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Del Fabro G, Venturini S, Avolio M, Basaglia G, Callegari A, Bramuzzo I, Basso B, Zanusso C, Rizzo A, Tonutti G, Chittaro M, Fiappo E, Tonizzo M, Crapis M. Time is running out. No excuses to delay implementation of antimicrobial stewardship programmes: impact, sustainability, resilience and efficiency through an interrupted time series analysis (2017-2022). JAC Antimicrob Resist 2024; 6:dlae072. [PMID: 38752207 PMCID: PMC11094472 DOI: 10.1093/jacamr/dlae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction The WHO declared antimicrobial resistance (AMR) a significant concern in 2014, sparking initiatives to ensure responsible antibiotic use. In human medicine, Antimicrobial Stewardship Programmes (ASPs) in hospitals play a pivotal role in combating AMR. Although evidence supports the effectiveness of ASPs in optimizing antimicrobial use, often the lack of resources becomes an excuse to limit their dissemination and use. This paper provides a comprehensive report on a 6-year analysis of an ASP implemented in a healthcare region in north-east Italy. Methods A retrospective data collection was conducted to assess the programme's impact on antibiotic consumption expressed as DDDs/100 patient-days, its sustainability over time, resilience during the COVID-19 pandemic and the efficiency of the ASP (relationship between workload and human resources). Results A substantial overall reduction in antibiotic consumption (-14%), particularly in fluoroquinolones (-64%) and carbapenems (-68%), was demonstrated, showcasing the programme's impact. Sustainability was confirmed through enduring trends in antibiotic consumption and ecological analysis over time. The ASP demonstrates resilience by maintaining positive trends even amid the challenging COVID-19 pandemic. Efficiency was underscored by an increase in on-site consultations despite consistent human resources until 2021. Conclusions This study offers insights into the prolonged success of a resource-efficient ASP, emphasizing the crucial role of long-term commitment in fostering responsible antibiotic use in the context of global health challenges such as AMR.
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Affiliation(s)
- Giovanni Del Fabro
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Sergio Venturini
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Manuela Avolio
- Department of Microbiology, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Igor Bramuzzo
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Barbara Basso
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Chiara Zanusso
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Anna Rizzo
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Giuseppe Tonutti
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Michele Chittaro
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Eva Fiappo
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
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Knighton SC, Engle J, Berkson J, Bartles R. A narrative review of how infection preventionist (IP) staffing and outcome metrics are assessed by health care organizations and factors to consider. Am J Infect Control 2024; 52:91-106. [PMID: 37978984 DOI: 10.1016/j.ajic.2023.06.017] [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: 02/18/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Infection Preventionist to date are experiencing staffing shortages, the purpose of this narrative review is to understand how heath care organizations track staffing and outcome metrics in relation to Infection Preventionists. METHODS Databases utilized included MEDLINE, PubMed, EMBASE, Web of Science, and Google Scholar. RESULTS The initial search included 668 studies. After excluding duplicates, the title and abstract review yielded 50 articles. After screening full texts, 37 studies met the inclusion criteria. Significant variability exists within infection prevention staffing metrics. Common metrics to account for IP staffing levels include the ratio of IPs per facility and IPs per inpatient bed. Frequently tracked outcomes in relation to infection preventionists include Catheter-associated urinary tract infections and central line bloodstream infection incidence rates and standardized infection ratios, as well as Clostridioides difficile incidence rates. Metrics and outcomes from included studies are available in our supporting tables. CONCLUSIONS This review highlights the need for a new IP staffing model that focuses on a granular assessment of each program and care setting. Additional studies can then be conducted to examine how ideal staffing impacts outcome metrics.
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Affiliation(s)
- Shanina C Knighton
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH.
| | - Joshua Engle
- Beth Israel Deaconess Medical Center, School of Medicine, Boston, MA
| | - Julia Berkson
- Association for Professions in Infection Control and Epidemiology, Center for Research, Practice and Innovation, Arlington, VA
| | - Rebecca Bartles
- Providence Saint Joseph Health, System Infectious Disease Management & Prevention, Seattle, WA; University of Providence, Infection Prevention and Epidemiology, Great Falls, MT
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El-Saed A, Othman F, AlMohrij S, Abanmi M, Tannous E, Alshamrani MM. Coverage and methods of surveillance of healthcare-associated infections in Middle Eastern and North African countries. Am J Infect Control 2023; 51:1151-1156. [PMID: 36931506 DOI: 10.1016/j.ajic.2023.03.004] [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: 12/29/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Surveillance of healthcare-associated infections (HAIs) is a cornerstone for effective infection prevention and control (IPC) programs. The objective was to evaluate the coverage and methods of HAI surveillance in Middle Eastern and North African (MENA) countries. METHODS A cross-sectional study targeted IPC staff working in MENA countries using the Infection Control Network electronic database of the Arab countries. The study focused on self-reported surveillance-related characteristics of IPC staff, facilities, and the IPC program. RESULTS A total of 269 IPC staff were included. They were mainly females (68%), nurses (63%), and working in GCC countries (83%). Approximately 69% of covered facilities had surveillance activities. Hand hygiene, multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infections were the most common surveillance activities (>90%). The surveillance workload consumed 27% of the average weekly working time. The scores of performing multiple surveillance, with appropriate methods and tools, were 83%, 67%, and 61% (respectively). Appropriate surveillance methods and/or tools were linked to GCC region, CBIC qualifications, surveillance training, specific setting (acute care and long term), staff-to-bed ratio, presence and active function of IPC committee, presence of IPC annual plan, communications with health care workers, and leadership support. CONCLUSIONS While most health care facilities in the MENA region perform multiple surveillance, surveillance methods and tools are still suboptimal and their optimization should be a priority.
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Affiliation(s)
- Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; The Arab Countries Infection Control Network (AcicN), Abu Dhabi, United Arab Emirates
| | - Fatmah Othman
- College of Medicine, King Saud Bin Abdul Aziz University for Health Science, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saud AlMohrij
- College of Medicine, University of Almaarefa, Riyadh, Saudi Arabia
| | - Mohammed Abanmi
- College of Medicine, King Saud Bin Abdul Aziz University for Health Science, Riyadh, Saudi Arabia
| | - Elias Tannous
- The Arab Countries Infection Control Network (AcicN), Abu Dhabi, United Arab Emirates; Infection Prevention and Control, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdul Aziz University for Health Science, Riyadh, Saudi Arabia.
