A Multidisciplinary-Based and Bundle Intervention for Controlling Carbapenem-Resistant Organisms in Neurosurgery.

Abstract

Purpose: Carbapenem-resistant organisms (CROs) have been listed as the primary risk resistance bacteria due to their high detection rates and extensive drug resistance. Research on the effectiveness of CRO intervention programs in secondary hospitals is limited. This study aims to observe the effect of multidisciplinary-based and bundle interventions under PDCA (plan-do-check-act) cycle management on the control of CROs in neurosurgery.

Patients and methods: We conducted a before-after study from January 2021 to December 2023, which was divided into pre-intervention phase and intervention phase. The surveillance analysis and event analysis were used to identify the key links and targeted pathogens of the intervention. PDCA cycle management tool was used to strengthen the bundle management of multidisciplinary collaboration. After one year of PDCA intervention, the process surveillance and outcome surveillance indicators of prevention and control measures from January 2023 to December 2023 were collected and compared with the pre-intervention phase (January 2021-December 2022).

Results: A total of 1809 patients were involved in our study. The 11 prevention and control measures were evaluated. After the implementation of PDCA cycle management, the measures including timely completion of multi-drug resistance prevention and control registration, and issuance of contact precaution orders, were significantly improved (p < 0.05). The total detection rate of CRO strains was 52.25%, which was significantly lower than 66.45% before intervention (RR = 0.786; 95% CI, 0.678-0.912; p < 0.05), and the incidence density of patients infected or colonized with CROs showed significant decrease from 18.75 per 1000 patient-days to 15.09 per 1000 patient-days (IRR = 0.563; 95% CI, 0.449-0.707; p < 0.05).

Conclusion: The multidisciplinary and bundle interventions based on PDCA cycle management tool had a good effect on the prevention and control of CROs in neurosurgery.