Page 144 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F4.4 Clinical Safety and Quality Service II 16:15 Room 421

Success of a Comprehensive Infection Control Programme to Stop the Spread of Vancomycin-resistant

Enterococci
Lau MY 1, 2, 3, Lau KY 2, 3, Wu KP 1, 2, 3, Wong J 2, 3, Cheng WY 2, 3, Wong R 2,3, Yao S 2, 3, Wu TC 1, 2, 3
1Division of Infectious Diseases, Medicine Department, Queen Elizabeth Hospital, 2Department of Medicine, Queen Elizabeth
Hospital 3Task Force on MDROs Infection Control, Department of Medicine, Queen Elizabeth Hospital, Hong Kong

Introduction

Repeated outbreaks and persistent spreading of Vancomycin-Resistant Enterococci (VRE) has been seen in Queen Elizabeth
Hospital since 2012 despite intensive environmental decontamination and “Find and Confine” infection control policy. Poor
hand hygiene compliance is considered to be one of the contributing factors for spreading VRE. Furthermore, large number
of VRE is found in the stool of patients colonised or infected with VRE. The environment around these patients is more likely
to be contaminated. Thus continence care is identified as one of the highest risk of nursing procedures for spreading VRE.

Tuesday, 3 May Objectives

To assess the effect of a comprehensive infection control programme including hand hygiene enhancement programme,
screening for gastrointestinal colonisation and development of Continence Nursing Care Workflow on limiting the spread of
VRE in the Medicine Department of Queen Elizabeth Hospital.

Methodology

Design Retrospective Observational Study Task Force on Multiple Drug-Resistant Organisms (MDROs) was formed under
the Medical Infection Control Working Group of the Medicine Department and a comprehensive infection control programme
was developed and instituted in the beginning of 2014. Hand hygiene enhancement programme via real-time feedback
was performed by medical infectious diseases nurses. An independent hand hygiene audit was conducted by the hospital
infection control team. A new rectal VRE culture surveillance programme called “Day14” for all medical patients who had
been hospitalised for more than 14 days was initiated as well. All patients colonised or infected with VRE were placed in
contact isolation or cohorted to a designated isolation ward. Continence Nursing Care Workflow with enhanced infection
control measures was developed and implemented, starting from one female and one male medical wards as model wards
then extending to all other medical wards by phases. The Continence Nursing Care Workflow training included lectures,
workshops at the Simulation Training Centre and on-site briefing. Audit and monitoring were also conducted to ensure
good compliance. The number of new patients per week with cultures positive for VRE was compared before and after the
intervention.

Results

Overall hand hygiene compliance rate was significantly increased from baseline around 40% to 90%. Implementation of
Continence Nursing Care Workflow in all medical wards was completed in September 2015. Training of Continence Nursing
Care Workflow was given to all medical ward nursing staff, supporting staff and student nurses. The number of new VRE
cases in the Medicine Department was significantly reduced from the peak of 35 per week to zero in most of the time with
only occasional sporadic cases since August 2015.

Conclusion

The comprehensive infection control programme including hand hygiene enhancement programme, screening for
gastrointestinal VRE colonisation (D14 programme) and implementation of Continence Nursing Care Workflow successfully
stopped VRE spreading in the medical wards.

142