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Kim B, Eun BW, Lee E, Kim TH, Park S, Park SY. Professional Status of Infectious Disease Specialists in Korea: A Nationwide Survey. J Korean Med Sci 2022; 37:e320. [PMID: 36472083 PMCID: PMC9723190 DOI: 10.3346/jkms.2022.37.e320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infectious disease (ID) specialists are skilled facilitators of medical consultation who promote better outcomes in patient survival, antibiotic stewardship as well as healthcare safety in pandemic response. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea. METHODS This was a nationwide cross-sectional study in Korea. An online-based survey was conducted over 11 days (from December 17-27, 2020), targeting all active adult (n = 281) and pediatric (n = 71) ID specialists in Korea (N = 352). Questions regarding the practice areas of the specialists were divided into five categories: 1) clinical practices of outpatient care, inpatient care, and consultations; 2) infection control; 3) antibiotic stewardship; 4) research; and 5) education and training. We investigated the weekly time-use patterns for these areas of practice. RESULTS Of the 352 ID specialists, 195 (55.4%; 51.2% [144/281] adult and 71.8% [51/71] pediatric ID specialists) responded in the survey. Moreover, 144 (73.8%) of the total respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%). Specialists worked a median of 61 (interquartile range: 54-71) hours weekly: patient care, 29 (14-37) hours; research 11 (5-19) hours; infection control 4 (2-10) hours; antibiotic stewardship, 3 (1-5) hours; and education/training, 2 (2-6) hours. CONCLUSION ID specialists in Korea simultaneously undertake multiple tasks and work long hours, highlighting the need for training and employing more ID specialists.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Nowon Eulji University Hospital, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
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Park SY, Kim YC, Lee R, Kim B, Moon SM, Kim HB. Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions. Infect Chemother 2022; 54:599-609. [PMID: 36596676 PMCID: PMC9840950 DOI: 10.3947/ic.2022.0158] [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: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
Identifying inappropriately prescribed antibiotics for infectious diseases by monitoring the quality of antibiotics use is essential for effective implementation of antibiotic stewardship. Qualitative assessment of the use of antibiotics has been conducted in some countries, including Korea, since the 2000s. The qualitative assessment generally involves an assessment of each component of the antibiotics prescription process, based on specific criteria. However, there is no standardized assessment method or cycle, and infectious diseases or antibiotics included in the assessments vary from country-to-country. According to the results reported in the United States, Europe, Australia, and Korea so far, approximately 20 - 55% of all antibiotics prescriptions are inappropriate. In this review, we describe the current progress in the quality assessment of the use of antibiotics on a global scale. Further, we highlight the future directions to improve antibiotic stewardship activities and the quality assessment of the use of antibiotics in Korea.
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Affiliation(s)
- Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.,Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.,Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Yong Chan Kim
- Department of Internal Medicine, Division of Infectious diseases, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Raeseok Lee
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kim CJ. Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs. Infect Chemother 2022; 54:674-698. [PMID: 36596680 PMCID: PMC9840952 DOI: 10.3947/ic.2022.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Palozyan G, Avetisyan S, Abovyan R, Melik-Andreasyan G, Vanyan A. EVALUATION OF THE IMPLEMENTATION OF PREVENTION AND INFECTION CONTROL PROGRAMS IN ARMENIAN HOSPITALS DURING THE COVID-19 PANDEMIC. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2022. [DOI: 10.15789/2220-7619-aio-2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT: Aim of the study: To determine the current state of implementation of key aspects of infection prevention and control (IPC) in Armenian hospitals, defined by the main components of WHO, using the survey tool IPCAF (Infection Prevention and Control Assessment Framework). Materials and methods. 113 hospitals were involved in the study. All participants filled in IPCAF questionnaire, Все они заполнили вопросник IPCAF, consisting of 8 sections (each rated up to 100 points) devoted to various aspects IPC. Depending on the total final score, IPC programs were divided into the following categories: advanced (601-800 points), intermediate (401-600 points), basic (201-400 points) and inadequate (0-200 points). The study conducted a descriptive analysis of the overall IPCAF score as well as the evaluation of scores of the relevant core components and some selected questions of particular interest. Results: The total average score for all IPCAF components for all hospitals in Armenia in 2021 is 578.07.9 points, which is currently regarded as an intermediate level. At the same time, 47 (41.6%) hospitals were assigned to the advanced category, 63 (55.7%) - to the average category and 3 (2.7%) - to the basic category. Analysis of the main IPC components (CC, Core component) revealed that the maximum average scores were obtained for the components CC2 (IPC Guidelines) - 80.8 points, CC8 (Creating a safe environment in medical premises, as well as materials and equipment for IPC) - 75.5 points and CC7 (Workload, staffing and number of beds) - 75.2 points. The lowest average scores were obtained for the key components: CC4 (Surveillance for healthcare-associated infections) with 54.7 points and CC3 (IPC education and training) with 59.5 points. Conclusion. Legislative and practical changes implemented in the real world during the novel coronavirus infection (COVID-19) pandemic have significantly contributed to improved scores for many key components of IPC programs. The study found that the IPCAF is a useful tool for assessing IPC standards and identifying gaps, regardless of a country economic development level. In our opinion, the re-use of IPCAF in all medical institutions should be encouraged, which is important for monitoring changes and trends in IPC, as well as developing individual strategies in the development and improvement of IPC.
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Fabre V, Cosgrove SE, Secaira C, Tapia Torrez JC, Lessa FC, Patel TS, Quiros R. Antimicrobial stewardship in Latin America: Past, present, and future. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e68. [PMID: 36483374 PMCID: PMC9726506 DOI: 10.1017/ash.2022.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 06/01/2023]
Abstract
Implementation of antimicrobial stewardship programs (ASPs) in well-resourced countries has been associated with reductions in antibiotic-resistant infections and improved patient outcomes. Several guidance documents providing recommendations on how to structure antimicrobial stewardship activities at the national and hospital level in resource-limited settings have been published. However, few hospitals in Latin America report having a structure or resources needed for a successful ASP. Given the alarming increases in antimicrobial resistance in Latin America, better understanding of barriers to promote implementation of effective ASPs is urgently needed. We have summarized past and present antimicrobial stewardship activities in Latin American hospitals, and we describe key elements needed in future efforts to strengthen antimicrobial stewardship in the region.
