American journal of infection control · 2026
Effect of a closed-loop audit and feedback system on compliance with multidrug-resistant organism prevention measures.
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Gao Qing, Gao Zhao, Wang Yan, Zhang Yinghua, Dai Qili, Yu Wanming, Cai Ling, Guo Kangle, He Yanzhi, Zhang Siying, Fan Yuqing
Аннотация
BACKGROUND: Knowledge-practice gaps hinder consistent compliance with multidrug-resistant organism (MDRO) prevention measures. We evaluated the impact of an integrated closed-loop audit and feedback system on infection prevention and control (IPC) adherence.
METHODS: This prospective pre-post study (2024-2025) implemented standardized checklist audits, fluorescent marker monitoring, and real-time mobile application feedback. Data were analyzed using generalized estimating equation (GEE) and Pareto analysis to identify independent predictors and key improvement drivers.
RESULTS: The intervention independently increased overall compliance by 24.97 percentage points (95% CI: 22.28-27.66, P < .001), with median compliance rising from 58.82%-84.62%. Pareto analysis showed that 13 key measures, including terminal cleaning, intensive caregiver engagement, and standardized isolation protocols, drove 82.34% of improvements. Bedside and single-room isolation were positive predictors, while informal caregiver presence was a negative predictor (β = -13.11, P < .001). Environmental cleaning compliance was 82.58%, with deficiencies noted on small, irregular surfaces. Post-intervention MDRO detection rates remained consistently below the 34.37% baseline.
CONCLUSIONS: The closed-loop system significantly enhanced compliance with IPC. Sustainable containment requires integrating precision microisolation and structured caregiver management into clinical workflows.
METHODS: This prospective pre-post study (2024-2025) implemented standardized checklist audits, fluorescent marker monitoring, and real-time mobile application feedback. Data were analyzed using generalized estimating equation (GEE) and Pareto analysis to identify independent predictors and key improvement drivers.
RESULTS: The intervention independently increased overall compliance by 24.97 percentage points (95% CI: 22.28-27.66, P < .001), with median compliance rising from 58.82%-84.62%. Pareto analysis showed that 13 key measures, including terminal cleaning, intensive caregiver engagement, and standardized isolation protocols, drove 82.34% of improvements. Bedside and single-room isolation were positive predictors, while informal caregiver presence was a negative predictor (β = -13.11, P < .001). Environmental cleaning compliance was 82.58%, with deficiencies noted on small, irregular surfaces. Post-intervention MDRO detection rates remained consistently below the 34.37% baseline.
CONCLUSIONS: The closed-loop system significantly enhanced compliance with IPC. Sustainable containment requires integrating precision microisolation and structured caregiver management into clinical workflows.