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Abdel Hadi H, Eltayeb F, Al Balushi S, Daghfal J, Ahmed F, Mateus C. Evaluation of Hospital Antimicrobial Stewardship Programs: Implementation, Process, Impact, and Outcomes, Review of Systematic Reviews. Antibiotics (Basel) 2024; 13:253. [PMID: 38534688 DOI: 10.3390/antibiotics13030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial Stewardship Programs (ASP) were introduced in healthcare as a public health priority to promote appropriate prescribing of antimicrobials, to reduce adverse events related to antimicrobials, as well as to control the escalating challenges of antimicrobial resistance. To deliver aimed outcome objectives, ASPs involve multiple connected implementation process measures. A systematic review was conducted to evaluate both concepts of ASPs. Guided by PRISMA frames, published systematic reviews (SR) focusing on ASPs restricted to secondary and tertiary healthcare were evaluated over the past 10 years involving all age groups. Out of 265 identified SR studies, 63 met the inclusion criteria. The majority were conducted in Europe and North America, with limited studies from other regions. In the reviewed studies, all age groups were examined, although they were conducted mainly on adults when compared to children and infants. Both process and outcomes measures of ASPs were examined equally and simultaneously through 25 different concepts, dominated by efficacy, antimicrobial resistance, and economic impact, while information technology as well as role of pharmacy and behavioral factors were equally examined. The main broad conclusions from the review were that, across the globe, ASPs demonstrated effectiveness, proved efficacy, and confirmed efficiency, while focused evaluation advocated that developed countries should target medium- and small-sized hospitals while developing countries should continue rolling ASPs across healthcare facilities. Additionally, the future of ASPs should focus on embracing evolving information technology to bridge the gaps in knowledge, skills, and attitude, as well as to enhance appropriate decision making.
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Affiliation(s)
- Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Faiha Eltayeb
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Sara Al Balushi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Joanne Daghfal
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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Tunio S, Dzioba A, Dhami R, Elsayed S, Strychowsky JE. Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study. Laryngoscope 2023; 133:3403-3408. [PMID: 37159098 DOI: 10.1002/lary.30740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). OBJECTIVE The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. METHODS The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. RESULTS Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. CONCLUSION Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3403-3408, 2023.
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Affiliation(s)
- Suhaima Tunio
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Rita Dhami
- Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Sameer Elsayed
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Julie E Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
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Sakaguchi M, Aminaka M, Nishioka M. The roles of bedside nurses in Japan in antimicrobial stewardship. Am J Infect Control 2023; 51:48-55. [PMID: 35231566 DOI: 10.1016/j.ajic.2022.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND In the United States and the United Kingdom, the roles of nurses in antimicrobial stewardship (AS) have been described in guidelines. However, in Japan, no previous studies have clarified nurses' recognition of the role of AS. Moreover, how the AS roles were implemented among nurses in Japan has not been fully clarified. The objectives of this study were to determine the perceptions of infection control nurses (ICNs) in Japan regarding the AS role of nurses and the extent of nurses' practice. METHODS A questionnaire survey of ICNs was conducted. RESULTS Four hundred responses (response rate, 30.8%) were analyzed. Some of the items that have already gained consensus as the AS role of nurses were not recognized as the AS role of nurses by ICNs or had low implementation rates in Japan. Meanwhile, both recognition and implementation rates were high for the 5 types of care proposed. DISCUSSION The reason the ICNs agreed that these 5 types of care are AS roles for nurses is that they know that such care can prevent infection and thereby obviate the need for antimicrobial administration. However, whether nurses themselves understand that these are roles for nurses in AS is unclear. To promote AS in Japan, communicating the fact that nurses already contribute to AS, strengthening nurse education, and improving staffing are desirable.
