A prospective evaluation of interventions to reduce the MDRO rate in ICU

Abstract

Background: Carbapenem resistance among the Gram negative rods is on the increase. Poor infection control practices are a major cause of these bugs becoming “endemic” in various ICUs. Hypothesis: Providing the nurses with target based incentives is an effective method for implementation of infection control principles. Methods & Materials: All admissions to the MDICU during the 18 months (January 1st 2012 to June 30th 2013) were included. Only Carbapenem Resistant Isolates among Gram Negative Bacilli were included in the surveillance. MDRO rates were calculated every month as Number of Carbapenem Resistant Isolates among Gram Negative bugs per 100 ICU admissions. Average Length of Stay in the ICU was calculated. Hand Hygiene compliance rates were calculated using the WHO Five Moments format every month. Interventions were introduced in sequential manner (every 6 months). The first intervention bundle comprised of cohorting of patients, enhanced training, evaluation of cleaning with ATP based monitoring and feedback, and a Restrictive policy on Carbapenem use. (only for hemodynamically unstable/immuno-compromised patients or based on culture results). After 6 months the incentives for target achievement were introduced.The nurses were provided with a target–to reduce Carbapenem Resistant isolates by 25% of the baseline (preceding 6 months average) within 3 months–and an incentive on achieving this target–cash awards & Letter of Appreciation from the Hospital Management followed by 15% increase over the regular yearly increment in pay if the rates stayed low (sustained effect) over next one year. Results: The MDRO rate came down from 15.5% in January 2012 (baseline) to 6% in June 2013 (end of 18 months)The hand hygiene compliance rates increased from 49% to 77% during the study period.The Average Length of Stay in the MDICU decreased from 5.7 days to 4.7 days during the study period.There was no significant change in the bed occupancy rate (97% to 95%)There was no significant change in Meropenem consumption during the study period. Conclusion: The preliminary results do suggest that incentives for achieving reasonable targets would be very effective in improving compliance to infection control practices as evidenced by the fall in MDRO rates.