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Affiliation(s)
- Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | | | - Fernanda C. Lessa
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Twisha S. Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Katoch O, Katyal S, Srivastav S, Rodrigues C, Rupali P, Chakrabarti A, Ray P, Tak V, Biswal M, Nath R, Mukhopadhyay C, Bhattacharya S, Padmaja K, Deotale V, Venkatesh V, Wattal C, Ma T, Nag VL, Ray R, Behera B, Baveja S, Karuna T, Singh SK, Fomda B, Devi SK, Das P, Khandelwal N, Verma P, Gaind R, Bhattacharyya P, Kumar P, Srivastava A, Iravane J, Majumdar T, Sharma R, Sankara D, Kalwaje Eshwara V, Varma M, Nazir S, Tripathy S, Mishra S, Dey A, Thangavelu P, Kapoor L, Malhotra R, Walia K, Guleria R, Mathur P. Self-reported survey on infection prevention and control structures in healthcare facilities part of a national level healthcare associated infection surveillance network in India, 2019. Am J Infect Control 2022; 50:390-395. [PMID: 34600081 DOI: 10.1016/j.ajic.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Healthcare associated infections (HAIs) are prevalent and difficult to treat worldwide. Most HAIs can be prevented by effective implementation of Infection Prevention and Control (IPC) measures. A survey was conducted to assess the existing IPC practices across a network of Indian Hospitals using the World Health Organization designed self-assessment IPC Assessment Framework (IPCAF) tool. METHODS This was a cross sectional observation study. Thirty-two tertiary care public and private facilities, part of the existing Indian HAI surveillance network was included. Data collected was analyzed by a central team at All India Institute of Medical Sciences, New Delhi, a tertiary care hospital of India. The WHO questionnaire tool was used to understand the capacity and efforts to implement IPC practices across the network. RESULTS The overall median score of IPCAF across the network was 620. Based on the final IPCAF score of the facilities; 13% hospitals had basic IPC practices, 28% hospitals had intermediate and 59% hospitals had advanced IPC practices. The component multimodal strategies had the broadest range of score while the component IPC guidelines had the narrowest one. CONCLUSIONS Quality improvement training for IPC nurses and healthcare professionals are needed to be provided to health facilities.
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Affiliation(s)
- Omika Katoch
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonal Katyal
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sharad Srivastav
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Camilla Rodrigues
- Department of Microbiology, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Pallab Ray
- Department of Microbiology, Assam Medical College, Assam, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manisha Biswal
- Department of Microbiology, Assam Medical College, Assam, India
| | - Reema Nath
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kanne Padmaja
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Thirunarayan Ma
- Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raja Ray
- Department of Microbiology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Tadepalli Karuna
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Sanjeev K Singh
- Department of Infection Control, Amrita Institute of Medicine Sciences, Amrita University, Kochi, Kerala, India
| | - Bashir Fomda
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | - Padma Das
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Neeta Khandelwal
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Prachi Verma
- Department of Critical Care Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur
| | - Rajni Gaind
- Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India
| | - Prithwis Bhattacharyya
- Department of Anaesthesiology and ICU, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Puneet Kumar
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Srivastava
- Department of Microbiology MGM Medical College, Bhopal, Madhya Pradesh, India
| | - Jyoti Iravane
- Department of Microbiology, Govt. Medical College, Aurangabad, Maharashtra, India
| | - Tapan Majumdar
- Department of Microbiology, AGMC & GBP Hospital, Agartala,, Tripura, India
| | - Rajni Sharma
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Dhanapaul Sankara
- Department of Microbiology, K.A,V.P. Govt. Medical College, Trichy, Tamil Nadu, India
| | | | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Karnataka, India
| | - Shaista Nazir
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Swagata Tripathy
- Department of Anesthesia and Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satyajeet Mishra
- Department of Anesthesia, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Premkumar Thangavelu
- Department of Infectious Disease, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Lata Kapoor
- Department of Microbiology, National Institute of Disease Control, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
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Alshamrani MM, El-Saed A, Farahat FM. Challenges of infection control capacity in the Middle Eastern countries; time to be actively involved. J Infect Public Health 2022; 15:448-449. [PMID: 35344772 PMCID: PMC8941849 DOI: 10.1016/j.jiph.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fayssal M Farahat
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Training in infectious diseases across europe in 2021 - A survey on training delivery, content and assessment. Clin Microbiol Infect 2021; 27:1693.e1-1693.e8. [PMID: 34371206 DOI: 10.1016/j.cmi.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To define the status of Infectious Diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery, and evaluation of postgraduate training in ID in different countries. METHODS Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses. RESULTS In responses received from 33/35 (94.3%) countries, ID is recognised as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in 8, but it is not recognised in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million. Median length of training is 5 (IQR 4.0 - 6.0) years with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75% (25/33) and assessed by final exams in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries. CONCLUSIONS There are substantial gaps in modernisation of ID training in many countries to match current European Training Requirements. Joint training with clinical microbiology and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.
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Training and assessment of medical specialists in clinical microbiology and infectious diseases in Europe. Clin Microbiol Infect 2021; 27:1581-1588. [PMID: 34260952 DOI: 10.1016/j.cmi.2021.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. OBJECTIVES To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID). SOURCES Narrative review of developments over the past two decades and related policy documents and scientific literature. CONTENT Responsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021. IMPLICATIONS The revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists.
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Slater K, Cooke M, Whitby M, Rickard CM. Needleless connector nursing care - Current practices, knowledge, and attitudes: An Australian perspective. Infect Dis Health 2021; 26:235-242. [PMID: 34053907 DOI: 10.1016/j.idh.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inappropriate needleless connector (NC) care is associated with device failure from catheter occlusion and patient blood stream infections (BSIs). This can be attributed to a lack of knowledge of connector designs and flushing, clamping, and syringe disconnection techniques. This study aimed to assess nurses' practice, knowledge, attitudes, and key influencers on appropriate care of NCs in an Australian facility and compare these with studies undertaken in the United States in 2011. METHODS A cross-sectional online survey was sent via email with a SurveyMonkey® link to all nurses working in clinical areas (total population sampling approach; approximately 1500 nurses), at an Australian hospital, in 2018. The survey was anonymous and open for 6 weeks. Analysis was with R software. RESULTS Response rate was approximately 19% (n = 283). Most (89%) of nurses stated that they clean NCs before each access. Only 25% correctly recognised the negative pressure NC, and 79% correctly identified the correct clamping and disconnection sequence. Positive pressure displacement devices were correctly identified by 44% of respondents, with 34% identifying the correct clamping and disconnecting technique. Nurses reported their behaviour was most influenced by local senior nurses. CONCLUSIONS There remains a significant gap in nurses' knowledge of NC device types, as well as the correct clamping and syringe disconnection for both negative and positive displacement NCs. This survey reaffirms that senior nurses are the key influencers of nurses' adherence to best practice guidelines.
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Affiliation(s)
- Karen Slater
- Princess Alexandra Hospital, Brisbane, 4102, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia.