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Affiliation(s)
- Mikiyo Sakaguchi
- National College of Nursing, Japan, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Mayumi Aminaka
- National College of Nursing, Japan, National Center for Global Health and Medicine, Tokyo, Japan
| | - Midori Nishioka
- National College of Nursing, Japan, National Center for Global Health and Medicine, Tokyo, Japan
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Brink AJ, Richards GA. Antimicrobial Stewardship: Leveraging the "Butterfly Effect" of Hand Hygiene. Antibiotics (Basel) 2022; 11:1348. [PMID: 36290006 PMCID: PMC9598193 DOI: 10.3390/antibiotics11101348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 10/18/2023] Open
Abstract
It is vital that there are coordinated, collaborative efforts to address the threat of antimicrobial resistance (AMR) and to prevent and control the spread of hospital-onset infections, particularly those due to multidrug-resistant (MDR) pathogens. The butterfly effect is a concept in which metaphorically speaking, small, seemingly trivial events ultimately cascade into something of far greater consequence, more specifically by having a non-linear impact on very complex systems. In this regard, antimicrobial stewardship programs (ASP), when implemented alongside infection prevention control (IPC) interventions in hospitals, particularly hand hygiene (HH), are significantly more effective in reducing the development and spread of AMR bacteria than implementation of ASP alone. In this perspective, we briefly review the evidence for the combined effect, and call for closer collaboration between institutional IPC and ASP leadership, and for well-functioning IPC programs to ensure the effectiveness of ASP.
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Affiliation(s)
- Adrian John Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Guy Antony Richards
- Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
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Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital. Antibiotics (Basel) 2022; 11:antibiotics11091172. [PMID: 36139951 PMCID: PMC9495017 DOI: 10.3390/antibiotics11091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016−2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5−8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue.
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Santos-Marques C, Ferreira H, Gonçalves Pereira S. Infection prevention and control strategies against carbapenem resistant Enterobacteriaceae - a systematic review. J Infect Prev 2022; 23:167-185. [PMID: 37256160 PMCID: PMC10226056 DOI: 10.1177/17571774211066762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/17/2021] [Indexed: 09/20/2023] Open
Abstract
Background Antimicrobial resistance is exponentially worsening, and the spread of prevalent carbapenem resistant Enterobacteriaceae (CRE) is a major contributor to this global concern. Infection prevention and control strategies are increasingly consolidated key tools to control this worldwide problem. Aim To identify, collect and analyse available evidence regarding the impact of infection prevention and control strategies on prevalent CRE dissemination. Methods Pubmed®, Scopus® and Web of Science® were searched systematically for articles published between 1th January 2017 and 30th June 2020, guided by the research question 'What are the most effective and efficient strategies to prevent and control infection/colonisation caused by Carbapenem resistant Escherichia coli and Carbapenem resistant Klebsiella pneumoniae?'. Findings Eleven thousand six hundred and thirty-five publications were found, but after applying the inclusion and exclusion criteria, only 30 were selected. The majority of reviewed studies (n = 24) were performed in outbreak situations, 26 studies occurred in acute care units and of those, 17 in intensive care units . From the set of implemented infection prevention and control measures, in 29 studies surveillance cultures were applied, in 23 studies patients were isolated or cohorted and, in general, all described the implementation of standard and contact precaution measures. Conclusion This systematic review underlines the importance of infection prevention and control strategies in CRE dissemination, standing out the need of further studies outside outbreak and intensive care units contexts. Investment increments and training and educating of all involved are also important contributors to shift this problem, but still with relevant gaps in their implementation, in all types of care units, that need to be addressed.
