Effectiveness Of The Bundle Interventions On ICU Infection Caused By Multi-drug Resistant Bacteria

1. BackgroundIntensive care unit (ICU) is a department assembled of critical patients. The hospital acquired infection of ICU is usually serious, the infection rate may up to 28.7%. The common exsist of multi-drug resistant bacteria in the ICU environment is an important source of ICU infection. A hospital in the United States was found that in all patients with mechanical ventilation, there are 31% Bauman Acinetobacter colonization or infection, of which 27% for multi-drug resistant Acinetobacter. Because the treatment of infection caused by multi-drug resistant organism (MDRO) is complex and difficult, the prevention of MDRO turns to be very important. The way MDRO related hospital infections is various and complex, only single intervention is not enough. The study attempts to establish a feasible clustering intervention measures, called bundle interventions, to prevent and control MDRO transmission and infection during the whole staying in ICU. Then, the study try to evaluate the effectiveness of the bundles in prevention and control on MDRO related hospital infection in ICU, and to see if it can reduce nosocomial infection rate in ICU.2. Participants and Methods2.1 ParticipantsThe patients admitted into ICU in 2013 were taken as control group, and implemented by common ward management. The patients admitted into ICU in 2015 were taken as intervention group, and implemented by the bundle interventions for the prevention of MDRO.2.2 Research methodsThe experimental research method of historical comparison was taken in this research. The intervention time was 1 year.2.3 Intervention measuresIntervention bundles to prevent MDRO were established and implemented, including improving multi-drug resistant bacteria management system and organization, hand hygiene, environment cleaning, rational use of antimicrobial drugs, strict invasive operation, contact isolation of MDRO carrier.2.4 Data collection and statistical analysisData collection included patients’ basic information, the implementation of the bundle interventions, ICU acquired infection and MDRO related nosocomial infection.T test was used for continuous variable data, chi square test was used for categorical variable data, rank sum test was used for grade data. Spss19.0 was used for all the data analysis. P< 0.05 was statistically significant difference.3. Results3.1 Basic information of patientsA total of 1537 patients were observed, including 937 males and 600 females, with an average age of 66.33±16.64 years. There was no significant statistically difference between the two groups in gender, age, acute physiology and chronic health score (APACHE Ⅱ score), average ICU days and basic disease.3.2 The implementation of intervention bundlesEnvironmental test found that qualified rate of object surface in intervention group (99.01%) was higher than that of the control group (93.79%), P<0.05. The intervention group of antibiotics usage (90.98%) was lower than that in control group (93.88%), submission rate rose from 71.2% to 81.47%, total positive rate rose from 76.72% to 97.39%, P<0.05.hand hygiene compliance increased from 64.17% to 80.56%, the accuracy rate increased from 79.22% to 85.52%, P<0.05. Compared with the control group, the intervention group has statistically significant improvement in the implementation of each contact isolation measures, P<0.05.3.3 The changes of nosocomial infection after interventionThe total nosocomial infection rate decreased from 15.56% to 8.07%, P<0.05. The two groups of infection position were the same, mainly for lower respiratory tract infection, followed by urinary tract infection, bloodstream infection. Comparing of the two groups of device usage and infection rate found that in the intervention group device usage was less than in the control group, and the difference is statistically significant. The device associated infection rate was lower than that of the control group, especially catheter associated urinary tract infection was dropped from 4.88 to 2.22, which is statistically significant (P< 0.05).The main nosocomial infection MDRO are carbapenems-resistant Acinetobacter Bauman(CR-AB), multi-drug resistant Pseudomonas aeruginosa(MDR-PA), methicillin-resistant Staphylococcus aureus (MRSA), ESBL producing Klebsiella pneumonia and Escherichia coli. There was no significant difference in the detection rate of pathogen and multi-drug resistant bacteria. The infection rate of multi drug resistant bacteria was decreased from 48.72% to 11.90%, which is statistically significant (P< 0.05). The hospital infection rates of multi drug resistant Klebsiella pneumoniae and Pseudomonas aeruginosa were decreased from 28.7% to 11.76%, 22.22% to 4.41% respectively, and the multi-drug resistant Acinetobacter Bauman was increased from 9.26% to 27.94%.ICU patients’outcomes turned better. Hospital stay in the intervention group were less than the control group, the difference was statistically significant. Meanwhile, treatment outcome was also different, cured or improved patients were more in the intervention group.4. ConclusionIntervention bundles can reduce the ICU nosocomial infection rate and total hospital acquired infection rate caused by MDRO, especially in decreasing the catheter associated urinary tract infection, can reduce hospital acquired infection caused by multi-drug resistant Pseudomonas aeruginosa and multi-drug resistant pneumonia Klebsiella pneumoniae, thus reducing ICU length of hospital stay and improve the treatment outcome. If possible, these intervention bundles should be promoted in other unit, in order to prevent MDRO infection better in hospital.