Authors (including presenting author) :
WONG YM(1), LAM J(1), LAI R(1), FUNG B(1), LAI WMY(1), YIP PN(1), CHEN MN(1), LO YM(1), CHAN LY(1), PANG YKC(1), TAM GY(1), LEE KY(1), CHENG HTH(1), CHUNG MC(1), LEE ST(1), LAM LT(1), WONG HW(1), CHOW LL(1), CHOW SH(1), MUI ML(1)
Affiliation :
(1)Infection Control Team, Hong Kong East Cluster
Keyword 3: :
root cause analysis
Keyword 5: :
multidrug-resistant organism
Introduction :
Multidrug-resistant organisms (MDROs) are significant global healthcare challenges. In Hong Kong, particularly at HKEC, addressing this evolving issue necessitates various prevention and control strategies.
Objectives :
Develop strategies for preventing the acquisition and transmission of MDROs among patients.
Methodology :
A root cause analysis (RCA) of MDRO cases identified since 2023 to drive the planning of prevention and control strategies from a 4M1E approach. MAN: High-risk patient groups were identified for targeted MDRO screening, including residential care homes (RCHE) residents, prolonged-stay patients, and recently discharged from high incident departments. New surveillance initiatives were established for renal cases, alongside care practice audits for prolonged-stay patients. MACHINE: RCA meetings were held within HKEC's Infection Control Team (ICT) to analyze each MDRO case. This facilitated knowledge sharing and standardized infection control practices across HKEC. An MDRO dashboard was introduced to help ward managers monitor MDRO situations, allowing for immediate adjustments to care practices. MATERIAL: Antimicrobial (AM) curtains were introduced in 2024, based on RCA findings. Designated MDRO cubicles with AM curtains were established in wards with higher MDRO incidence, and regular sampling ensured their effectiveness. METHOD: Enhanced MDRO screening protocols targeted high-risk groups at various time points, including admission, prolonged hospitalization, and transfers from convalescent hospitals. A comprehensive bathing practice included proactive MRSA decolonization for newly identified MRSA bacteremia cases and for prolonged-stay patients in convalescent hospitals, while post-discharge MRSA suppressive therapy was introduced for new MRSA cases in clinical specimens since 2025. ENVIRONMENT: Simulation training for supporting staff on environmental cleansing techniques was conducted, with ongoing audits not only by ICTs but also by frontline supervisors to boost staff engagement and prevent MDRO transmission.
Result & Outcome :
The holistic 4M1E approach has led to a decline in hospital-apportioned MDRO rates since Q1 2023, with reductions in MRSA bacteremia (from 0.1180 to 0.0703), MDRA (from 0.0788 to 0.0135), and VRE (from 0.0325 to 0.0045). In view of the implemented strategies were focusing on hospital setting, we suggest more community-focused tactics should be introduced in RCHE and community to break the vicious cycle of MDRO transmission between community and hospital.
