Healthcare-associated infections (HAI) continue to be a major public health concern. A number of multi drug resistant microorganisms (MDR) are gradually increasing in the world. WHO indicates that the infection by MDR may cause higher medical expense, longer hospitalization and long-term functional disability. Reducing the MDR infection rate has become a vital approach to the quality of patient care in Taiwan. The density of occurrence of MDR from January 2014 to March 2015 in one cardiovascular surgery intensive care unit (CVSICU) is 9.1 per thousand, which was higher than other ICUs in a Northern Medical Center. The aim of this program is to apply a bundle care to reduce the infection rate of MDR.
Methods:
The nurse managers, nurse educators, infection manager, staff nurses and Intensive care unit director were involved in this program. According to the guidelines published by the Centers for Disease Control of Taiwan, we investigated the cause of high density of MDR infection. After the conclusion of the assessment, we decided to apply a bundle care to implement. The interventions were developed in four domains – environmental cleaning, oral care, hand hygiene and isolation measures. We standardized the protocol of preparing bleach concentration and establish the standard protocol of cleaning environment. Use the correct oral mouthwash concentration according to the evidence. Then we set up the oral care protocols and promote the standard operation. The hand hygiene educational trainings were hold to promote the correct timing and steps. We established the standard operations of MDR isolation measures. Staff nurses and janitors were asked to attend educational sessions on infection prevention and disinfection practice. Audit mechanisms were also established to ensure the consistency and compliance of the protective practice. The interventions were implemented from April to September of 2015. The outcomes were evaluated by the incidence density rate of MDR infection among patients in the CVSICU.
Results:
26 staff nurses and 5 janitors completed the education sessions. The MDR infection incidence density rate dropped from 9.1 to 4.56 per thousand (from October to December) after the quality initiative implemented. The length of staying in CVSICU from 8.29 days decreased to 6.84 days. We continued to tracking effects the MDR infection incidence density average rate was 5.69 per thousand from January to September of 2016.
Conclusion:
The findings of this project suggest that apply a bundle care that are tailored to the needs of the individual unit can successfully reduce the MDR infection incidence density rate and improve the patients’ outcomes.