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia
| | - Michael Whitby
- Greenslopes Clinical School, University of Queensland, Brisbane, 4120, Australia
| | - Claire M Rickard
- Princess Alexandra Hospital, Brisbane, 4102, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, 4111, Australia; Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, 4111, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Herston and Metro North Hospital and Health Service, Brisbane, 4006, Australia
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14
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Jang Y, Park SY, Kim B, Lee E, Lee S, Son HJ, Park JW, Yu SN, Kim T, Jeon MH, Choo EJ, Kim TH. Infectious Diseases Physician Workforce in Korea. J Korean Med Sci 2020; 35:e428. [PMID: 33350186 PMCID: PMC7752260 DOI: 10.3346/jkms.2020.35.e428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022] Open
Abstract
This study aimed to evaluate the infectious disease (ID) physician workforce in Korea. We investigated the acquisition of ID physicians from 1992 to 2019 with their current working place in the Health Care System. We defined ID physicians working at general or tertiary-care hospitals as active ID physicians. A total 275 physicians acquired ID as a sub-specialty. Among the 275, 242 were active ID physicians. The density of active ID physicians was 0.47 per 100,000 population. Of all the 17 administrative districts, 11 (64.7%) fell short of 0.47, and 131 medical institutions employed the service of ID physicians. The median number of beds per adult ID physician was 372 (interquartile range, 280-507). It is essential to secure human resources to respond to emerging infectious diseases and perform the inherent work of ID physicians.
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Affiliation(s)
- Youngeun Jang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Se Yoon Park
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Eunjung Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seungjae Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyo Ju Son
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung Wan Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Shi Nae Yu
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Tark Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Hyok Jeon
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eun Ju Choo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae Hyong Kim
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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15
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Impact of national policy on hand hygiene promotion activities in hospitals in Korea. Antimicrob Resist Infect Control 2020; 9:157. [PMID: 32967735 PMCID: PMC7509816 DOI: 10.1186/s13756-020-00817-3] [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: 05/14/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the Government established a strategy for infection prevention to encourage infection control activities in hospitals. The new policy was announced in December 2015 and implemented in September 2016. The aim of this study is to evaluate how infection control activities improved within Korean hospitals after the change in government policy. METHODS Three cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using a multivariable linear regression model, we analyzed the change in total HHSAF score according to survey year. RESULTS A total of 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In the multivariable linear regression model, total HHSAF score was significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% confidence interval [CI], 8.9 to 96.4; P = 0.018), beds size (β coefficient of 100 beds increase, 5.1; 95% CI, 0.3 to 9.8; P = 0.038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3 to 70.9; P = 0.001). CONCLUSIONS After the new national policy was implemented, the number of infection control professionals increased, and hand hygiene promotion activities were strengthened across Korean hospitals.
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Foley DA, Chew R, Raby E, Tong SYC, Davis JS. COVID-19 in the pre-pandemic period: a survey of the time commitment and perceptions of infectious diseases physicians in Australia and New Zealand. Intern Med J 2020; 50:924-930. [PMID: 32881266 PMCID: PMC7436897 DOI: 10.1111/imj.14941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infectious diseases (ID) physicians perform a pivotal role in directing the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM To assess the impact of SARS-CoV-2 on workload and the perceptions of ID physicians regarding the national response in Australia and New Zealand in the pre-pandemic. METHODS A survey of ID physicians in Australia and New Zealand was undertaken from 3 to 10 March 2020. Respondents were asked to estimate time spent on SARS-CoV-2-related activities in February and report their agreement with statements on a 5-point Likert scale ranging from 'strongly agree' to 'strongly disagree'. We also asked about the intended use of investigational agents. RESULTS There were 214 respondents (36% of 600 eligible participants). The median workload due to SARS-CoV-2-related activities was 34% of one full-time equivalent (interquartile range 18-68%). Less than a quarter (50, 23%) of respondents had experience managing cases, while 33% (70) had experience preparing during similar pandemics. Nevertheless, 88% (188/213) believed they were well informed when giving testing and management advice, and 45% (95/212) believed their national response was well coordinated. Additionally, 41% (88/214) were worried about becoming infected through occupational exposure. Over half (116, 54%) the respondents intended to use lopinavir/ritonavir in confirmed cases of COVID-19 with severe disease. CONCLUSIONS ID physicians spent a large proportion of time on SARS-CoV-2-related activities. Increased staffing is required to avoid burnout. Importantly, ID physicians feel well informed when giving advice. A national body should be established to co-ordinate response. Treatment efficacy trials are needed to clarify the utility of unproven treatments.
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Affiliation(s)
- David A Foley
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Rusheng Chew
- Infectious Diseases Unit, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Edward Raby
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
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17
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Heng ST, Wong J, Young B, Tay HL, Tan SH, Yap MY, Teng CB, Ang B, Lee TH, Tan HL, Lew TW, Lye DC, Ng TM. Effective Antimicrobial StewaRdship StrategIES (ARIES): Cluster Randomized Trial of Computerized Decision Support System and Prospective Review and Feedback. Open Forum Infect Dis 2020; 7:ofaa254. [PMID: 32704514 PMCID: PMC7368373 DOI: 10.1093/ofid/ofaa254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Prospective review and feedback (PRF) of antibiotic prescriptions and compulsory computerized decision support system (CDSS) are 2 strategies of antimicrobial stewardship. There are limited studies investigating their combined effects. We hypothesized that the use of on-demand (voluntary) CDSS would achieve similar patient outcomes compared with automatically triggered (compulsory) CDSS whenever broad-spectrum antibiotics are ordered. Methods A parallel-group, 1:1 block cluster randomized crossover study was conducted in 32 medical and surgical wards from March to August 2017. CDSS use for piperacillin-tazobactam or carbapenem in the intervention clusters was at the demand of the doctor, while in the control clusters CDSS use was compulsory. PRF was continued for both arms. The primary outcome was 30-day mortality. Results Six hundred forty-one and 616 patients were randomized to voluntary and compulsory CDSS, respectively. There were no differences in 30-day mortality (hazard ratio [HR], 0.87; 95% CI, 0.67–1.12), re-infection and re-admission rates, antibiotic duration, length of stay, or hospitalization cost. The proportion of patients receiving PRF recommendations was not significantly lower in the voluntary CDSS arm (62 [10%] vs 81 [13%]; P = .05). Appropriate indication of antibiotics was high in both arms (351/448 [78%] vs 330/433 [74%]; P = .18). However, in geriatric medicine patients where antibiotic appropriateness was <50%, prescription via compulsory CDSS resulted in a shorter length of stay and lower hospitalization cost. Conclusions Voluntary broad-spectrum antibiotics with PRF via CDSS did not result in differing clinical outcomes, antibiotic duration, or length of stay. However, in the setting of low antibiotic appropriateness, compulsory CDSS may be beneficial.
