Authors (including presenting author) :
Leung HW(1), Chau WW(1); Kwong WF(1)
Affiliation :
(1) Department of Orthopaedics & Traumatology, Queen Mary Hospital
Keyword 1: :
infection control
Keyword 2: :
safety huddle
Introduction :
Frail and post-operative patients are highly vulnerable to healthcare-associated infections and multidrug-resistant organisms (MDROs). In 2025, the baseline hand hygiene compliance was not satisfactory, with quarterly compliance of 68% in Q1 and 75% in Q2. Notably, five nosocomial vancomycin-resistant Enterococci (VRE) cases occurred within a 3-month period, highlighting the need to strengthen ward-level clinical safety and risk management. Although only 1–2 rectal swab rejection episodes due to suboptimal specimen quality were formally reported by the Infection Control team, this may underestimate the true frequency and was treated as an early warning indicator of inconsistent sampling quality. Moreover, the existing infection control link person model was predominantly nursing-oriented, and a structured, regular platform, including both nursing and supporting staff, to disseminate updates, facilitate discussion, and reinforce infection control practices was lacking. An infection control bundle, comprising weekly safety huddles and rectal swab technique training, was introduced to reinforce key practices and improve infection control outcomes.
Objectives :
Aim To evaluate the effectiveness of a ward-based infection control bundle of weekly safety huddles and rectal swab technique training in enhancing clinical safety by improving hand hygiene compliance, rectal swab sampling technique, and staff infection control awareness, while preventing nosocomial VRE transmission in an orthopaedic ward. Objectives Outcomes were measured as follows: ⚫ To achieve ≥80% hand hygiene compliance among nurses and supporting staff within 3 months. ⚫ To maintain zero nosocomial VRE cases during the project period. ⚫ To reduce rectal swab rejection due to specimen quality issues. ⚫ To attain ≥95% staff attendance in huddles and workshops. ⚫ To promote a “speak-up” culture for reporting infection control issues.
Methodology :
The programme commenced in Q3 2025. This ward-based quality improvement project adopted a PDCA framework. Weekly infection control safety huddles were conducted at the nurses’ station, with all participants required to remain standing to promote focus and effectiveness. Huddles were chaired by the ward Infection Control Link Person with participation from the Ward Manager, ward nurses and patient care assistants. Each huddle followed a SBAR discussion format, focused on one designated item per session, and was time- limited (target ≤10 minutes). Content included review of relevant audit findings, clarification of infection control standards and discussion of recent ward infection control issues, with timely knowledge dissemination by incorporating contemporaneous public-health topics where relevant. In parallel, a structured rectal swab technique workshop was delivered, combining teaching, emphasis on common sampling errors and a post-training knowledge quiz. Audit data, nosocomial VRE surveillance, quiz results and staff questionnaire feedback were collected to evaluate the impact.
Result & Outcome :
No new nosocomial VRE cases were detected after initiation. All planned interventions were completed, including 12 weekly safety huddles and rectal swab technique workshops. Across the 12 huddles, a total of 104 staff attendances (cumulative) were recorded, 100% of ward staff attended at least one huddle session. Overall hand hygiene compliance improved to 82%. All nursing staff participated in rectal swab technique training. The post-training quiz performance was 100% correct. There were no subsequent reports of poor swab specimen quality. Questionnaire feedback suggested increased infection control awareness and engagement. Speak-up behaviours were demonstrated during huddles, with six staff-initiated contributions raised and discussed, ranging from practical ward workflow queries to evidence-based infection control updates. Follow-up actions were completed where indicated. Conclusion An infection control bundle combining weekly safety huddles with rectal swab technique training is a simple, low-cost strategy that can be embedded in routine workflow to enhance infection control management in an orthopaedic ward. Early results indicate successful prevention of further nosocomial VRE cases after programme implementation and signal potential benefits for hand hygiene compliance and safety culture.
