The Impact of an Enhanced Infection Prevention Bundle on Gram-Negative Infection Rates

Abstract

BACKGROUND: Gram-negative bacteria (GNB) are a growing concern for hospitals due to the reduced susceptibility to antibiotics. The purpose of this study was to compare the rate of hospital-associated GNB (HA-GNB) infections before and after the implementation of an enhanced infection prevention (IP) bundle that included pulsed-xenon ultraviolet light (PX-UV) room disinfection, hand hygiene, and an awareness campaign that brought heightened attention to the facility's infection rates and IP program. METHODS: This quasi-experimental study compared the intervention period (December 2017 – October 2018) to baseline period (November 2016 – October 2017). November 2017 was a “washout” period between baseline and implementation. The enhanced IP bundle was implemented on four study units and was the only change that occurred on the units during the intervention period. New hand hygiene stations were installed to improve accessibility and patient rooms were disinfected with PX-UV after manual cleaning for every discharge and transfer across the study units throughout the intervention period. A negative binomial model was used to assess the relative risk of HA-GNB from baseline to post implementation with alpha=0.05 considered statistically significant. RESULTS: On average, 90% of patient rooms were disinfected with PX-UV during the intervention period. Overall hand hygiene compliance increased from 55% to 77%. The rate of HA-GNB infections dropped by 75% from baseline to post-implementation (from 8.22 to 2.05 infections per 10,000 patient-days). The relative risk of HA-GNB was statistically significantly lower during the intervention compared to baseline (RR=0.25; 95% CI 0.09, 0.66; p=0.005). CONCLUSIONS: Our enhanced bundle was successful at reducing the rate of HA-GNB for a number of reasons. We had support from hospital leadership, unit staff were engaged throughout the intervention, and there was EVS buy-in for using PX-UV robots after manual cleaning.