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Affiliation(s)
- Shi Thong Heng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Joshua Wong
- Office of Clinical Epidemiology, Analytics, and kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Barnaby Young
- Department of Infectious Diseases, National Centre for Infectious Disease, Singapore
| | - Hui Lin Tay
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Sock Hoon Tan
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Min Yi Yap
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Christine B Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Brenda Ang
- Department of Infectious Diseases, National Centre for Infectious Disease, Singapore
| | - Tau Hong Lee
- Department of Infectious Diseases, National Centre for Infectious Disease, Singapore
| | - Hui Ling Tan
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Thomas W Lew
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - David Chien Lye
- Department of Infectious Diseases, National Centre for Infectious Disease, Singapore
| | - Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
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One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections. Antimicrob Resist Infect Control 2020; 9:78. [PMID: 32487220 PMCID: PMC7268532 DOI: 10.1186/s13756-020-00737-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Despite improvements in hospital infection prevention and control, healthcare associated infections (HAIs) remain a challenge with significant patient morbidity, mortality, and cost for the healthcare system. In this review, we use a One Health framework (human, animal, and environmental health) to explain the epidemiology, demonstrate key knowledge gaps in infection prevention policy, and explore improvements to control Gram-positive pathogens in the healthcare environment. We discuss patient and healthcare worker interactions with the hospital environment that can lead to transmission of the most common Gram-positive hospital pathogens – methicillin-resistant Staphylococcus aureus, Clostridioides (Clostridium) difficile, and vancomycin-resistant Enterococcus – and detail interventions that target these two One Health domains. We discuss the role of animals in the healthcare settings, knowledge gaps regarding their role in pathogen transmission, and the absence of infection risk mitigation strategies targeting animals. We advocate for novel infection prevention and control programs, founded on the pillars of One Health, to reduce Gram-positive hospital-associated pathogen transmission.
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Park JY, Kwon KT, Lee WK, Kim HI, Kim MJ, Song DY, Yu MH, Park HJ, Lee KH, Chae HJ. The impact of infection control cost reimbursement policy on central line-associated bloodstream infections. Am J Infect Control 2020; 48:560-565. [PMID: 31677923 DOI: 10.1016/j.ajic.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In September 2016, the Korean National Health Insurance Service began reimbursing infection control (IC) costs on the condition that a certain number of doctors and full-time nurses for IC be allocated to supported hospitals. We analyzed the impact of the IC cost reimbursement policy on central line-associated bloodstream infections (CLABSIs). METHODS A before-and-after study that analyzed the CLABSI rate trends between preintervention (January 2016 to February 2017) and intervention (March to December 2017) periods using autoregression time series analysis was performed in intensive care units (ICUs) at a 750-bed, secondary care hospital in Daegu, Republic of Korea. The enhanced IC team visited ICUs daily, monitored the implementation of CLABSI prevention bundles, and educated all personnel involved in catheter insertion and maintenance from March 2017. RESULTS Autoregressive analysis revealed that the CLABSI rates per month in the preintervention and intervention periods were -0.256 (95% confidence interval, -0.613 to 0.101; P = .15) and -0.602 (95% confidence interval, -0.972 to -0.232; P = .008), respectively. The rates of compliance with maximal barrier precautions significantly improved from the preintervention (36.2%) to the intervention (77.9%) period (χ² test, P < .001). CONCLUSIONS The IC cost reimbursement policy accelerated the decline in CLABSI rates significantly in monitored ICUs. A nationwide study to evaluate the effectiveness of the IC cost reimbursement policy for various health care-associated infections is warranted.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Won Kee Lee
- Medial Research Collaboration Center, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hye In Kim
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Min Jung Kim
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Do Young Song
- Department of Laboratory Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Mi Hyae Yu
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Hyun Ju Park
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Kyeong Hee Lee
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Hyun Ju Chae
- Department of Infection Control, Daegu Fatima Hospital, Daegu, Republic of Korea
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Gastmeier P. From ‘one size fits all’ to personalized infection prevention. J Hosp Infect 2020; 104:256-260. [DOI: 10.1016/j.jhin.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022]
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21
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Tebano G, Mouelhi Y, Zanichelli V, Charmillon A, Fougnot S, Lozniewski A, Thilly N, Pulcini C. Selective reporting of antibiotic susceptibility testing results: a promising antibiotic stewardship tool. Expert Rev Anti Infect Ther 2020; 18:251-262. [PMID: 31928257 DOI: 10.1080/14787210.2020.1715795] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Selective reporting of antibiotic susceptibility testing (AST) results is a potentially interesting tool for antibiotic stewardship. It consists of performing AST according to usual practices, but the results are reported to the prescriber only for a few antibiotics (i.e. first-line agents) or not reported at all when colonization is likely.Areas covered: We retrieved 20 studies exploring the impact of selective reporting. Overall, selective reporting is able to influence antibiotic use, both discouraging prescription in case of colonization, and promoting the selection of narrow-spectrum agents. Most studies concerned urine samples. Evidence on the impact on antibiotic resistance is insufficient. Unintended consequences were not observed, but evidence on this topic is scarce. Selective reporting is well implemented in a few countries, and a huge heterogeneity of practices exists.Expert opinion: Evidence shows that selective reporting can help reducing inappropriate and unnecessary antibiotic prescriptions. Uncomplicated urinary tract infections are probably the best initial target, both in hospital and community settings, but other non-severe infections can be a suitable option. The implementation of selective reporting should be promoted by the scientific community, with detailed practical guidelines, and its impact should be further assessed in large interventional studies.
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Affiliation(s)
- Gianpiero Tebano
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Veronica Zanichelli
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | | | | | - Alain Lozniewski
- CHRU-Nancy, Microbiology Department, Université de Lorraine, Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France.,CHRU-Nancy, Methodology, Promotion and Investigation Department, Université de Lorraine, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,CHRU-Nancy, Infectious Diseases Department, Nancy, France
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Abstract
Antimicrobial stewardship improves patient care and reduces antimicrobial resistance, inappropriate use, and adverse outcomes. Despite high-profile mandates for antimicrobial stewardship programs across the healthcare continuum, descriptive data, and recommendations for dedicated resources, including appropriate physician, pharmacist, data analytics, and administrative staffing support, are not robust. This review summarizes the current literature on antimicrobial stewardship staffing and calls for the development of minimum staffing recommendations.
