What Nursing Intervention Can Decrease MDRO Infection Rate ?

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Authors (including presenting author) :
Lam WC, Cheng YY, Mak KM, Lam LP, Cheung CC C, Chow HC
Affiliation :
Department of Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
Multiple Drug Resistance Organism (MDRO) is a threat throughout the world due to antibiotic overuse and cross-transmission (WHO, 2014). High incidence rate of hospital acquired MDRO infection rate with 1.4 in M&G, compared with the overall PMH rate 0.86 is noted in 2017. Mainly, most newly MDRO acquired cases are with respiratory problems, which need either Invasive Mechanical Ventilation (IMV) or Non-invasive Ventilation (NIV) or with tracheostomy which lead to increase length of stay (LOS), morbidity and mortality. Education program including photo guides on oropharyngeal suctioning, closed suctioning and oral toileting, and video guide in open suctioning for intubated or tracheostomised patients are designed for staff guidance and enhancement in the procedures. The program rolled out on 1/8/2018 in 2 pilot wards, S15 and D6 of PMH and completed in March 2019.
Objectives :
To prevent MDRO transmission by reinforcing hand hygiene, promoting infection control practice in sputum suction for patients, promoting oral hygiene especially those with mechanical ventilation or tracheostomy.
Methodology :
Video guide to educate performing open suction in ventilated or tracheostomized patients using disposable sterile copolymer gloves. Use photo guides to standardize in sputum suctioning for ventilated patients or patients with tracheostomy by using close-system or open suction with sterile technique in general wards. To adopt usage of 0.2% chlorhexidine mouthwash for all cases with mechanical ventilation or tracheostomy.
Result & Outcome :
The program conducted from Aug 2018 to March 2019 in 2 pilot wards. From Aug 2018 to March 2019, newly acquired MDRO infection rate reduced from 1.17 to 0.59 with the rate below M&G rate. There were total 17 cases of newly acquired MDRO in 2 pilot wards in 2018, compared with total 34 cases in 2017 by reducing 50%. Staff compliance audit conducted in Nov 2018. Overall compliance rate was 98.6% by 10 points-audit criteria. Hence, stringent hand hygiene, standardize nursing interventions and enhance staff compliance are very important for reducing MDRO infection in patient care.

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