Total 297 contact tracing (CPE & VRE) screening test performed by CGAT nurses, early detected 19 positive case discharge to community, average around 8 days for specimen collection. 2. Over 120 (CPE & VRE) cases successfully cleared MDROs carriage status in 2024. 3. No occurrence of any outbreak of MDROs in residential home in HKEC in 2024. Conclusion Optimal control of MDROs in RCHEs relies on collaborative works among CGAT, RCHE staff, residents & their family members. Through onsite support, education and training, the awareness of MDROs of RCHE staff/residents/families and respective control measures in RCHEs could be enhanced. Regular compliance assessment, knowledge enhancement, internal early detection and monitoring mechanism within CGAT must be part of integral measures to sustain such good practice in managing MDROs in RCHEs.