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Doernberg SB, Abbo LM, Burdette SD, Fishman NO, Goodman EL, Kravitz GR, Leggett JE, Moehring RW, Newland JG, Robinson PA, Spivak ES, Tamma PD, Chambers HF. Essential Resources and Strategies for Antibiotic Stewardship Programs in the Acute Care Setting. Clin Infect Dis 2019; 67:1168-1174. [PMID: 29590355 DOI: 10.1093/cid/ciy255] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/23/2018] [Indexed: 11/12/2022] Open
Abstract
Background Antibiotic stewardship programs improve clinical outcomes and patient safety and help combat antibiotic resistance. Specific guidance on resources needed to structure stewardship programs is lacking. This manuscript describes results of a survey of US stewardship programs and resultant recommendations regarding potential staffing structures in the acute care setting. Methods A cross-sectional survey of members of 3 infectious diseases subspecialty societies actively involved in antibiotic stewardship was conducted. Survey responses were analyzed with descriptive statistics. Logistic regression models were used to investigate the relationship between stewardship program staffing levels and self-reported effectiveness and to determine which strategies mediate effectiveness. Results Two-hundred forty-four respondents from a variety of acute care settings completed the survey. Prior authorization for select antibiotics, antibiotic reviews with prospective audit and feedback, and guideline development were common strategies. Eighty-five percent of surveyed programs demonstrated effectiveness in at least 1 outcome in the prior 2 years. Each 0.50 increase in pharmacist and physician full-time equivalent (FTE) support predicted a 1.48-fold increase in the odds of demonstrating effectiveness. The effect was mediated by the ability to perform prospective audit and feedback. Most programs noted significant barriers to success. Conclusions Based on our survey's results, we propose an FTE-to-bed ratio that can be used as a starting point to guide discussions regarding necessary resources for antibiotic stewardship programs with executive leadership. Prospective audit and feedback should be the cornerstone of stewardship programs, and both physician leadership and pharmacists with expertise in stewardship are crucial for success.
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Affiliation(s)
- Sarah B Doernberg
- Department of Internal Medicine, Division of Infectious Diseases, University of California, San Francisco
| | - Lilian M Abbo
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Florida
| | | | - Neil O Fishman
- Infectious Diseases Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Edward L Goodman
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas
| | | | | | - Rebekah W Moehring
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Jason G Newland
- Division of Pediatric Infectious Diseases, Washington University, St Louis, Missouri
| | | | - Emily S Spivak
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry F Chambers
- Department of Internal Medicine, Division of Infectious Diseases, University of California, San Francisco
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Kallen MC, Ten Oever J, Prins JM, Kullberg BJ, Schouten JA, Hulscher MEJL. A survey on antimicrobial stewardship prerequisites, objectives and improvement strategies: systematic development and nationwide assessment in Dutch acute care hospitals. J Antimicrob Chemother 2019; 73:3496-3504. [PMID: 30252063 DOI: 10.1093/jac/dky367] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
Background Stewardship guidelines define three essential building blocks for successful hospital antimicrobial stewardship programmes (ASPs): stewardship prerequisites, stewardship objectives and improvement strategies. Objectives We systematically developed a survey, based on these building blocks, to evaluate the current state of antimicrobial stewardship in hospitals. We tested this survey in 64 Dutch acute care hospitals. Methods We performed a literature review on surveys of antimicrobial stewardship. After extraction and categorization of survey questions, five experts merged and rephrased questions during a consensus meeting. After a pilot study, the survey was sent to 80 Dutch hospitals. Results The final survey consisted of 46 questions, categorized into hospital characteristics, stewardship prerequisites, stewardship objectives and stewardship strategies. The response rate was 80% (n = 64). Ninety-four percent of hospitals had established an antimicrobial stewardship team, consisting of at least one hospital pharmacist and one clinical microbiologist. An infectious diseases specialist was present in 68% of the teams. Nine percent had dedicated IT support. Forty-one percent of the teams were financially supported, with a median of 0.6 full-time equivalents (FTE; 0.1-1.8). The majority of hospitals performed monitoring of restricted antibiotic agents (91%), dose optimization (65%), bedside consultation (56%) and intravenous-to-oral switch (53%). Fifty-eight percent of the hospitals provided education to residents and 28% to specialists. Conclusions The survey provides information on the progress that is being made in hospitals regarding the three building blocks of a successful ASP, and provides clear aims to strengthen ASPs. Ultimately, these data will be related to national data on antibiotic consumption and resistance.
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Affiliation(s)
- M C Kallen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - J M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands
| | - B J Kullberg
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - J A Schouten
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.,Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - M E J L Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Steul K, Exner M, Heudorf U. [Personal preconditions for the prevention of nosocomial infections-guidelines of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), federal state hygiene regulations in Germany, and compliance by hospitals in Frankfurt am Main]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:329-340. [PMID: 30783685 DOI: 10.1007/s00103-019-02896-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
According to the amendment of the Infection Protection Act (2011), § 23, 8, all federal states in Germany had to pass their own hospital hygiene regulations, in which the need for hygiene specialists in a hospital is defined.This publication explains in its first part the differences between the nationwide Commission for Hospital Hygiene and Infection Prevention (KRINKO) regulations and the hygiene regulations of the different federal states (Hesse, Bavaria, etc.). All federal states - with the exception of Hesse (Hessian Hygiene Regulation, HHygVO) - refer to the relevant expert recommendations of KRINKO.In a second part of this publication, we highlight differences between KRINKO and HHygVO with the example of hospitals in the city of Frankfurt. In 2017, all Frankfurt hospitals had the necessary hygiene specialists (authorized hygiene practitioners, infection control nurses, authorized hygiene care nurses). However, the need for hospital hygienists could not be met, because there is an insufficient number of physician specialists for hospital hygiene available in Germany.The hospitals cannot solve this problem on their own - a political, superordinate decision and regulation must be made, i. e. by regulation and financial support for the advanced training of post-graduate physicians in hygiene. This is important since only experienced hospital hygienists can instruct or supervise hygiene specialists-in-training.
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Affiliation(s)
- Katrin Steul
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland.
| | - Martin Exner
- Institut für Hygiene und öffentliche Gesundheit, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Ursel Heudorf
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland
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Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey. Eur J Clin Microbiol Infect Dis 2019; 38:2061-2068. [PMID: 31396830 PMCID: PMC6800847 DOI: 10.1007/s10096-019-03648-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/15/2019] [Indexed: 12/27/2022]
Abstract
Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking.
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Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2510875. [PMID: 31321231 PMCID: PMC6610727 DOI: 10.1155/2019/2510875] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023]
Abstract
Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli's score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.
