How to improve hospital admission screening for patients at risk of multidrug-resistant organism carriage: a before-and-after interventional study and cost-effectiveness analysis.
Cost-effectiveness
Education
Infection control
Quality improvement
Quality measurement
Journal
BMJ open quality
ISSN: 2399-6641
Titre abrégé: BMJ Open Qual
Pays: England
ID NLM: 101710381
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
12
10
2021
accepted:
18
04
2022
entrez:
28
4
2022
pubmed:
29
4
2022
medline:
3
5
2022
Statut:
ppublish
Résumé
Infection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings. In the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record 'order-set' including AS and AP compliance indicators was designed. We compared the cost-benefit of the audits and the automated indicators for AS and AP compliance. Compliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested. Training ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
Sections du résumé
BACKGROUND
Infection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings.
METHODS
In the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record 'order-set' including AS and AP compliance indicators was designed. We compared the cost-benefit of the audits and the automated indicators for AS and AP compliance.
RESULTS
Compliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested.
CONCLUSION
Training ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
Identifiants
pubmed: 35483731
pii: bmjoq-2021-001699
doi: 10.1136/bmjoq-2021-001699
pmc: PMC9052048
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
J Infect Dis. 2017 Feb 15;215(suppl_1):S28-S36
pubmed: 28375512
BMJ Open. 2019 May 19;9(5):e027683
pubmed: 31110101
Antimicrob Resist Infect Control. 2019 Feb 13;8:37
pubmed: 30809380
Am Fam Physician. 2014 Sep 15;90(6):377-82
pubmed: 25251230
Ann Emerg Med. 2014 Sep;64(3):299-313
pubmed: 24721718
Implement Sci. 2014 Oct 06;9:152
pubmed: 25287951
BMC Infect Dis. 2017 Jan 5;17(1):17
pubmed: 28056820
Ann Intensive Care. 2016 Dec;6(1):96
pubmed: 27714706
Virulence. 2013 Feb 15;4(2):163-71
pubmed: 23302791
Swiss Med Wkly. 2021 Mar 01;151:w20454
pubmed: 33705560
PLoS Med. 2011 Oct;8(10):e1001104
pubmed: 22022233
N Engl J Med. 2014 Mar 27;370(13):1198-208
pubmed: 24670166
Antimicrob Resist Infect Control. 2016 May 21;5:19
pubmed: 27213039
Infect Control Hosp Epidemiol. 1996 Aug;17(8):496-502
pubmed: 8875292
J Hosp Infect. 2004 Sep;58(1):1-13
pubmed: 15350707
Clin Infect Dis. 2005 Aug 1;41(3):327-33
pubmed: 16007529
Infect Control Hosp Epidemiol. 2005 Feb;26(2):166-74
pubmed: 15756888
Swiss Med Wkly. 2015 May 21;145:w14141
pubmed: 25996594
Lancet. 2011 Jan 15;377(9761):228-41
pubmed: 21146207
Int J Antimicrob Agents. 2008 Nov;32 Suppl 1:S2-9
pubmed: 18757182
Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1615-20
pubmed: 25957988
Clin Infect Dis. 2011 Jul 1;53(1):60-7
pubmed: 21653305
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
pubmed: 22696318
Open Forum Infect Dis. 2015 May 05;2(2):ofv050
pubmed: 26125030
Dtsch Arztebl Int. 2013 Aug;110(31-32):533-40
pubmed: 24069074
Bull World Health Organ. 2015 Feb 1;93(2):66
pubmed: 25883395