Authors: (including presenting author): :
Wong YM(1), Lai WMY(1), Wong WM(1), Chow SH(1), Yip PN(1), Chen MN(1), Ng SL(1), Wong KM(1), Tam GY(1), Chau KY(1), Tsin LK(1), Tsang HY(1), Kong HY(1), Chen WY(1)
Affiliation: :
(1) Infection Control Team, Pamela Youde Nethersole Eastern Hospital
Introduction: :
Emergence of Multi-drug Resistant Acinetobacter (MDRA) causing hospital-acquired infections (HAIs) is well-known worldwide. An upsurge of MDRA cases with 28 HAI-MDRA cases were found in the Department of Medicine (MED) between Jan to May 2020, while only 28 HAI-MDRA cases detected in 2019.
With reference to evidence had showed MDRA can survive on environmental surfaces for months, increased the risk of transmission and hinder difficulty in control in anticipated. An active environmental sampling program was conducted in the Department of Medicine.
Objectives: :
- To investigate the level of environmental contamination in the in-patient ward
- To heighten staff awareness of environmental hygiene
Methodology: :
An active environmental sampling for MDRA performed across different in-patient wards in MED since June 2020. Sampling wards were divided into “Hot” Ward where had recent MDRA outbreak and “Non Hot Ward” as control. Sampling sites were stratified into four different zones. The environmental sampling would be performed repeatedly whenever positive site(s) was detected until results achieved “Zero-positive”.
To evaluate the effectiveness of active environmental monitoring, evaluation conducted after 6 months to see whether the measures could minimize the number of positive MDRA isolate.
Univariate analysis for the categorical value was performed using Pearson Chi-Square Test or Continuity Correction depended on the minimum expected count.
Result & Outcome: :
A total of 20 periodical MDRA environmental sampling conducted in 13 wards (Hot wards: 3 and Non Hot wards: 10) with the overall positive rate at 12.9% (51/395). Positivity rate was 11.1% (23/207) and 14.9% (28/188) for the “Hot Ward” and “Non Hot Ward” respectively. The “Non Hot Ward” had a higher MDRA positive rate.
Among the 20 times of samplings, 40% (8/20) had to perform repeated environmental sampling (range: 0 to 3) to achieve “Zero-positive”.
Top 3 sites with frequent MDRA contamination were Soiled Linen bucket (30.8%), Kardex trolley (23.1%) and Napkin trolley (22.2%). When stratified the sampling site into different zones, Zone C were found to have the highest MDRA contamination.
Zone A: Computer station, Kardex trolley, Nurses station (+ve:11%)
Zone B: Blood taking trolley, Injection trolley, Medical Equipment, Medication trolley, Procedure trolley (+ve:8%)
Zone C: Dirty utility, Napkin trolley, Soiled Linen bucket, Urinal trolley (+ve:21%)
Zone D: Curtain, High touch area, Sink and drain (+ve:12%)
When comparing the environmental sampling result (57/177) before this programme launched (Jan 20 to May 20), the number of positive sample detected were statistically significant lower after implementation of this active periodical environmental sampling (Odds Ratio [OR]: 0.460; 95% Confidence Interval [CI]: 0.303, 0.700; P = 0.0002).
A systematic, active environmental sampling was able to increase the staff awareness on the importance of thorough and proper environmental decontamination. This environmental sampling program was able to reduce the MDRA contamination in the in-patient setting, so as to lower the possibility of MDRA transmission among the patients, staff and environment. The quantified data provided precise information for future improvement and education in healthcare setting.