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Affiliation(s)
- Catarina Santos-Marques
- Center for Innovative Care and
Health Technology – ciTechCare, Polytechnic of Leiria, Portugal
- Microbiology Laboratory, Biological
Sciences Department, Faculty of Pharmacy of University of Porto, Portugal
- Research Unit on Applied Molecular
Biosciences – UCIBIO, Portugal
| | - Helena Ferreira
- Microbiology Laboratory, Biological
Sciences Department, Faculty of Pharmacy of University of Porto, Portugal
- Research Unit on Applied Molecular
Biosciences – UCIBIO, Portugal
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and
Health Technology – ciTechCare, Polytechnic of Leiria, Portugal
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Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea. Microbiol Spectr 2022; 10:e0033522. [PMID: 35467411 PMCID: PMC9241935 DOI: 10.1128/spectrum.00335-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To optimize antibiotic use, the US CDC has outlined core elements of antimicrobial stewardship programs (ASP). However, they are difficult to implement in limited-resource settings. We report on the successful implementation of a series of ASP with insufficient number of infectious diseases specialists. We retrospectively collected data regarding antibiotic administration and culture results of all patients admitted to a tertiary care teaching hospital, Seoul National University Bundang Hospital (SNUBH), from January 2010 to December 2019. Trends of antibiotic use and antibiotic resistance rates were compared with those from Korean national data. Trend analyses were performed using nonparametric, two-sided, correlated seasonal Mann–Kendall tests. Total antibiotic agent usage has significantly decreased with ASP implementation at SNUBH since 2010. National claim data from tertiary care hospitals have revealed an increase in the use of all broad-spectrum antibiotics except for third-generation cephalosporins (3GC). In contrast, at SNUBH, glycopeptide and fluoroquinolone use gradually decreased, and 3GC and carbapenem use did not significantly change. Furthermore, the rate of colonization with methicillin-resistant Staphylococcus aureus showed a consistently decreasing trend, while that with 3GC- and fluoroquinolone-resistant Escherichia coli significantly increased. Unlike the national rate, the rate of colonization with antibiotic resistant-Klebsiella pneumoniae did not increase and that of 3GC- and fluoroquinolone-resistant Pseudomonas aeruginosa significantly decreased. Stepwise implementation of core ASP elements was effective in reducing antibiotic use despite a lack of sufficient manpower. Long-term multidisciplinary teamwork is necessary for successful and sustainable ASP implementation. IMPORTANCE Antimicrobial stewardship programs aimed to optimize antibiotic use are difficult to implement in limited-resource settings. Our study indicates that stepwise implementation of core antimicrobial stewardship program elements was effective in reducing antibiotic use in a tertiary care hospital despite the lack of sufficient manpower.
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Effectiveness of Antimicrobial Stewardship Program in Long-Term Care: A Five-Year Prospective Single-Center Study. Interdiscip Perspect Infect Dis 2022; 2022:8140429. [PMID: 35464254 PMCID: PMC9019452 DOI: 10.1155/2022/8140429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To report the effectiveness of the antimicrobial stewardship program (ASP) in a long-term care (LTC) facility, by analyzing the change in antimicrobial consumption and cost and multidrug resistance (MDR) rates over a 5-year period. Method A prospective interventional study was conducted at a 106-bed facility (nursing home: 100 beds and an intensive care unit (ICU): 6 beds). The ASP was designed and led by a multidisciplinary team including an infectious disease consultant, two clinical pharmacists, a clinical microbiologist, and an infection control preventionist. Five key performance indicators were monitored: (1) intravenous (IV)-to-oral switch rate, (2) consumption of restricted IV antimicrobials (raw consumption and defined daily doses (DDD) index), (3) cost of restricted IV antimicrobials, (4) antimicrobial sensitivity profiles, and (5) MDR rate among hospital-acquired infections (MDR-HAI). Result A ∼5.5-fold enhancement of the IV-to-oral switch and a 40% reduction in the overall consumption of restricted IV antimicrobials were observed. Regarding the cost, the cumulative cost saving was estimated as 5.64 million SAR (US$1.50 million). Microbiologically, no significant change in antimicrobial sensitivity profiles was observed; however, a large-size reduction in the MDR-HAI rate was observed, notably in ICU where it declined from 3.22 per 1,000 patient days, in 2015, to 1.14 per 1,000 patient days in 2020. Interestingly, the yearly overall MDR rate was strongly correlated with the level of antimicrobial consumption. Conclusion The implementation of a multidisciplinary ASP in LTC facilities should be further encouraged, with emphasis on physicians' education and active involvement to enhance the success of the strategy.
