Authors (including presenting author) :
Chung PYP(1), Mak CW(1), Hui CP(1), Leung KL(1), Pang PY(1), Choi CY(1)
Affiliation :
(1) Department of Orthopaedics and Traumatology, North District Hospital
Introduction :
The spread of healthcare-associated multidrug-resistant organisms (MDROs) is a global health challenge. The World Health Organization declared MDROs a major public health threat, which significantly increases hospital length of stays, medical cost and mortality. Infection control is important to cease the chain of transmission of MDROs. Methicillin-resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant Acinetobacter (MDRA) and Vancomycin-resistant Enterococci (VRE) are some common examples of MDROs challenging the Hospital Authority. Overseas and local studies suggest that 80 to 95% medical equipment are contaminated in clinical settings. The healthcare-associated infections (HAI) can be transmitted indirectly to hospitalized patient via contact with contaminated medical equipment. The crucial role of cleanliness of medical equipment indicates the need for modification of ward routine.
In 2019, there was a drastic elevation in the number of HAI of MDROs (CPE, MRAB, CRA and MDRA infection and MRSA bacteraemia) in the Department of O&T in NDH, from 5 cases in 2018 to 28 cases in 2019. With collaboration with infection control team, a workgroup was formed in the Department to look into the problem and strive for improvement.
Objectives :
(1) To reduce HAI of MDROs linked to contaminated medical equipment
(2) To minimize the risk of cross contamination of dirty and clean medical equipment
(3) To enhance staff’s behavior in medical equipment cleansing
Methodology :
A new workflow was implemented to ensure the cleanliness of medical equipment. All used and standby medical equipment are properly cleansed, then labeled with “I am Clean” with date and placed in a clean zone. Equipment is re-cleansed every 7 days and re-labelled if not used. The clean equipment is tested with Adenosine triphosphate (ATP) bioluminescence, which is a sensitive, simple and fast test for hospital environment screening. The equipment is re-cleansed if failing the ATP test. The cleansed equipment is allocated to a designated area for storage. Training of new workflow is delivered to all ward staff with return demonstration. Training on ATP test was provided to designated nursing and supporting staff.
Data collection took place monthly with random sampling to evaluate the cleanliness of medical equipment.
Result & Outcome :
The “I am Clean” workflow was successful. Before implementation, the number of HAI of MDROs linked to contaminated medical equipment in the Department was dropped from 28 in 2019 to 7 in 2020. There was tremendous achievement in medical equipment cleaning. The ATP test passing rate has sharply risen from 19% before implementation to 91% in the end of 2020, showing 4.5 times increase in medical equipment cleanliness. Culture in equipment cleaning was positively changed. Nursing and supporting staff highly appreciated the outcomes of the workflow and they gained stronger awareness in HAI prevention and early identification of patients with MDROs.
