Multidisciplinary Strategy Assessment

Introduction

The rapid spread of multidrug-resistant organisms (MDROs) in hospitals has become a global public health threat. At present, the drug resistance problem in China is more serious than that in some developed countries.1 Among them, the most attention needs to be paid to carbapenem-resistant organisms (CROs), which have been listed as the primary risk resistance bacteria of WHO due to its high detection rate and extensive drug resistance.2 It mainly includes carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA).3,4 Carbapenem-resistant Klebsiella pneumonia (CRKP) and carbapenem-resistant Escherichia coli (CREC) were the main CRE.5 CROs are among the most challenging antibiotic-resistant pathogens to emerge in the clinical setting. They spread rapidly in healthcare environments and can lead to significant outbreaks by contaminating the environment, equipment, and hands, particularly in institutions with limited infection prevention and control (IPC) resources.4,6 Their extensive or pan-drugresistance results in very limited therapeutic options, causing high mortality rates in infected patients.

Formulation of Multidisciplinary Collaborative Bundle Management Measures CROs infection management is complicated and involves multiple disciplines and departments, so it is urgent to propose collaborative and bundle prevention and control plans in multi-disciplinary team (MDT). In 2023, a MDT management team was established under the unified leadership of the director in charge of hospital infection control, with the participation of department of IPC, neurosurgery, the clinical microbiology laboratory, nursing department. 

Assignment Task 

1. What was the main problems that this PDCA cycle addressed?

2. What were the main causes of the problems related to Carbapenem resistance. What tool was used as part of the analysis to determines the causes of the problem?

3. What were the interventions made as a solution to address the problems that this hospital faced?

4. What were the key indicators used to determine whether the PDCA cycle worked or not? Were they successful? What results were obtained?

5. Why it was important to have a multidisciplinary team for this improvement project?

6. What would be the lessons learnt from this improvement project?
 

Question 1

The research paper was analyzed and the high detection rates and nosocomial spread of Carbapenem-Resistant Organisms (CROs) in the neurosurgery department of a secondary hospital in Shanghai were the key issues encountered in the PDCA cycle. These organisms in particular CRKP, CRAB, and CRPA, which were extremely drug-resistant strains were key public health threats, whose existence resulted in additional morbidity and mortality. The hospital realized a dire need to prevent the spread of CROs, by enhancing the infection control mechanisms (Zhu et al., 2025). In addition, the PDCA cycle was required in order to address embedded issues such as lack of accountability, slow inter-department communication, and the disjointed application of infection control measures. With the absence of a set method for improving things, the hospital’s reactive efforts had been unable to contain the spread of CROs. The PDCA approach sought to develop a react, sustainable and iterative culture of quality improvement based on surveillance data. The World Health Organization (WHO, 2020) has outlined the importance of the addition of such structured quality frameworks in infection control which supports the validity of this approach.

Question 2

The major causes of CRO outbreak were environmental contamination particularly from the ward sinks, poor hand hygiene, lack of awareness amongst caregivers, poor interdepartmental communication, and ineffective antimicrobial management. In order to analyse these causes, the team employed a fishbone diagram (Ishikawa diagram) which classified the contributing factors under environment, staff behaviour, methods, equipment and hospital management. This visual analysis guided the focus on systemic failures that led to the facilitation of CRO transmission (Zhu et al., 2025). Notably, according to fishbone analysis, there was a crucial missing of structural mechanisms like specified hygiene for caregivers and lacked disinfection processes of the sink areas. It also revealed areas of short comings in the senior leadership commitment and responsiveness of pharmacy departments to antimicrobial resistance patterns, highlighting technical aids such as fish bone diagrams as necessary in facilitating collective understanding between a trans disciplinary team. It additionally enabled the stakeholders to jointly deconstruct root causes which resulted into a roadmap for exact, possible, and monitored interventions. This clarity enhanced staff ownership of solutions and the institutions’ accountability towards addressing issues raised.

Question 3

The PDCA model was used while implementing several bundled interventions. These were joining hands to set up a multidisciplinary team (MDT), training the staff and caregivers, putting up active screening and isolation measure, intensifying environmental cleaning (particularly around sinks), and rolling out an antimicrobial stewardship program. Members of the MDT were members of staff in the IPC, neurosurgeons, microbiologists, pharmacists, and nurses. They collaborated to develop and implement targeted action on decreasing infection risks (Zhu et al., 2025). The antimicrobial stewardship program helped to use carbapenems judiciously and strict monitoring, periodic auditing created a feedback loop for a continual improvement. Training was role specific— cleaners were trained on methods of disinfection, while clinicians were given new updates on early-warnings of CROs. Besides that, structural interventions such as sink redesign and fixing of leaking drainage enhanced the environmental safety shape of the ward, confirming the multi-faced nature of successful CRO control strategies. These were done systematically under PDCA model with each plan appropriately checked for results and further improved on, which was evidence based and a cyclical approach to change. Other improvements are caregivers restriction protocols, enhanced signages of contact precautions, and isolation management using data (Wang et al., 2023). In real-time, pharmacists fed back to physicians about antimicrobial usage and environmental sampling verified sanitation measures therefore completing the circle of intervention to effect (Li et al, 2022). The evidence of such multidimensional methods from the similar intervention bundles in tertiary hospitals is supporting these (Wassef et al., 2020).

Question 4

There were two types of indicators that were applied: process indicators and outcome indicators. Process indicators monitored the metric of implementation such as contact precaution orders, MDRO registration, and hand hygiene compliance. Outcome indicators were CRO detection rate, and the incidence density per 1000 patient-days. There was significant improvement; CRO detection rates went down (66.45–52.25%), and incidence density declined (18.75–15.09 per 1000 patient-days). The trend of CRKP was also negatively affected as the rate of detection decreased drastically from 81.15% to 49.40% proving that the PDCA cycle worked (Zhu et al., 2025). Other improvements made included improvement of care givers’ awareness towards hygiene practices (from 17.43 % to 32.14 %) while the practice of terminal disinfection protocols is only lagging behind with 7.33 % of care facilities. Together, these metrics prove the effectiveness of the PDCA model to regulate multidrug-resistant infections in a notoriously risky environment as neurosurgery. The hospital also intends to embed these indicators in the regular quality dashboards, providing for a sustained monitoring. Such findings demonstrate the benefits of incessant monitoring and feedback systems in retaining the effects of interventions and addressing new risks. This is in line with the findings of Odda et al. (2023) as they attributed the role of key performance indicators to long-term infection reduction. Moreover, such indicators help to compare different departments and allow the leadership to see where they should invest more resources or change policies.