BACKGROUND The Sangre Grande Hospital (SGH) experienced several Multi Drug Resistant Organism (MDRO) outbreaks for 2015. In this regard, a study was conducted to understand factors contributing to MDRO acquisition and control, for policy and implementation of prevention and control measures. METHODOLOGY A Case-Control Study Design was chosen to execute this research project in order to determine risk factors and factors associated with control of the outbreaks. This was done retrospectively from January to March 2015. Cases and controls were unmatched. Cases were defined as patients admitted to wards with a contracted MDRO, discharged or died and had a medical or surgical diagnosis. MDROs included Methicillin resistant Staphylococcus aureus (MRSA) and Multi Drug Resistant Gram-Negative Bacilli (MDRGNB). Controls were any other patients on the wards with similar demographics and diagnosis and disposition, not infected or colonized with a MDRO and had a medical or surgical diagnosis. RESULTS Eight (8) cases and ten (10) Controls were incorporated in the study. Patients recently hospitalized had 14 times the odds of the group not recently hospitalized, of developing a MDRO, 95% CI: 1.1352 – 172.6502, p = 0.05. Length of Stay (LOS) on the ward for a minimum of five days showed a significant association with MDRO acquisition (p < 0.036). The main contributory factors to increased MDRO acquisition: greater than one (1) invasive devices, urinary catheter and/or central venous catheter (p < 0.043 and p < 0.007 respectively). Most MDRO cases had at least one invasive device attached to them during their stay on the ward: Central Venous Catheter (CVC), a Urinary Catheter or both. MDRO cases mean LOS: 29.5 days (19.27 S.D.) as opposed to the controls with 5.2 days (4.29 S.D.). CONCLUSION There is a significant association between recent hospitalization and developing an MDRO. Patients with an MDRO also stayed a mean of 29.5 days compared to 5.2 days for controls.
Objectives To assess the compliance of hand hygiene (HH) practices of staff and determine the impact of multimodal interventions to improve hand hygiene practices. Methods A prospective study was conducted to determine the hand hygiene (HH) practices of staff according to the World Health Organization’s “5 moments of HH”. During random visits to the general wards, HH practices of staff were observed for 41 weeks during 2014-15. During the first 8 weeks, the basic compliance rate (BCR) was calculated. A BCR of 50% or more was considered compliant. Data were provided to the staff via email. Toolbox talks, posters, and other educational interventions were instituted in a multimodal manner. Wards were visited by infection control staff to reinforce HH practices. During the post-intervention phase, the HH practices were reassessed for 33 weeks to compare the impact of interventions. Results A total of 13,120 observations were made. Participants ranged from ages 18 to 65. The overall average BCR before intervention was 34.1%, for the first 8 weeks, while it increased to 62.3%, over the next 33 weeks, after the multimodal interventions (p =0.007). The wards which showed significant improvement include Paediatrics (p <0.0001), Male Surgical (p = 0.001), Female Surgical (p = 0.005), Male Medical (p < 0.0001), Haemodialysis Unit (p < 0.0001), ICU, (p = 0.038), and Accident and Emergency (p = 0.007). Obstetric, Female Medical, and Oncology wards did not show statistically significant improvement. Conclusion Hand Hygiene compliance rate of staff can be improved by multimodal interventions in a General Hospital setting.
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