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Lephart P, LeBar W, Newton D. Behind Every Great Infection Prevention Program is a Great Microbiology Laboratory: Key Components and Strategies for an Effective Partnership. Infect Dis Clin North Am 2021; 35:789-802. [PMID: 34362544 DOI: 10.1016/j.idc.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A great clinical microbiology laboratory supporting a great infection prevention program requires focusing on the following services: rapid and accurate identification of pathogens associated with health care-associated infections; asymptomatic surveillance for health care-acquired pathogens before infections arise; routine use of broad and flexible antimicrobial susceptibility testing to direct optimal therapy; implementation of epidemiologic tracking tools to identify outbreaks; development of clear result communication with interpretative comments for clinicians. These goals are best realized in a collaborative relationship with the infection prevention program so that both can benefit from the shared priorities of providing the best patient care.
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Affiliation(s)
- Paul Lephart
- Clinical Microbiology Laboratory, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road Building 36-1221-52, Ann Arbor, MI 48109-2800, USA.
| | - William LeBar
- Clinical Microbiology Laboratory, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road Building 36-1221-52, Ann Arbor, MI 48109-2800, USA
| | - Duane Newton
- NaviDx Consulting, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road Building 36-1221-52, Ann Arbor, MI 48109-2800, USA
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Walia K, Gangakhedkar RR. Infectious disease blocks in district hospitals to augment India's resolve to contain antimicrobial resistance. Indian J Med Res 2021; 153:416-420. [PMID: 34380787 PMCID: PMC8354047 DOI: 10.4103/ijmr.ijmr_4031_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamini Walia
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
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Knobloch MJ, McKinley L, Keating J, Safdar N. Integrating antibiotic stewardship and infection prevention and control programs using a team science approach. Am J Infect Control 2021; 49:1072-1074. [PMID: 33524453 PMCID: PMC8060952 DOI: 10.1016/j.ajic.2021.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
Reduction of health care-associated infections is trending in the right direction after decades of work by those involved in infection prevention and control and antibiotic stewardship. With institutional priorities currently pivoting to meet the needs of COVID-19 patients, this may be an advantageous time to promote integration of facility-level antibiotic stewardship and infection prevention and control programs. We propose a team science framework as a tool to leverage the complementary expertise of stewardship and infection prevention and control professionals. This framework considers stages of team development and fluidity needed when working with shifting priorities and can be used by leaders and team members throughout all phases of team building—from developing and launching the team, through evaluating and modifying team activities to best suit local needs.
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Affiliation(s)
- Mary Jo Knobloch
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI.
| | - Linda McKinley
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Julie Keating
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI
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Al Salman J, Al Dabal L, Bassetti M, Alfouzan WA, Al Maslamani M, Alraddadi B, Elhoufi A, Khamis F, Mokkadas E, Romany I, Enani M, Somily A, Kanj SS. Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East. J Infect Public Health 2021; 14:978-984. [PMID: 34130122 DOI: 10.1016/j.jiph.2021.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant global issue that presents an increasing threat to patients' wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. METHODS A Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. RESULTS A total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. CONCLUSIONS This paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance.
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Affiliation(s)
| | | | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences University of Genoa and Policlinico San Martino Hospital, Genoa, Italy
| | - Wadha A Alfouzan
- Kuwait University, Kuwait City, Kuwait; Farwanyia Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Basem Alraddadi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | - Ingy Romany
- Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | | | - Ali Somily
- King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Souha S Kanj
- American University of Beirut Medical Center, Beirut, Lebanon.
