QAPI 115 - Increasing Infection Prevention Practices in a Trauma/burn ICU with Heightened Awareness of Multiple Drug-resistant Organisms

Background: The burn program at an academic medical center experienced an increase in burn patient census in 2021. Critically ill burn patients are placed in an intensive care unit (ICU) serving burn, trauma and neurosurgery patients. Burn patients are at an increased risk for severe multiple drug-resistant organism (MDRO) infections, and burn-specific interventions are necessary to effectively reduce the infection risk in this patient population.

Methods: A pre-post interventional study was conducted starting in April 2021 to measure the impact of burn-specific infection prevention protocols on MDRO acquisition. For this study, a multidisciplinary team standardized procedures for bedside burn dressing changes and bedside bronchoscopies, expanded contact isolation for all burn patients, eliminated use of portable computer workstations inside patient rooms, mitigated water contamination risks from both sinks and ventilator circuits, enhanced environmental disinfection, reinforced hand hygiene practices among healthcare workers and patients, and implemented targeted active surveillance culturing. Rates of MDRO acquisition from the baseline period were compared to the post-implementation period using a rate ratio (RR). MDROs included in the analysis were carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter, and extended-spectrum beta-lactamase producing organisms. All isolates were determined to be healthcare facility-onset (HO) when the initial specimen was collected on or after hospital day 4.

Results: The HO-MDRO rate during the baseline period was 6.74 isolates/10,000 patient days and decreased to 3.57 in the intervention period. This represents a 47.1% reduction in HO-MDRO Rate (RR: 0.529, p-value < 0.001).

Conclusions: In 2021, IP worked with multiple stakeholders to implement identified action items to create a culture of enhanced IP practices in the ICU. Implementation and adherence to these practices has lowered rates of HO-MDROs among trauma and burn patients. This work is ongoing as we continue to see a steady increase in MDROs in the United States.