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Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project.
Barbara Ragonese1, Alessandra Mularoni, Andrea Valeri
1Quality and Accreditation Department (Mss Ragonese, Corso, Fazzina, and Barone), Department of Infectious Diseases (Dr Mularoni), and Department of Diagnostic and Therapeutic Services (Dr Luca), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy; Quality and Accreditation Department, University of Pittsburgh Medical Centre (UPMC), Rome, Italy (Mr Valeri); Infection Control and Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy (Ms Campanella); and Corporate Nursing, Technical, and Rehabilitation Services, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy (Messrs Arena and Lombardo).
Improving hand hygiene compliance significantly reduced healthcare-associated Carbapenem-resistant Enterobacteriaceae (HA-CRE) colonization. The DMAIC framework and Targeted Solution Tool (TST) implementation led to a substantial decrease in HA-CRE rates.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Quality Improvement Science
Background:
- Carbapenem-resistant Enterobacteriaceae (CRE) presents a critical global health challenge.
- Healthcare-associated (HA) CRE colonization rates increased in a major Italian transplant center in 2017.
- Effective hand hygiene (HH) is crucial for mitigating CRE transmission.
Purpose of the Study:
- To decrease HA-CRE colonization rates within a multiorgan transplant center.
- To enhance hand hygiene compliance among healthcare professionals.
Main Methods:
- A pre-/post-intervention study was conducted from November 2017 to December 2020.
- The Define, Measure, Analyze, Improve, and Control (DMAIC) framework guided the implementation of the HH Targeted Solution Tool (TST).
Main Results:
- Hand hygiene compliance rose from 49% to 81.9% post-intervention (P = .0001).
- The rate of HA-CRE colonization decreased significantly from 24.9% to 5.6% (P = .0001).
Conclusions:
- The DMAIC framework effectively enhanced hand hygiene compliance.
- Implementing the TST using DMAIC led to substantial reductions in HA-CRE colonization rates.
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