Authors (including presenting author) :
Ip TFF (1), Leung LYE (1), Chiu HF (1), Lie KWA (1) Wong SC (2) Cheng CC (2)
Affiliation :
(1) Department of Medicine, Queen Mary Hospital, (2) Infection Control Team, Department of Medicine
Introduction :
Carbapenems are medications reserved for treating drug resistant organisms. Resistant to Carbapenems will leave clinicians and patients with even lesser treatment options and patients who are having Carbapenemase-producing Enterobacteriaceae (CPE) or Carbapenem-resistant Enterobacteriaceae (CRE) infections will face higher risks of mortality. These nosocomial infections could be spread among patients through fecal-oral route or contacts with contaminated high-touch surfaces, e.g. bed rails, toilets or shared medical devices. Increased incidences of CPE will increase isolation beds demands, prolonged hospitalization and added costs of laboratory testing for acute and convalescent hospitals. Since 7 Sep 2018, there was a sudden surge of 8 CPE nosocomial cases in the second week of September 2018, eventually, a work group led by ICT, COS, DOM and Ward Managers of Department of Medicine was formed and preventive measures were carried out targeting in containing these nosocomial infections before the Demand Surge commenced in early December.
Objectives :
1. Prevent CPE transmission in Acute Medical wards 2. Maintain ward environment, facilities, beddings and shared medical equipment clean to minimize CPE transmission 3. Ensure patients’ quality care will not be adversely affected by CPE or CRE infections 4. Enhance frontline staffs’ vigilance and awareness in good hand hygiene compliance
Methodology :
1. Infective Control surveillance include
* CPE CRE Admission screening for all Medical patients commenced on 6th Sept 2018 * Observational surveys by ICT for staffs and patients’ hand hygiene * Environmental site visits by ICO and DOM of Department of Medicine. (Bi-Monthly visits by DOM) 2. Weekly Departmental ICO meeting from 18th Sept 2018 aimed at : * Keeping frontline staffs updated about CPE trend * Providing feedback to Hospital Manager for improvement measures and evaluation in environmental & facilities cleanliness, beddings (Mattresses) 3. Post up in-house posters to alert supporting and nurses the rationale of applying and donning gloves and proper hand hygiene practice.
4. Interactive Workshop conducted by ICN for nurses and supporting staffs for nosocomial infection prevention during patients’ care
5. Admitted patients were offered bottled water to minimize CPE transmission through shared use of water jars.
6. Additional supporting staffs were recruited by Hospital Manager for beds, mattresses, and hospital environment cleansing.
7. One set of Medical equipment will be assigned per cubicle per ward to avoid CPE transmission.
8. Disposable curtain and portable colored screen were purchased to denote the isolated and infectious case allocated at Medical wards corners.
9. Patients’ folders and observation chart boards are placed in patient record carts so that contamination is minimized
Result & Outcome :
12 CPE nosocomial incidents cases were confirmed in early September and had been reduced to four in October after preventive measures were carried out. Incidences were further reduced to three in November and December respectively.The collaborative efforts of ICO and Department of Medicine proved to be effective in minimizing CPE infection in Acute Medical Setting
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