Authors (including presenting author) :
Lam HY (1), Ng Tracy (1), I Wong (1), Chan TC(2)
Affiliation :
Department of Nursing, TWGHs Fung Yiu King Hospital (1) Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital (2)
Introduction :
MRSA bacteremia was the Key Performance Indicator in Hospital Infection Statistics. The surveillance would be quarterly update on MDRO statistics of CICO webpages. However, the MRSA bacteremia statistics with the rising trend from 2017 Q2 (above 0.100 per 1000 patient day) and reached to the histological high in 2018 Q2 (0.225 per 1000 patient day) and Q3 (0.200 per 1000 patient day in FYKH. Major contributing factors for the high MRSA bacteremia were (1) no regular assessment / audit for the phlebotomists’ blood culture sampling technique (2) no regular screening for the indication of blood culture sampling (3) difficult to trace back for the sampling technique by the practitioner as no identity information of the health care practitioner was recorded. The alarming statistic persuaded the FYKH Infection Control Team to implement the bundle approach in monitoring and reviewing the blood culture sampling approach in TWHGs Fung Yiu King Hospital.
Objectives :
To keep the MRSA bacteria statistic in TWHGs Fung Yiu King Hospital below 0.100 per 1000 patient day.
Methodology :
The operation work for the improvement was started in January 2019. The improvements measures are divided into 2 streams: For the management approach, review and update the in house rules/guideline of the blood culture sampling: Invasive procedure including blood sampling should be excluded from patient recruited in the ‘End-of-life’ program. M.O orientation program was arranged to each new batch of Medical Offer upon rotation for reminding: (1) the aseptic technique of blood culture (2) no blood culture for the patients in ‘End of Life’ program Staff should inform ICN for the blood culture treatment. ICN would screening the case and on-site audit the blood culture sampling procedure performed by the phlebotomist or staffs during office hours. For practical approach: Regularly checking and replace the stocks of the blood culture sampling devices (e.g. sterile & single use vacutainer, disposable –for contact precaution patients & reusable tourniquet – for standard precaution patients, 2% CHG in 70% alcohol swab stick etc.) Regular update the latest blood culture collection procedure of the blood culture sampling for the phlebotomist according to the HA guideline. Provide on-site assessment for blood culture sampling technique during office hour and give recommendation and advises to the phlebotomist for the skill improvement. Periodically review the MRSA bacteremia surveillance
Result & Outcome :
The MRSA bacteremia incidents successfully decreased from 0.225 per 1000 patient day in 2018 Q2, to 0.065 per 1000 patient day in 2019 Q1, 0.066 per 1000 patient day in 2019 2Q and 0.00 in 2019 3Q in FYKH.
