Authors (including presenting author) :
Chan KY (1), Tse KC(1), Chan YY(1), Chan HY(1), Leung SC(1), Cheng KL(2), Ng PY(2), Cheong HY(1), Yuen SK(1)
Affiliation :
(1)Renal Unit, Caritas Medical Centre, (2) Infection control unit, Caritas Medical Centre
Introduction :
MRSA may colonize renal patients, and episodically cause morbidity and mortality through catheter-related bloodstream infections (CRBSI) and peritoneal dialysis (PD) peritonitis. Therefore, timely screening and early eradication of MRSA carriage is critical.
Objectives :
To enhance transdisciplinary communication to improve the efficiency of MRSA eradication program for renal patients
Methodology :
A transdisciplinary continuous quality initiative (CQI) program intends to improve the efficiency of MRSA eradication at Caritas Medical Centre (CMC) since January 2024. All patients planned for kidney replacement therapy (KRT) were screened for MRSA carriage while patients on chronic haemodialysis (HD) with catheters received screening every 3 months. All laboratory requests were made through the electronic Generic Clinical Request System (GCRS), which automatically notified the renal team head of the results. The infection control team also sent encrypted emails to inform the clinical team of any positive MRSA culture timely. Lastly, a transdisciplinary HA chat (a corporate instant messaging platform) communication group including renal doctors, nurses, ward manager, and infection control team professionals was created. Any member should notify colleagues if MRSA was detected in any renal patient. The renal MRSA management (nursing) team promptly reviewed case records formulated appropriate eradication plans and communicated across disciplines through HA chat with documentation in the Clinical Management System (CMS). Doctors would then prescribe drugs for eradication while nurses would arrange re-testing and communicate with all disciplines in case eradication failed.
Result & Outcome :
From January to June, 2024, MRSA was isolated from 864 specimens at CMC. A total of 1069 MRSA nasal swab screenings were performed, of which 104 specimens were on renal patients. In 24 renal patients (3 female, 21 male) with mean (±standard deviation) age of 68.3±11.6, MRSA was detected in 15 nasal swabs and 20 other specimens (sputum, wound swab and peritoneal fluid). Five patients were on hemodialysis (HD) while 19 were on PD. Fourteen patients (58.3%) were considered appropriate for MRSA eradication. The median time to eradication was 33.5 days (interquartile range 18.0-46.8 days). The eradication rate, as determined by repeat nasal swabs, wound swabs or clinical specimens 2 days and 9 days after completion of eradication, was 50%. The MRSA bacteremia episode had remained 0 in the first half of 2024, compared with 3 in 2023. In the staff satisfaction survey, all renal physicians and the majority of nurses agreed that early MRSA eradication improved outcomes of renal patients, the transdisciplinary communication group contributed to effective communication and improved the efficiency of MRSA eradication. 100% of renal physicians strongly believed the communication system was well devised and markedly enhanced the eradication rate and timeliness. The programme markedly improved the efficiency and possibly effectiveness of MRSA eradication.