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Doctors' Perceptions, Attitudes and Practices towards the Management of Multidrug-Resistant Organism Infections after the Implementation of an Antimicrobial Stewardship Programme during the COVID-19 Pandemic. Trop Med Infect Dis 2021; 6:tropicalmed6010020. [PMID: 33562723 PMCID: PMC7930958 DOI: 10.3390/tropicalmed6010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Greece is among the European countries with the highest consumption of antibiotics, both in community and hospital settings, including last-line antibiotics, such as carbapenems. We sought to explore doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) infections after the implementation of an antimicrobial stewardship programme (ASP) in a tertiary academic hospital during the COVID-19 pandemic. Methods: A self-administered, internet-based questionnaire survey was completed by doctors of the University Hospital of Heraklion in Crete, Greece. Results: In total, 202 (59.1%) hospital doctors fully completed the questionnaire. Most of them agreed that the prospective audit and feedback ASP strategy is more effective and educational than the preauthorization ASP strategy. ASP implementation prompted most respondents to monitor the continuously evolving microbiological data of their patients more closely and affected them towards a multidisciplinary and personalised care of patients with infections caused by MDROs and towards a more rigorous implementation of infection prevention and control measures. The vast majority of participants (98.5%) stated that ASP must be continued and further developed during the COVID-19 pandemic. Conclusion: The ASP implementation in our hospital had a beneficial impact on doctors’ perceptions, attitudes and practices with regard to the management of infections due to MDROs.
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Mayi BS, Mainville M, Altaf R, Lanspa M, Vaniawala S, Ollerhead TA, Raja A. A Crucial Role for Antimicrobial Stewardship in the Midst of COVID-19. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2021; 22:jmbe-22-69. [PMID: 33953821 PMCID: PMC8060144 DOI: 10.1128/jmbe.v22i1.2285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/15/2021] [Indexed: 05/04/2023]
Abstract
As the world deals with a pandemic, there remains another global challenge that cannot be ignored. Use of broad-spectrum antibiotics may be justified as we are trying to treat a novel disease condition, which in turn could lead to an increase in antimicrobial resistance. We can decrease morbidity, mortality, and health care costs by controlling antimicrobial resistance, but it requires antimicrobial stewardship. Major components of effective and timely antimicrobial stewardship are diagnostic stewardship, infection prevention and control, and integration of COVID-19 specific flags into electronic health records, all of which may be integrated into current strategies of COVID-19 mitigation and management. Going through the influenza season of 2020, implementation of antimicrobial stewardship education efforts in the United States can help us contend with influenza in addition to COVID-19 and any bacterial co-infections or secondary infections. Additional solutions include the development of vaccines, alternative therapies such as antibodies, and advanced diagnostics using advances in genomics and computer science.
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Affiliation(s)
- Bindu S. Mayi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759
- Corresponding author. Mailing address: Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3400 Gulf to Bay Blvd., Clearwater, FL 33759. E-mail:
| | - Manda Mainville
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Rida Altaf
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Michelle Lanspa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Sheel Vaniawala
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Thomas A. Ollerhead
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Aarti Raja
- Department of Biological Sciences, Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL 33314
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15
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Olans RD, Hausman NB, Olans RN. Nurses and Antimicrobial Stewardship: Past, Present, and Future. Infect Dis Clin North Am 2020; 34:67-82. [PMID: 32008696 DOI: 10.1016/j.idc.2019.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Successful antimicrobial stewardship programs must be a truly collaborative multidisciplinary team effort. Nurses have critical contributions and are recognized more in publications about antimicrobial stewardship. Examination of patient care workflow patterns indicates the central role of nurses in the application of stewardship concepts in patient care. Education about antimicrobial resistance and antimicrobial stewardship is important not only for nurses and other health care providers but also for the general public. Analysis of the health care workforce population shows the importance of integrating this largest segment of health care providers in the routine daily care of patients into all stewardship efforts.
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Affiliation(s)
- Rita Drummond Olans
- MGH Institute of Health Professions - School of Nursing, 36 First Avenue, Boston, MA 02129, USA.
