Zero projects: compliance and evaluation of direct observation checklist as surveillance method

BACKGROUND: The multimodal projects: “Zero Urinary Tract Infection” (Z-UTI), “Zero Resistance” (Z-R), “Zero Pneumonia” (Z-P) and “Zero Bacteraemia” (Z-B) consist in implementing a bundle of evidence-based recommendations to prevent healthcare-associated infections (HAIs) and acquisition of multidrug-resistant bacteria (MDR-B) during patient's intensive care unit stay. They have been instituted in our tertiary hospital for several years and in order to assess compliance, we perform surveillance based on direct observation checklist. The aim was to examine compliance of recommendations and to evaluate direct observation as surveillance method. METHODS: Descriptive analysis of audits performed between 2020-2022. Compliance was estimated as the average of “yes”-marked percentage. Recommendations with “yes”-marked below 50% were excluded. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of direct observation checklist was conducted. RESULTS: Regarding Z-R (n = 129 observations) compliance was 86.5%.”Giving information about isolation to family” was excluded registering 55.4% “not seen”-marked. In Z-P (n = 262 obs.) compliance was 82.3%. “Hand hygiene and sterile technique for bronchial secretions aspiration” was excluded registering 48.2% “not seen”-marked. As for Z-UTI (n = 607 obs.) compliance was 92,5% (excluded: 4 standards with 78.2% “not seen”-marked). In Z-B (n = 988 obs.) compliance was 78.5% (excluded: 4 standards with 80.6% “not seen”-marked; 1 standard with 49.5% “not appropriate”-marked). Surveillance of projects by direct observation allows in-the-moment feedback but some recommendations could be checked as “not seen” due to observation's schedule. Lack of time and people involved could threaten surveillance. However, HAIs and MDR-B are a major public health problem to deal with. CONCLUSIONS: Study demonstrates good compliance of recommendations, existing standards with high “not seen” percentages. SWOT analysis gives guidance on doing effective surveillance. KEY MESSAGES: • Due to increasing concern of MDR-B acquisition and HAIs, is crucial to develop projects including evidence-based recommendations to prevent this major public health problem. • Once we develop a strategy we must become able to monitor it and moreover, evaluate how we are doing surveillance in order to improve and make changes if necessary.