Prevention management of antimicrobial resistant infections in medical and negative pressure ward: A case study in Thammasat University Hospital

Abstract

       Antimicrobial-resistant infections are a major problem in hospitals all over the world, including Thailand. These infections lead to decreased patient recovery, prolonged hospital stays, and increased use of expensive antibiotics. All of which result in higher treatment costs. Effective management can help reduce the incidence and impact of antimicrobial-resistant infections. This approach involves key elements: reducing the chance of infection and preventing its spread. This article aims to present the management experience of the medical and negative pressure ward at Thammasat University Hospital. For this development, management principles derived from the 4M1E concept and the Deming cycle served as guiding principles.

        Applying the 4M1E framework to analyze the main factors related to infection, we identified: 1) patient factors, 2) personnel practices, 3) tools/equipment, 4) management of work systems, 5) patient care processes, and 6) environmental factors. These findings were then used to develop continuous care interventions based on three rounds of the Deming cycle. These interventions, aimed at preventing antimicrobial-resistant infections in the medical and negative pressure ward, consisted of 11 elements: standard operating procedures, team-based care, zoning of patients with drug-resistant infections, zoning of at-risk patients, and establishment of an infection surveillance group, nurse safety rounds, communication, stimulation and warnings, equipment preparation, hand hygiene, training of care team skills, supervision, and monitoring. The results showed that the incidence of severe drug-resistant infections decreased from 24 cases in 2023 to 8 cases in 2024. These guidelines can be applied to prevent drug resistant infection in other wards.