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Aghdassi SJS, Hansen S, Bischoff P, Behnke M, Gastmeier P. A national survey on the implementation of key infection prevention and control structures in German hospitals: results from 736 hospitals conducting the WHO Infection Prevention and Control Assessment Framework (IPCAF). Antimicrob Resist Infect Control 2019; 8:73. [PMID: 31080588 PMCID: PMC6505265 DOI: 10.1186/s13756-019-0532-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background Healthcare-associated infections (HAI) pose a burden on healthcare providers worldwide. To prevent HAI and strengthen infection prevention and control (IPC) structures, the WHO has developed a variety of tools and guidelines. Recently, the WHO released the Infection Prevention and Control Assessment Framework (IPCAF), a questionnaire-like tool designed for assessing IPC structures at the facility level. The IPCAF reflects the eight WHO core components of IPC. Data on the implementation of IPC measures in German hospitals are scarce. Therefore, it was our objective to utilize the IPCAF in order to gather information on the current state of IPC implementation in German hospitals, as well as to promote the IPCAF to a broad audience. Methods The National Reference Center for Surveillance of Nosocomial Infections (NRZ) sent a translated version of the IPCAF to 1472 acute care hospitals in Germany. Data entry and transfer to the NRZ was done electronically between October and December 2018. The IPCAF was conceived in a way that depending on the selected answers a score was calculated, with 0 being the lowest possible and 800 the highest possible score. Depending on the overall score, the IPCAF allocated hospitals to four different “IPC levels”: inadequate, basic, intermediate, and advanced. Results A total of 736 hospitals provided a complete dataset and were included in the data analysis. The overall median score of all hospitals was 690, which corresponded to an advanced level of IPC. Only three hospitals (0.4%) fell into the category “basic”, with 111 hospitals (15.1%) being “intermediate” and 622 hospitals (84.5%) being “advanced”. In no case was the category “inadequate” allocated. More profound differences were found between the respective core components. Components on multimodal strategies and workload, staffing, ward design and bed occupancy revealed the lowest scores. Conclusions IPC key aspects in general are well established in Germany. Potentials for improvement were identified particularly with regard to workload and staffing. Insufficient implementation of multimodal strategies was found to be another relevant deficit. Our survey represents a successful attempt at promoting the IPCAF and encouraging hospitals to utilize WHO tools for self-assessment. Electronic supplementary material The online version of this article (10.1186/s13756-019-0532-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Sonja Hansen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Peter Bischoff
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
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Tickell KD, Mangale DI, Tornberg-Belanger SN, Bourdon C, Thitiri J, Timbwa M, Njirammadzi J, Voskuijl W, Chisti MJ, Ahmed T, Shahid ASMSB, Diallo AH, Ouédrago I, Khan AF, Saleem AF, Arif F, Kazi Z, Mupere E, Mukisa J, Sukhtankar P, Berkley JA, Walson JL, Denno DM. A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines. PLoS One 2019; 14:e0212395. [PMID: 30908499 PMCID: PMC6433255 DOI: 10.1371/journal.pone.0212395] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Accelerating progress in reducing child deaths is needed in order to achieve the Sustainable Development Goal child mortality target. This will require a focus on vulnerable children–including young children, those who are undernourished or with acute illnesses requiring hospitalization. Improving adherence to inpatient guidelines may be an important strategy to reduce child mortality, including among the most vulnerable. The aim of our assessment of nine sub-Saharan African and South Asian hospitals was to determine adherence to pediatric inpatient care recommendations, in addition to capacity for and barriers to implementation of guideline-adherent care prior to commencing the Childhood Acute Illness and Nutrition (CHAIN) Cohort study. The CHAIN Cohort study aims to identify modifiable risk factors for poor inpatient and post discharge outcomes above and beyond implementation of guidelines. Methods Hospital infrastructure, staffing, durable equipment, and consumable supplies such as medicines and laboratory reagents, were evaluated through observation and key informant interviews. Inpatient medical records of 2–23 month old children were assessed for adherence to national and international guidelines. The records of children with severe acute malnutrition (SAM) were oversampled to reflect the CHAIN study population. Seven core adherence indicators were examined: oximetry and oxygen therapy, fluids, anemia diagnosis and transfusion, antibiotics, malaria testing and antimalarials, nutritional assessment and management, and HIV testing. Results All sites had facilities and equipment necessary to implement care consistent with World Health Organization and national guidelines. However, stockouts of essential medicines and laboratory reagents were reported to be common at some sites, even though they were mostly present during the assessment visits. Doctor and nurse to patient ratios varied widely. We reviewed the notes of 261 children with admission diagnoses of sepsis (17), malaria (47), pneumonia (70), diarrhea (106), and SAM (119); 115 had multiple diagnoses. Adherence to oxygen therapy, antimalarial, and malnutrition refeeding guidelines was >75%. Appropriate antimicrobials were prescribed for 75% of antibiotic-indicative conditions. However, 20/23 (87%) diarrhea and 20/27 (74%) malaria cases without a documented indication were prescribed antibiotics. Only 23/122 (19%) with hemoglobin levels meeting anemia criteria had recorded anemia diagnoses. HIV test results were infrequently documented even at hospitals with universal screening policies (66/173, 38%). Informants at all sites attributed inconsistent guideline implementation to inadequate staffing. Conclusion Assessed hospitals had the infrastructure and equipment to implement guideline-consistent care. While fluids, appropriate antimalarials and antibiotics, and malnutrition refeeding adherence was comparable to published estimates from low- and high-resource settings, there were inconsistencies in implementation of some other recommendations. Stockouts of essential therapeutics and laboratory reagents were a noted barrier, but facility staff perceived inadequate human resources as the primary constraint to consistent guideline implementation.
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Affiliation(s)
- Kirkby D. Tickell
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Dorothy I. Mangale
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Stephanie N. Tornberg-Belanger
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Celine Bourdon
- Program in Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Jenala Njirammadzi
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Wieger Voskuijl
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
- Global Child Health Group, Emma Children’s Hospital, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Mohammod J. Chisti
- Centre for Nutrition & Food Security (CNFS), icddr, b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), icddr, b, Dhaka, Bangladesh
| | | | - Abdoulaye H. Diallo
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Issaka Ouédrago
- Department of Paediatrics, Banfora Regional Referral Hospital, Banfora, Burkina Faso
| | - Al Fazal Khan
- Centre for Nutrition & Food Security (CNFS), icddr, b, Dhaka, Bangladesh
| | - Ali F. Saleem
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fehmina Arif
- Department of Paediatrics, Civil Hospital Karachi, Karachi, Pakistan
| | - Zaubina Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Judd L. Walson
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Donna M. Denno
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
- Department of Health Services, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Practices, organisation, and regulatory aspects in advising on antibiotic prescription: the international ESCMID AntibioLegalMap survey. Infection 2019; 47:749-760. [PMID: 30903590 DOI: 10.1007/s15010-019-01298-2] [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: 11/25/2018] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Giving advice about antibiotic prescription through dedicated consultations is a cornerstone of antibiotic stewardship programmes. Our objective was to explore practices, organisation, and regulatory requirements related to antibiotic advising. METHODS We performed an international, exploratory, Internet-based, cross-sectional survey targeting infectious diseases and clinical microbiology specialists. It was disseminated through ESCMID and ESGAP networks. RESULTS Answers from 830 participants (74 countries, 77% of participants from Europe) were collected. Consultations were mostly given on demand (81%, 619/764), while unsolicited consultations targeting specific conditions (e.g., positive blood culture) were less frequent (66%, 501/764). Consultations usually included indications on diagnostic work-up and follow-up (> 79%). Curbside consultations (i.e., without examining the patient) were reported by 82% (598/733) of respondents, mainly by phone (89%, 531/598). The referring physician was considered authorised not to follow the advice by 57% (383/676). Direct consultations (i.e., after examining the patient) were recorded in the medical file more frequently than curbside consultations (69%, 472/689 vs 35%, 206/592). Concerning legal liability, the majority of respondents considered that it is shared between the adviser and the referring physician, who, however, is considered primarily responsible. The advisers' liability was considered to be lower in cases of curbside and unrecorded consultations. Significant inter-countries and intra-country variability were identified, suggesting that the setting markedly influenced practices. CONCLUSION Significant variability exists in the practice of antibiotic advising. This concerns both the organisation of care and how advisers perceive regulatory requirements. These elements must be taken into account when implementing antibiotic stewardship programmes and when training stewards.
