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How to improve hospital admission screening for patients at risk of multidrug-resistant organism carriage: a before-and-after interventional study and cost-effectiveness analysis.
Joubert, Dominique; Cullati, Stephane; Briot, Pascal; Righi, Lorenzo; Grauser, Damien; Ourahmoune, Aimad; Chopard, Pierre.
Afiliação
  • Joubert D; Nursing Department, Quality of care, University Hospitals of Geneva, Geneva, Switzerland dominique.joubert@hcuge.ch.
  • Cullati S; Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.
  • Briot P; Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
  • Righi L; Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.
  • Grauser D; Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.
  • Ourahmoune A; IT System Department, University Hospitals of Geneva, Geneva, Switzerland.
  • Chopard P; Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.
BMJ Open Qual ; 11(2)2022 04.
Article em En | MEDLINE | ID: mdl-35483731
BACKGROUND: Infection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings. METHODS: In the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record 'order-set' including AS and AP compliance indicators was designed. We compared the cost-benefit of the audits and the automated indicators for AS and AP compliance. RESULTS: Compliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested. CONCLUSION: Training ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecção Hospitalar / Farmacorresistência Bacteriana Múltipla Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecção Hospitalar / Farmacorresistência Bacteriana Múltipla Idioma: En Ano de publicação: 2022 Tipo de documento: Article