European Clinical Trial Drives Quality

The Hospital General Universitario de Alicante (HGU Alicante), 

a key Spanish partner in the REVERSE project, recently shared compelling data demonstrating the power of clinical research to transform healthcare practice. 

The hospital's Medical Director, Dr. Diego Díez, presented the results 

at the 24th Congreso Nacional De Hospitales y Gestión Sanitaria (SEDISA 2025), held in Zaragoza from 28 to 30 May, 2025.

The presentation, titled "Participation in a European Clinical Trial 

as a Tool for Optimising PROA Activities in a Hospital", detailed 

how the REVERSE project has become a fundamental tool for structuring and elevating the hospital's Antimicrobial Stewardship Programme (PROA) activities.

The REVERSE Framework: Structured Improvement

The REVERSE project focuses on implementing and evaluating integrated strategies across three main domains to reduce the incidence of multidrug-resistant infections.

Dr. Díez's presentation summarised the abstract submitted to the SEDISA Congress, outlining the strategies implemented and their impact over the first two years of the trial:

Key Results: Improvements in Hand Hygiene and Antibiotic Use

Infection Prevention and Control

• Hand Hygiene Compliance: The evaluation of compliance showed a "notable increase across all areas in 2024 compared to 2023." Significant improvements were reported in the ICU (from 63.1% to 82%), internal medicine (from 32.9% to 85.7%), and nephrology (from 44% to 59%). 
• MDRO Screening: Following one year of implementation, the hospital decided to discontinue universal screening for Methicillin-resistant Staphylococcus aureus (MRSA) due to the low colonisation prevalence observed: 0.67% (8 patients out of 1,182 samples). Screening was, however, maintained for MDR Gram-negative bacteria.
• Isolation Measures: Overall compliance with isolation measures reached . Notably, adherence was 100% for cases involving multidrug-resistant organisms, though some inadequacy (30%) was observed during the 2024-25 influenza season.

Antibiotic Stewardship

• Surgical Prophylaxis: Following the implementation of updated guidelines (available on www.proabalmis.es), the compliance rate for correct prophylaxis indication reached 84.74%, with adherence to the recommended duration at 76.4%.
• Prescribing Appropriateness: Point-prevalence surveys (PPS) conducted in 2024 showed strong appropriateness rates (80% to 85%) in medical departments (such as Internal Medicine and Nephrology). As is common, surgical departments demonstrated lower compliance, ranging from 55% to 60%. 

Impact on MDROs

Perhaps the most significant finding was the observed reduction in the incidence of certain healthcare-associated infections (HAI) caused by MDRO per 10,000 patient-days in 2024 compared to 2023:

• MRSA: Reduced from 1.52% to 0.39% .
• Carbapenem-resistant Pseudomonas aeruginosa: Reduced from 2.55% to 1.21%.

While the incidence of some organisms remained stable (Carbapenem-resistant Klebsiella pneumoniae and Clostridioides difficile) or saw a slight increase (Vancomycin-resistant Enterococcus faecium), the overall trend validated the coordinated intervention strategy.

Conclusion: Clinical Research as a Quality Tool 

The conclusions presented by Dr. Díez Herrero emphasised that the :

"high standards set by the clinical trial, supported by dedicated project-funded personnel, have demonstrated the capacity to implement and assess multiple coordinated strategies".

The participation in REVERSE has not only optimised the management of infectious diseases but has proven that clinical research is a fundamental tool for improving the quality of care.