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Matulionytė R, Žagminas K, Balčiūnaitė E, Matulytė E, Paulauskienė R, Bajoriūnienė A, Ambrozaitis A. Routine HIV testing program in the University Infectious Diseases Centre in Lithuania: a four-year analysis. BMC Infect Dis 2019; 19:21. [PMID: 30616558 PMCID: PMC6322331 DOI: 10.1186/s12879-018-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program. METHODS A retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18-55 that were hospitalized in one department. In the second period, all inpatients aged 18-65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods. RESULTS During the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group. CONCLUSION Routine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
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Affiliation(s)
- Raimonda Matulionytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Žagminas
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Eglė Balčiūnaitė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elžbieta Matulytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rasutė Paulauskienė
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Almina Bajoriūnienė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Kim Y, Kim J, Shin SA. Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data. Int J Nurs Stud 2019; 89:104-111. [DOI: 10.1016/j.ijnurstu.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022]
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How are trainees in clinical microbiology and infectious diseases supervised in Europe? An international cross-sectional questionnaire survey by the Trainee Association of ESCMID. Eur J Clin Microbiol Infect Dis 2018; 37:2381-2387. [PMID: 30255431 DOI: 10.1007/s10096-018-3386-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to map the supervision of European trainees in clinical microbiology and infectious diseases during their training. An international cross-sectional questionnaire survey of 38 questions was distributed among trainees and recently graduated medical specialists from European countries. Descriptive analyses were performed on both the total group of respondents and regionally. In total, 393 respondents from 37 different countries were included. The median of overall satisfaction with the supervisor was 4 (interquartile range 3-4) on a Likert scale (range 1, not satisfied at all-5, completely satisfied). Overall, merely 34% of respondents received constructive feedback from their supervisor on a regularly basis, 36% could evaluate their own supervisor, and just 63% were evaluated on their skills using a written plan. Fifty-two percent did not receive the opportunity to do a part of the specialty training abroad and 63% received support from their supervisors to be involved in research projects or publishing papers. A considerable proportion of trainees, mainly in Southern and Eastern European regions, felt that they did not receive sufficient supervision. This information may be useful in the pursuit of harmonizing the quality of training, achieving a common curriculum, and identifying robust and objective criteria to coach and evaluate trainees in a proper way.
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Pulcini C, Morel CM, Tacconelli E, Beovic B, de With K, Goossens H, Harbarth S, Holmes A, Howard P, Morris AM, Nathwani D, Sharland M, Schouten J, Thursky K, Laxminarayan R, Mendelson M. Human resources estimates and funding for antibiotic stewardship teams are urgently needed. Clin Microbiol Infect 2017; 23:785-787. [PMID: 28778544 DOI: 10.1016/j.cmi.2017.07.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- C Pulcini
- Lorraine University, EA 4360 APEMAC, Nancy, France; Nancy University Hospital, Infectious Diseases Department, Nancy, France; ESCMID Study Group for Antimicrobial stewardshiP (ESGAP).
| | - C M Morel
- University of Geneva Medical School, Geneva, Switzerland; London School of Economics, London, United Kingdom
| | - E Tacconelli
- Infectious Diseases, Internal Medicine 1, DZIF Centre, Tübingen University, Germany; European Committee on Infection Control (EUCIC)
| | - B Beovic
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - K de With
- University Hospital Carl Gustav Carus at the TU Dresden, Division of Infectious Diseases, Dresden, Germany
| | - H Goossens
- Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - S Harbarth
- Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Holmes
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - P Howard
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health System, University Health Network, University of Toronto, Toronto, Canada
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, UK; British Society for Antimicrobial Chemotherapy (BSAC), Birmingham, UK
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - J Schouten
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
| | - R Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Leibovici L. The nuts and bolts of doing science. Clin Microbiol Infect 2017; 23:275. [DOI: 10.1016/j.cmi.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
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Dyar OJ, Tebano G, Pulcini C. Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect 2017; 23:441-447. [PMID: 28433726 DOI: 10.1016/j.cmi.2017.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/14/2017] [Accepted: 04/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare systems consist of building blocks. Shaping how these building blocks function and interact can promote responsible antimicrobial use, and this represents an important opportunity for managers at different points within healthcare systems to act upon. AIMS To review real-world examples of how healthcare systems can promote responsible antimicrobial use, focusing on the role of governance and managers. SOURCES We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We also drew on the diverse experiences of the ESGAP (the ESCMID (European Society of Clinical Microbiology and Infectious Diseases) Study Group for Antimicrobial stewardshiP) network. CONTENT First, we explored at the institution level the implementation of antimicrobial stewardship programmes, the need to embrace multidisciplinary approaches, the benefits of engaging with social sciences experts, and the role of governance and leadership. We look beyond individual institutions and highlight the urgent need for workforce capacity estimates for antimicrobial stewardship activities, how antimicrobial stewardship efforts can connect to form networks, and the importance of governance and regulation at national and international levels. IMPLICATIONS Managers in the healthcare system are in a strong position to look beyond individual prescriptions and to recognize the many ways in which different healthcare system building blocks can contribute to responsible use of antimicrobials. At the institution level this can be achieved by implementing antimicrobial stewardship programmes, ensuring they are adequately resourced, and driving buy-in across clinical leadership. At regional and national levels this includes facilitating the sharing of experiences and resources between institutions, and developing the standards and regulations needed to support responsible antimicrobial use.
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Affiliation(s)
- O J Dyar
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - G Tebano
- Service des maladies infectieuses, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - C Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy, and EA 4360 APEMAC, Université de Lorraine, Nancy, France.
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