What Works to Improve Staff Compliance With Multi-Drug-Resistant Organism (MDRO) Screening

Purpose of the presentation: To present the evaluation of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital in New Zealand 

Target Audience: The target audience of this presentation are staff nurses, nurse educators, nurse managers, quality improvement advisers and infection control practitioners who are keen to identify interventions that work in improving staff compliance to MDRO admission screening

Objective: To evaluate the effect of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital

Research question: What is the effect of multi-modal infection prevention and control interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital?

Design: A retrospective review of monthly MDRO admission screening audits was done to compare the compliance rate before and after multi-modal interventions were implemented. The audit was conducted in the care of older people and elective surgical department of a public secondary hospital in Auckland, New Zealand from December 2010 to November 2014.

Setting: Two departments of a public secondary hospital in Auckland, New Zealand

Methods: Monthly MDRO admission screen audits were done in a representative ward of each department for the purpose of quality improvement. Audits were conducted by generating a monthly list of patients who were eligible to be screened for MDRO on admission to the ward. Twenty patients were randomly selected from the monhtly list for a specified period of time to evaluate whether nurses screened them for MDRO within 24 hours of admission. Eligibility to be screened is based on the criteria published in the organisational policy for MDRO management. Nursing staff compliance rate with the MDRO admission screen policy was computed using frequency and percentage.

Multi-modal interventions focusing on the nursing staff were implemented by the infection control practitioner. Interventions include: monthly MDRO admission screen compliance audits, regular reporting of audit result, feedback with regard to missed screens, regular education sessions with the nursing staff and staff encouragement from both the infection control practitioner and nurse manager.

Compliance rates were reported to the charge nurse managers on a monthly basis through an e-mail. Compliance rates of greater than 90% were celebrated and reinforced, whereas a drop in the compliance rate or a compliance rate of < 90% was followed up with the nurse manager. Regular 10-15 minute-education sessions during staff handovers were done by the infection control practitioner to present the audit results, to provide input, to answer queries and to encourage the staff to do better. Nurse managers also encourage staff to improve screening compliance rate.

Data analysis utilized Microsoft Excel Software in quantitative data collation and encoding. MDRO admission screen audits were presented using descriptive statistics such as frequency, percentage, mean, median and mode. Standard deviation was used to show data variability. T-test was utilized to test for a significant difference in the overall compliance rate before and after the multi-modal interventions were introduced. T-test is a parametric procedure of testing the difference in group means. The level of significance was set at P < 0.05 to identify a significant difference in the compliance rate.

Results: Results show that the MDRO admission screen compliance rate in the two departments were variable. The average compliance rate from October, 2012 to November, 2014 in the elective surgical department is 85.75% compared to 75.91% from December, 2010 to September, 2012 (Table 1).

Table 1.MDRO admission screen compliance at the elective surgical department

Surgical Department
Before*		After**
Mean	75.90909091	Mean	85.75
Number of patient records audited	1670	Number of patient records audited	2058
Number of monthly audits completed	22	Number of monthly audits completed	24

^*Period coverage is from December, 2010 to September, 2012

^**Period coverage is from October, 2012 to November, 2014

In the care of older people department, results show that the MDRO admission screen compliance was also variable. The average MDRO admission screen compliance rate from August, 2013 to October, 2014 is 96.80% compared to 83.84% from December, 2010 to July 2013 (Table 2).

Variability in the compliance may be due to patient acuity, staff mix, thorough history-taking of the patient, review of previous admissions, completeness of handover, staff knowledge of the organisational policy, staff motivation to adhere to organisational policy and availability of staff support.

Table 2.MDRO admission screen compliance at the health of older people department

Health of Older People
Before***		After****
Mean	83.83870968	Mean	96.8
Number of patient records audited	2599	Number of patient records audited	1452
Number of monthly audits completed	31	Number of monthly audits completed	15

 

^*** Period coverage is from December, 2010 to July 2013

^****Period coverage is from August, 2013 to October, 2014

Statistical analysis of the overall MDRO admission screening compliance rate before and after the interventions showed a significant difference (P < 0.05) in the compliance rate in both departments. A two-sample T-test with unequal variance was utilized in the statistical analysis given the variability in the screening rate and count. Table 3 provides a summary of the statistical testing done. The last column shows that there is a significant difference in the compliance rate in the surgical department (P < 0.009) and the care of older people department (P < 0.00003)

 Table 3.Descriptive summary of statistical testing of the MDRO admission screen compliance rate before and after the interventions

Departments	Before		After		T-Test  (P < 0.05)
	Number of Audits	Mean Compliance Rate	Number of Audits	Mean Compliance Rate
Surgical Department	22	75.91	24	85.75	0.009324379
Care of Older People	31	83.84	15	96.80	0.000036141

Conclusion: The multi-modal interventions addressed to nurses had a significant impact on the MDRO admission screening compliance rate in various departments of a tertiary public hospital. While various factors may affect the staff MDRO admission screening compliance rate, the rate could be kept at a high level through regular audits, regular reporting of audit result, regular education sessions and consistent staff encouragement.