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Novel preventive bundle for multidrug-resistant organisms in intensive care setting; tertiary care experience
Majid M Alshamrani1,2,3, Aiman El-Saed1,2,3,4, Mohammed Al Zunitan1,2,3
1Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Background:
A widely-accepted standardized preventive bundle targeting multidrug-resistant organisms (MDROs) is lacking. The objective was to describe the components, implementation, compliance, and impact of a novel MDROs bundle in intensive care units (ICUs).
Methods:
Cohort study of surveillance activities on the components of MDROs bundle (July 2019 to June 2022) and the incidence of MDROs (April 2016 to June 2022). The implementation of MDROs bundle were preceded by ICPs-led education of the staff working in target ICUs about the importance and components of the MDROs bundle. These included the overall use of antimicrobials, appropriate environmental cleaning, appropriate contact precautions, and hand hygiene compliance.
Results:
During implementation, the overall use of antimicrobials was 57.8 days of therapy per 100 patient-days (44,492/76,933). It was higher in adult compared with pediatric/neonatal ICUs (p < 0.001). Appropriate environmental cleaning was 74.8% (12,409/16,582), appropriate contact precautions was 83.8% (10,467/12,497), and hand hygiene compliance was 86.9% (27,023/31,096). The three components were significantly higher in pediatric/neonatal compared with adult ICUs (p = 0.027, p < 0.001, p = 0.006, respectively). The MDROs rates per 10,000 patient-days were 71.8 before (April 2016 to June 2019) and 62.0 during (July 2019 to June 2022) the bundle implementation (858/119,565 versus 891/143,649 p = 0.002). The reduction in MDROs rates were replicated in adult (p = 0.001) but not pediatric/neonatal ICUs (p = 0.530).
Conclusions:
The finding of this study indicate that the implementation of the current bundle was associated with a modest decrease in MDROs rates in adult ICUs. The provided detailed definitions and methodology will facilitate its use by other healthcare facilities.
Insights
A new multidrug-resistant organism (MDRO) bundle modestly decreased infection rates in adult intensive care units (ICUs). This study details the bundle
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Healthcare Epidemiology
Background:
- Standardized preventive bundles for multidrug-resistant organisms (MDROs) are lacking in healthcare settings.
- This study addresses the need for a novel MDROs bundle in intensive care units (ICUs).
Purpose of the Study:
- To describe the components, implementation process, compliance rates, and impact of a new MDROs bundle.
- To evaluate the effectiveness of the MDROs bundle in reducing infection rates within ICUs.
Main Methods:
- A cohort study analyzed surveillance data on MDROs bundle components and MDRO incidence from July 2019 to June 2022.
- Staff education on antimicrobial use, environmental cleaning, contact precautions, and hand hygiene preceded bundle implementation.
- Data were compared before and during the bundle implementation period.
Main Results:
- Antimicrobial use was 57.8 days of therapy per 100 patient-days.
- Compliance rates were 74.8% for environmental cleaning, 83.8% for contact precautions, and 86.9% for hand hygiene.
- MDRO rates decreased from 71.8 to 62.0 per 10,000 patient-days, a statistically significant reduction (p=0.002), primarily in adult ICUs.
Conclusions:
- The implemented MDROs bundle was associated with a modest reduction in infection rates in adult ICUs.
- The detailed methodology and definitions provided can assist other healthcare facilities in adopting similar bundles.
- Further research may be needed to optimize the bundle for pediatric/neonatal ICUs.
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