Page 127 - Hospital Authority Convention 2017

Service Enhancement Presentations

F2.2 Staff Engagement and Empowerment 13:15 Room 421

Success of Preventing Multiple Drug Resistant Organisms Spread by the Enhanced Infection Control Measures
in High Risk Nursing Procedures
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Wu TC 1,2 ,3, Lau MY 1,2 ,3, Cheng WY 2,3 , Wong H, 2,3 , Lau KY 2,3 , Tsang CS , Yuen SW ,Chu MY 1,2 ,3, Lam KW 1,2 ,3, Yao PW 2,3 HOSPITAL AUTHORITY CONVENTION 2017
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1 Division of Infectious Diseases, Department of Medicine, Department of Medicine, Task Force on MDROs Infection Control of
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the Medical Infection Control Working Group, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
Introduction
Repeated outbreaks and persistent spreading of Multiple Drug Resistant Organisms (MDROs) including Vancomycin-
Resistant Enterococci (VRE), Multiple Drug Resistant Acinetobacter (MDRA) have been seen in Queen Elizabeth Hospital (QEH)
since 2012. Carbapenemase Producing Enterobacteriaceae (CPE) is also a major public health challenge because of limited
therapeutic alternatives. Poor hand hygiene compliance is considered to be one of the contributing factors for spreading
MDROs. Furthermore, VRE and CPE, and MDRA are found in very high numbers in the stool and respiratory secretion of
the patients infected or colonised with these MDROs, respectively. The environment around these patients can be easily
contaminated during daily nursing procedures.

Objectives
To assess the effect of a comprehensive infection control programme including enhancement of hand hygiene, and
development of nursing care workflow with enhanced infection control measures for four high risk nursing procedures in
controlling the spread of VRE, CPE and MDRA in the Department of Medicine of QEH.

Methodology
The study is designed as a retrospective observational study. Tuesday, 16 May

Task Force on MDROs was formed under the Medical Infection Control Working Group of the Department of Medicine. Four
high risk nursing procedures for spreading MDROs were identified and a comprehensive infection control programme called
Hand Hygiene PLUS FOUR Programme (Enteral Feeding, WOund Care, SpUtum Suction and Napkin Round) was developed
and instituted since 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.
Nursing care workflows with enhanced infection control measures were implemented by phases in all medical wards. Nursing
training for these four nursing procedures including lectures, workshops at the Simulation Training Centre and on-site briefing
were provided to frontline nursing staff, ward supporting staff and student nurses. Audit and monitoring were also conducted
to ensure good compliance. The numbers of new patients with cultures positive for VRE, CPE and MDRA were compared
before and after the intervention.

Results
Overall hand hygiene compliance rate was significantly improved from baseline by around 40% to 90%. Implementation of
the four nursing care workflows with enhanced infection control measures in all medical wards was completed. The annual
numbers of new VRE and MDRA cases in QEH significantly dropped from a peak of 252 cases and 67 cases to 13 cases
and two cases (per 1,000 patient days) respectively after implementation of the Hand Hygiene PLUS FOUR Programme.
Furthermore, there was no CPE outbreak despite there were many sporadic cases (47 patients with CPE) during 2015-16.

Conclusion
The Hand Hygiene PLUS FOUR programme which enhanced infection control measures for high risk nursing procedure was
effective in stopping MDROs spread in the hospital.

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