A Hospital Infection Management Department-Led Intervention to Improve the Pathogen Submission Rate Before Antimicrobial Therapy Using a FOCUS-PDCA Model.

Abstract

Background: Antimicrobial resistance (AMR) is a growing global public health threat, which is primarily driven by the irrational use of antibiotics. Enhancing the pathogen submission rate before antimicrobial therapy is crucial for effective antimicrobial management in healthcare institutions. This study aimed to improve this rate using the FOCUS-PDCA (Find, Orgnize, Clarify, Understand, Select, Plan, Do, Check, Act) model in a tertiary hospital.

Methods: The present study was conducted from 2021 to 2024, applying the FOCUS-PDCA model. Led by the Hospital Infection Management Department, a multi-disciplinary collaboration team was set up, with indicators and problems as the guide. The interventions included improving information monitoring technology, optimizing specimen collection and delivery processes, strengthening regulatory efforts, and establishing a diversified training system. Data were collected from 56 clinical departments and compared before and after intervention.

Results: The pathogen submission rate before antimicrobial therapy was notably increased from 64.99% in 2021 to 76.40% in 2024 (p < 0.001), with a similar increase in the targeted pathogen submission rate from 55.51% to 69.48% (p < 0.001). The pathogen submission rate related to hospital-acquired infections (HAIs) and the pathogen submission rate before the combined use of key antibiotics were also improved. Specimen quality was enhanced, with the proportion of sterile specimens increasing from 38.07% to 43.24% (p < 0.001). Detection rates of multidrug- resistant organisms (MDRO) were decreased overall, with notable declines in MRSA, CRPA, and CRKP.

Conclusion: The FOCUS-PDCA model effectively improved pathogen submission rates and specimen quality, reduced the detection rate of MDRO, and promoted rational antimicrobial use. This approach provides valuable experience for other clinical institutions aiming to enhance antimicrobial stewardship.