Abstract
This research and developmental project aimed to develop appropriate and practical evidence-based practice guidelines for prevention of multidrug resistant organisms (MDRO) transmission and infections for intensive care units (ICUs) of secondary and tertiary care hospitals, to increase knowledge and promote correct practices among ICU personnel in prevention of MDRO infections from invasive medical device procedures, to create collaborative network among ICU personnel of hospitals and to promote knowledge sharing to improve quality of patient care, leading to reducing hospital associated infections (HAIs) in ICUs, costs of treatment and length of hospital stay including HAI related death.
This project applied collaborative quality improvement concept of the Institute for Healthcare Improvement (IHI), USA. Fifty hospitals participated in the project, including regional and general hospitals under Ministry of Public Health, hospitals under Ministry of Defence and a university hospital. The duration of the project was from November 2013 to November 2014. The project activities consisted of preparation of “draft” guidelines for prevention of MDRO infection, prevention of ventilator-associated pneumonia (VAP), prevention of catheter-related bloodstream infection (CRBSI), prevention of catheter-associated urinary tract infection (CAUTI), Two workshops were conducted for participating hospitals in order to educate ICU personel on collaborative quality improvement and practices in prevention of MDRO infections and HAI related to medical devices invasive procedures, and hand hygiene and providing information toward MDRO problems and trend, consequences of MDRO to patients, personnel and hospitals, reviewing HAI surveillance, advantages, utilization of surveillance information, and diagnosis criteria of frequent HAIs in ICUs. Brainstorming sessions for hospital personnel were conducted to determine the draft guidelines, exchange experiences and determine the appropriate and practical methods in solving HAIs in ICUs. Participating hospitals continuously improved their practices in prevention of HAIs using the outcomes of the project workshop. Researchers supported useful information. Hospital personnel presented their works in the project workshop in order to encourage hospitals to work continuously. The project intervention was assessed by using information from HAI surveillance.
Outcomes of the project included guideline for prevention of MDRO infections in ICUs, including guideline for prevention of MDRO transmission, guideline for prevention of VAP, guideline for prevention of CAUTI, guideline for prevention of CRBSI, guideline for environmental control and guideline for diagnosis of HAIs. Information from HAI surveillance of 79 ICUs of 40 participating hospitals which regularly sent the information from September 2013 to September 2014 indicated the highest infection rate was from VAP (7.8 per 1,000 ventilator-days), followed by CAUTI 4.6 per 1,000 catheter-days and CRBSI 2.5 per 1,000 catheter-days. Case fatality rate from VAP and CRBSI were 36.4% and case fatality rate from CAUTI was 24%. Cost of antibiotic treatment for VAP , CAUTI and CRBSI were 30,734,713 Baht, 8,317,268 and 2,545,381 Baht, respectively.
Prevention of MDRO infections in the ICUs need to be implemented continuously. Establishing evidence-based practice guidelines in prevention of important HAIs in ICUs can help improve up-to-date knowledge of ICU personnel and create more confident in practices among them. All guidelines developed from this project can be distributed to ICUs of other hospitals not participating in the project for patient care practices and educating their personnel.
