Effect of a closed-loop audit and feedback system on compliance with multidrug-resistant organism prevention measures

Knowledge-practice gaps hinder consistent compliance with multidrug-resistant organism (MDRO) prevention measures. We evaluated the impact of an integrated closed-loop audit and feedback system on infection prevention and control (IPC) adherence.

This prospective pre-post study (2024-2025) implemented standardized checklist audits, fluorescent marker monitoring, and real-time mobile application feedback. Data were analyzed using generalized estimating equation (GEE) and Pareto analysis to identify independent predictors and key improvement drivers.

The intervention independently increased overall compliance by 24.97 percentage points (95% CI: 22.28-27.66, P < .001), with median compliance rising from 58.82%-84.62%. Pareto analysis showed that 13 key measures, including terminal cleaning, intensive caregiver engagement, and standardized isolation protocols, drove 82.34% of improvements. Bedside and single-room isolation were positive predictors, while informal caregiver presence was a negative predictor (β = -13.11, P < .001). Environmental cleaning compliance was 82.58%, with deficiencies noted on small, irregular surfaces. Post-intervention MDRO detection rates remained consistently below the 34.37% baseline.

The closed-loop system significantly enhanced compliance with IPC. Sustainable containment requires integrating precision microisolation and structured caregiver management into clinical workflows.