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16
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Shapiro JT, Leboucher G, Myard-Dury AF, Girardo P, Luzzati A, Mary M, Sauzon JF, Lafay B, Dauwalder O, Laurent F, Lina G, Chidiac C, Couray-Targe S, Vandenesch F, Flandrois JP, Rasigade JP. Metapopulation ecology links antibiotic resistance, consumption, and patient transfers in a network of hospital wards. eLife 2020; 9:54795. [PMID: 33106223 PMCID: PMC7690951 DOI: 10.7554/elife.54795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and between-ward patient transfers (or connectivity) impact population-level AMR in hospital networks can help optimize antibiotic stewardship and infection control strategies. Here, we used a metapopulation framework to explain variations in the incidence of infections caused by seven major bacterial species and their drug-resistant variants in a network of 357 hospital wards. We found that ward-level antibiotic consumption volume had a stronger influence on the incidence of the more resistant pathogens, while connectivity had the most influence on hospital-endemic species and carbapenem-resistant pathogens. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data provide evidence that both antibiotic use and connectivity measurably influence hospital AMR. Finally, we provide a ranking of key antibiotics by their estimated population-level impact on AMR that might help inform antimicrobial stewardship strategies.
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Affiliation(s)
- Julie Teresa Shapiro
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | | | - Anne-Florence Myard-Dury
- Pôle de Santé Publique, Département d'Information Médicale, Hospices Civils de Lyon, Lyon, France
| | - Pascale Girardo
- Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Anatole Luzzati
- Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Mélissa Mary
- Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | | | - Bénédicte Lafay
- Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, University of Lyon, Lyon, France
| | - Olivier Dauwalder
- Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Gerard Lina
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Couray-Targe
- Pôle de Santé Publique, Département d'Information Médicale, Hospices Civils de Lyon, Lyon, France
| | - François Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Jean-Pierre Flandrois
- Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, University of Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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17
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Compliance with South Africa's Antimicrobial Resistance National Strategy Framework: are we there yet? J Chemother 2020; 33:21-31. [PMID: 32693710 DOI: 10.1080/1120009x.2020.1789389] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework. METHODS Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate. RESULTS Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant. CONCLUSION Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.
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Affiliation(s)
- Deirdré Engler
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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18
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Unger SA, Mark H, Pagliari C. Nutrition: the missing link in the battle against microbial resistance? J Glob Health 2020; 9:010321. [PMID: 31217957 PMCID: PMC6551546 DOI: 10.7189/jogh.09.010321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Stefan A Unger
- University of Edinburgh, Department of Child Life and Health, Edinburgh, UK.,Royal Hospital for Sick Children, Department of Respiratory Medicine, Edinburgh, UK.,Equal authorship
| | - Henry Mark
- International Development Consultant in Nutrition, Nottingham, UK.,Equal authorship
| | - Claudia Pagliari
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.,Equal authorship
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19
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Monsees E, Goldman J, Vogelsmeier A, Popejoy L. Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals. Am J Infect Control 2020; 48:239-245. [PMID: 31926758 DOI: 10.1016/j.ajic.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses' antimicrobial stewardship (AS) involvement. METHODS Cross-sectional survey to determine bedside nurses' recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme. RESULTS A total of 558 nurses participated (13% response rate). A significant positive association rs = 0.454, P < .001 was found between nurses' beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture. CONCLUSIONS Nurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.
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Affiliation(s)
- Elizabeth Monsees
- Division of Infectious Diseases, Children's Mercy Hospital, Patient Care Services Research, Kansas City, MO.
