Effect of a Closed-Loop Audit and Feedback System on Compliance with Multidrug-Resistant Organism Prevention Measures.

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 < 0.001), with median compliance rising from 58.82% to 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 < 0.001). 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 micro-isolation and structured caregiver management into clinical workflows.