Authors: (including presenting author): :
Chan SW(1), Lam YC(1), Leung KY(1), Au WT(1), Leung TK(1), Lam WK(1)
Affiliation: :
(1)Department of Paediatrics, Queen Elizabeth Hospital
Keyword 2: :
PCA Competency
Keyword 4: :
Infection control
Introduction: :
Methicillin-resistant Staphylococcus aureus (MRSA) critically threatens neonates in intensive care due to their immature immunity and exposure to invasive care, risking severe outcomes and increased healthcare burdens. Its persistence on surfaces enables transmission among people and the environment. Patient Care Assistants (PCAs), through high-contact patient and environmental care tasks, are pivotal in this chain. This quality improvement project employed a Plan-Do-Check-Act (PDCA) cycle framework to empower PCAs to disrupt transmission chains at critical points involving hands and environmental surfaces.
Objectives: :
1) Review and strengthen PCA’s knowledge of hand hygiene and environmental cleaning;
2) Increase their awareness of and alertness to infection control practices; 3) Improve hand hygiene compliance and strengthen environmental cleaning practices.
Methodology: :
A quasi-experimental study using purposive sampling recruited all NICU PCAs (n=19) at Queen Elizabeth Hospital. The PDCA cycle structured the intervention. In the Plan phase, a two-phase programme was designed: an educational intervention and an environmental audit, targeting knowledge and practice. In the Do phase, all PCAs viewed a 23-minute educational video in Cantonese, integrating animation and high-fidelity footage of local NICU workflows to cover different precautions, hand hygiene, and environmental cleaning. Knowledge was assessed via identical pre- and post-video multiple-choice questions (MCQs). Satisfaction was measured via a 6-point Likert scale. Phase 2 consisted of a hands-on environmental hygiene audit where PCAs cleaned five UV-marked high-touch surfaces, with compliance verified by UV torch. In the Check phase, pre- and post-test scores were analyzed using a paired t-test. Audit results were evaluated against an 80% compliance threshold. In the Act phase, immediate feedback was provided, with re-assessment for any initial failures, and successful materials were institutionalized for ongoing training.
Result & Outcome: :
All PCAs (n=19) completed the programme. Phase 1 yielded a statistically significant increase in mean MCQ scores from 8.63 to 14.26 (p< 0.0001, paired t-test). Likert scale responses indicated strong agreement regarding material effectiveness and relevance (mean scores ranging from 5.57 to 5.84). In Phase 2, all participants passed the environmental audit on their first attempt, achieving 98.9% compliance. Subsequently, environmental MRSA positivity declined from 40% at baseline (April 2025) to zero by July 2025, demonstrating the effectiveness of the intervention. The reusable, cost-effective programme was highly recommended for future use.