| | - Jennifer Goldman
- Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO
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20
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Vaughn VM, Saint S, Greene MT, Ratz D, Fowler KE, Patel PK, Krein SL. Trends in Health Care-Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017. JAMA Netw Open 2020; 3:e1920464. [PMID: 32022877 DOI: 10.1001/jamanetworkopen.2019.20464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown. OBJECTIVE To evaluate changes over time in infection prevention practices and the perception of the importance of infection prevention to hospital leadership. DESIGN, SETTINGS, AND PARTICIPANTS For this survey study, every 4 years between 2005 and 2017, infection preventionists were surveyed at all VA hospitals on use of practices associated with common HAIs, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and (beginning in 2013) Clostridioides difficile infection. Data analysis was performed from February 1, 2019, to July 1, 2019. MAIN OUTCOMES AND MEASURES Reported regular use of key infection prevention practices and perceived importance of infection prevention to hospital leadership. RESULTS Between 2005 and 2017, 320 total surveys were completed with response rates ranging from 59% (73 of 124) in 2017 to 80% (95 of 119) in 2005. Use of 12 different infection prevention practices increased. Since 2013, 92% (69 of 75) to 100% of VA hospitals reported regular use of key infection prevention practices for C difficile infection and CLABSI. In contrast, adoption of many practices to prevent CAUTI, although increasing, have lagged. Despite reported increases in the use of some practices for VAP such as semirecumbent positioning (89% [79 of 89] in 2005 vs 97% [61 of 63] in 2017, P = .007 for trend) and subglottic secretion drainage (23% [19 of 84] in 2005 vs 65% [40 of 62] in 2017, P < .001), use of other key practices such as daily interruptions of sedation (85% [55 of 65] in 2009 vs 87% [54 of 62] in 2017, P = .66) and early mobilization (81% [52 of 64] in 2013 vs 82% [51 of 62] in 2017, P = .88) has not increased. Antibiotic stewardship programs are now reported in nearly every VA hospital (97% [71 of 73]); however, some hospitals report practices for microbiologic testing for HAIs (eg, 22% [16 of 72] report routine urine culture testing in 2017) that could also contribute to antibiotic overuse. CONCLUSIONS AND RELEVANCE From 2005 to 2017, reported use of 12 different infection prevention practices increased in VA hospitals. Areas for continued improvement of infection prevention practices appear to include CAUTI, certain VAP practices, and diagnostic stewardship for HAI. The reported adoption of many infection prevention practices in VA hospitals was higher than in non-VA hospitals. As hospitals continue to merge and health systems become increasingly integrated, these successes could help inform patient safety broadly.
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Affiliation(s)
- Valerie M Vaughn
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - M Todd Greene
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Payal K Patel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
- Department of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
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21
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Agarwal M, Dick AW, Sorbero M, Mody L, Stone PW. Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018. J Am Med Dir Assoc 2020; 21:97-103. [PMID: 31888867 PMCID: PMC6948108 DOI: 10.1016/j.jamda.2019.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Burgeoning rates of antibiotic resistance have resulted in a shift in national focus to improve infection prevention and control programs in US nursing homes (NHs). We sought to evaluate the changes in nursing home infection prevention and control programs over time. DESIGN Retrospective comparative analysis of national nursing home survey data from 2014 and 2018. SETTING AND PARTICIPANTS We used survey data from 2 nationally representative samples of US nursing homes (945 NHs in 2014 and 888 in 2018). METHODS Three indices measuring antibiotic stewardship, outbreak control, and urinary tract infection prevention (ranging from 0 to 100) were developed to measure the change in infection prevention and control programs. Multivariable linear regression models were used to identify facility and infection preventionist characteristics associated with each index. Decomposition models were used to identify contributions of factors on the differences in each index over time. RESULTS From 2014 to 2018, we saw strengthening of antibiotic stewardship practices by 33 percentage points, outbreak control practices by 13 percentage points, and urinary tract infection prevention practices by 6 percentage points. Although we found several predictors of these improvements, much of the improvement was due to the difference in time. CONCLUSIONS AND IMPLICATIONS Policy mandates and greater national attention are likely important factors in improving nursing home infection prevention and control practices. Further work is needed to evaluate the effect of these programs on resident outcomes.
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Affiliation(s)
- Mansi Agarwal
- Columbia University School of Nursing, New York, NY.
| | | | | | - Lona Mody
- University of Michigan, Ann Arbor, MI
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22
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Opportunities to Overcome Implementation Challenges of Infection Prevention and Control in Low-Middle Income Countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00200-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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