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Checking rounds for isolation precautions in the control of multidrug-resistant organisms: reduction achieved

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective of this investigation was to analyze the effectiveness of a quality improvement initiative in limiting the spread of multidrug-resistant organisms (MDROs) in the hospital setting. During the period 2011–2013, a multimodal intervention was activated at a tertiary care center in Italy. The intervention included: laboratory-based surveillance, interdisciplinary training sessions, monitoring the adoption of isolation precautions and daily supervision provided by infection control nurses, and a monthly feedback. Time series analysis was used to evaluate the trends and correlations between the MDROs rate, intensity of checking rounds, and hospital-wide data (i.e., transfer of patients, patients’ days, site of isolation, etc.). A total of 149,251 patients were included in the study. The proportion of patients undergoing transmission-based isolation precautions within 24 h from a positive laboratory finding increased from 83% in 2011 to 99% in 2013 (p < 0.05). The wards appropriately adopting the correct isolation precaution increased from 83% in 2011 to 97.6% in 2013 (p < 0.05). The frequency of controls was significantly reduced after the observation of compliance in the appropriate wards (p < 0.05). After three years, the incidence rate changed from 5.8/1000 days of stay [95% confidence interval (CI) 5.6–6.1] in 2011 to 4.7 (95% CI 4.4–4.9) in 2013 (p < 0.0001). Moreover, microorganisms isolated from different types of specimens showed variable potential for transmission (i.e., skin as the most potential and urine the least). The results demonstrate the efficacy of the multimodal intervention, with sustained reduction of MDROs rate, besides check reduction, and highlight the long-term efficacy of checking rounds in changing professionals’ behaviors.

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Acknowledgements

The authors would like to acknowledge all the healthcare workers participating in the adoption of isolation precautions and to the educational initiatives.

Authors’ contributions

All authors provided input into the design of the study and gave final approval of the version to be published. PB contributed to the conception and design, analysis of the data, and drafting and revising the article. MMDE contributed to the conception and design, revising the article, and is the guarantor of the study. MGG, EM, EM, RS, and SS contributed to the conception and implementation of the study, and revising the article. GS contributed in supervising the implementation of the intervention. EP contributed to critically revising the article.

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Authors and Affiliations

  1. Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy

    P. Barbadoro, E. Prospero & M. M. D’Errico

  2. Azienda Ospedaliero Universitaria “Ospedali Riuniti”, Ancona, Italy

    E. Martini, M. G. Gioia, R. Stoico, S. Savini, E. Manso, G. Serafini & M. M. D’Errico

  3. Department of Biomedical Sciences and Public Health, Hospital Hygiene Unit, AOU Ancona United Hospitals, Università Politecnica delle Marche, via Tronto, 10/a, Torrette di Ancona, Italy, 60020

    M. M. D’Errico

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  1. P. Barbadoro
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  2. E. Martini
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  3. M. G. Gioia
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  4. R. Stoico
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  5. S. Savini
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  6. E. Manso
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  7. G. Serafini
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  8. E. Prospero
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  9. M. M. D’Errico
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Corresponding author

Correspondence to M. M. D’Errico.

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Funding

This study was conducted as part of our routine work at the Ancona Associated Hospital and the Università Politecnica delle Marche.

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None.

Ethical approval

Not required, since the analysis was performed on data belonging to the routine care of patients.

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Not required, since the procedures have been performed in the context of the routine care of patients.

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Barbadoro, P., Martini, E., Gioia, M.G. et al. Checking rounds for isolation precautions in the control of multidrug-resistant organisms: reduction achieved. Eur J Clin Microbiol Infect Dis 36, 1105–1109 (2017). https://doi.org/10.1007/s10096-016-2896-1

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  • DOI: https://doi.org/10.1007/s10096-016-2896-1

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