Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project
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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).
Background:
Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE.
Local Problem:
In 2017, an increase in the rate of health care-associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance.
Methods:
A pre-/post-intervention project was conducted from November 2017 through December 2020.
Interventions:
The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST).
Results:
Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001).
Conclusions:
Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.
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