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

Article Article scientifique Article 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 eng 2022-04-28 2022-04 author Joubert Dominique 0000-0001-5530-101X 624197 author Cullati Stéphane 0000-0002-3881-446X 524286 author Briot Pascal 862820 author Righi Lorenzo 884435 author Grauser Damien author Ourahmoune Aimad 0000-0002-8884-4034 829222 author Chopard Pierre André 0009-0009-9993-827X 24647 e001699 10.1136/bmjoq-2021-001699 35483731 2399-6641 PMC9052048 https://bmjopenquality.bmj.com/content/11/2/e001699 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. Cost-effectiveness Education Infection control Quality improvement Quality measurement Cost-Benefit Analysis Cross Infection / prevention & control Cross-Sectional Studies Drug Resistance, Multiple, Bacterial Hospitals, University Humans Dewey 617 Dewey 618.97 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 65 Département de réadaptation et gériatrie 22B false 1296 Evaluation en qualité des soins 1012 BMJ open quality 11 2 2faff38d-8814-4aec-897b-f0302c0ae88e Article (Published version) Public Article-scientifique-from-europePmc.pdf 416686 application/pdf CC BY-NC-4.0 90dc9663-38f4-4dbd-a382-daf5f36928cd Supplemental data Public bmjoq-2021-001699supp001_data_suppl.pdf 72124 application/pdf 458911c1-f89a-4ebc-9eb0-373f62c9a69c Supplemental data Public bmjoq-2021-001699supp002_data_suppl.pdf 81202 application/pdf Table S1 4f7f6ad9-795b-417c-865a-896c3bdebf42 Supplemental data Public bmjoq-2021-001699supp003_data_suppl.pdf 164055 application/pdf S Figure 1 9c029460-3397-482e-9d1e-8b7c15bc5420 Supplemental data Public bmjoq-2021-001699supp004_data_suppl.pdf 111666 application/pdf Table 3 & 4 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de réadaptation et gériatrie

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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	BMJ open quality			2022	217	166

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