Authors (including presenting author) :
C M HO, TWH RN(ICN), Ivan WONG, TWH APN(ICN), M Y MOK Dr, TWH Assoc CONS(MED), T K KWOK Dr. HKWC ISPO/TWH/MMRC CONS(MED),Lily Ng TWH CONS(SRG), Judy Fung TWH DOM(MED), S C Lam TWH DOM(SRG),Gladys NG, TWH HM(AS), Nobo YIP, TWH CHF(SS)
Affiliation :
(1) Infection Control Unit, (2) Central Nurse Department, (3) Medical Department (4) Surgical Department (5) Supporting Service Department
Introduction :
Multi-drug Resistant Acinetobacter (MDRA) became a threat to Tung Wah hospital. Significantly increase in the numbers of MDRA may result increase the length of hospitalization, mortality, morbidity and increase of the pressure and workload to the frontline colleagues. The number and rate of MDRA decreased to 2 cases (0.02%) per 1,000 patient days in 2021 as compared with 6 cases (0.06) per 1,000 patient days in 2020. However, in 2022 and Q1-Q2 2023, the cases rose to 26 cases (0.38%) and 29 cases (0.8%) per 1,000 patient days respectively. To address these issues, a multidisciplinary approach to control MDRA with concerning parties are established and “I-CARE” programme are developed in July 2023.
Objectives :
To reduce MDRA rate in TWH To minimize the risk of MDRA clustering in clinical department
Methodology :
The implementation of I-CARE programme aimed at reducing the transmission of MDRA in hospital. It includes: Identification early for newly diagnosed MDRA patients via admission screening or contact screening. Cohort MDRA patients in a same cubicle or designated room. Antiseptic bath provides to all MDRA patients for bed bath or shower bath to reduce bacterial load on the skin, and decrease the rate of nosocomial transmission of MDRA. Reinforce hand hygiene among all health-care workers with strictly to comply with 5 moments of hand hygiene, hand hygiene before meal/ medications and direct observe hand hygiene by infection control nurse (ICN). Enhanced environmental cleansing and terminal disinfection includes shared equipment for example e-vital machine. Other infection control measures such as provide just-in-time education to staff in the affected ward that include the transmission route of MDRA, the environmental factor is an important source of MDRA transmission. Educate visitors the importance of hand hygiene and the proper way to wear and de-gown of personal protective equipment (PPE) before entering and leaving the MDRA cohort cubicle or designated room, regular meeting with DOM, WM and supporting service to discuss the infection control measures, increase ICN patrol to the affected ward and perform ad-hoc hand hygiene audit, diaper changing audit, and environmental cleansing audit.
Result & Outcome :
The key measures to evaluate the successfully implementation of I-CARE programme. The compliance rate of hand hygiene in the affected ward increased to 98% in Q3-Q4, 2023 as compared with 83% in Q1-Q2, 2023. The percentage of diaper changing audit reached to 98.9% in Q3-Q4, 2023. The environmental cleansing audit increased to 100% in Q3-Q4, 2023 as compared with 93% in Q1-Q2, 2023. The overall of MDRA rate was significant reduced in 3 cases (0.08%) per 1,000 patient days in Q3-Q4, 2023 as compared with 29 cases (0.8%) per 1,000 patient days in Q1-Q2, 2023. In 2024, the number and rate of MDRA was 7 cases (0.09%) per 1,000 patient days as compared with 32 cases (0.43%) per 1,000 patient days in 2023.
