Impact of Cohorting for Multidrug-Resistant Organisms with and without Real-Time Feedback

Abstract

A 2-period observational study was conducted to evaluate the effect of creating a cohort area with and without frequent real-time feedback on compliance with infection prevention practices to prevent transmission of multidrug-resistant organisms (MDROs) in a 30-bed open unit at Thammasat University, Pathumthani, Thailand. An 8-bed cohort area was created in the unit, with one nurse per shift being assigned to care for patients in this area. Two one-hour educational sessions per month were provided to all unit nurses on the importance of adherence to infection control measures. Observations using a standardized data collection tool were performed by infectious diseases physicians on isolation equipment preparation (e.g., isolation signs being posted and availability of isolation equipment, such as gloves, gowns, masks, alcohol gel, and stethoscopes), infection control practices (e.g., hand hygiene before and after patient contact, appropriate use of gloves and gowns, and environmental cleaning), and time spent with each patient. In period 1 (1-30 September 2012) no feedback of observations was given to the staff, while in period 2 (1-30 November 2012) real-time feedback on infection control adherence was provided to healthcare workers (HCWs) in the cohort area. 600 observations were performed, 300 in each period. In period 1, there was no significant difference in isolation equipment preparation and infection control compliance between the cohort and non-cohort areas. In period 2, there was a significantly higher compliance with infection control practices in the cohort than in the non-cohort area, and HCWs spent more time caring for patients in the cohort area. Notably, compliance with gown use was still low in the cohort area (37.2%). When comparing period 2 with period 1, there was a significant increase in the frequency of environmental cleaning in the cohort and non-cohort area, and the proportion of each specific MDRO (ESBL-producing Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus) was different. However, there was no significant change in other isolation precaution practices within the non-cohort area. This study suggests that compliance of contact isolation and hand hygiene is significantly increased only when frequent real-time feedback (3 times per week) is performed and that creating a cohort area alone is insufficient to change HCW behaviour. Additional studies are needed to evaluate the impact of strategies to prevent the transmission of MDROs in resource-limited healthcare settings.