PIN49 EXAMINING THE CLINICAL AND ECONOMIC IMPACT OF ANTIMICROBIAL RESISTANCE AT ACUTE CARE FACILITIES: A PRACTICAL TOOL

Background: Antibiotic-resistant organisms (AROs) are associated with greater disease severity and poor outcomes. Previous studies have investigated AROs and healthcare-associated infections (HAIs) within larger urban acute-care settings, but similar data for rural settings are scarce. In this stud, we aimed to fill this gap. Methods: Data on antimicrobial resistance (AMR), additional precautions and HAI were collected from 8 rural Alberta acute-care facilities over a 24-hour period from February 4–28, 2019. Data were gathered as part of the national Canadian, Rural, and Northern Acute Care Point Prevalence (CNAPP) survey. All inpatients on included units were reviewed. CNAPP protocol surveillance definitions were used. Results: In total, 961 patients were surveyed, of whom 94 of 961 (9.8%) were on additional precautions. Contact precautions only were most common (54 of 94, 57.4%) and were predominantly in place for MRSA (30 of 94, 31.9%). Of 961 patients, 100 (~10%) met the surveillance definitions for any infection. The most common infections were skin and soft-tissue infections (29 of 100, 29.0%) and bloodstream infections (28 of 100, 28.0%). An HAI occurred in 30 of 961 patients (3.1%); the most common HAIs were surgical site infections (8 of 30, 26.7%) and urinary tract infections (8 of 30, 26.7%). An antimicrobial was prescribed to 333 of 961 patients (34.6%) at the time of the survey, with ceftriaxone the most commonly prescribed (68 of 333, 20.4%). Most patients receiving an antimicrobial (237 of 333, 71.2%) did not meet the surveillance definition for any infection. The most common reason for any antimicrobial administration was empiric therapy (167 of 333, 50.1%). Conclusions: Investigations into antimicrobial use and the burden of HAIs in rural acute-care settings have been limited. In this study, we (1) established provincial baseline data for burden of disease in these facilities due to HAIs and (2) demonstrated that antimicrobial use is common, though most patients who were prescribed an antimicrobial did not meet study definitions for infection. It will be important to continue this type of surveillance in this understudied population to monitor the burden of HAIs over time, to establish antimicrobial utilization trends, and to continue to identify potential antimicrobial stewardship initiatives.Funding: NoneDisclosures: None

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The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation

Critical Care Medicine ◽

10.1097/00003246-200002000-00009 ◽

2000 ◽

Vol 28 (2) ◽

pp. 342-350 ◽

Cited By ~ 79

Author(s):

Michael G. Seneff ◽

Doug Wagner ◽

Douglas Thompson ◽

Charlene Honeycutt ◽

Michael R. Silver

Keyword(s):

Mechanical Ventilation ◽

Acute Care ◽

Prolonged Mechanical Ventilation ◽

Cost Of Care ◽

Care Facilities ◽

Acute Care Facilities ◽

The Impact

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Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2017004703286 ◽

2018 ◽

Vol 51 (0) ◽

Cited By ~ 2

Author(s):

Maria-Eulàlia Juvé-Udina ◽

Núria Fabrellas-Padrés ◽

Jordi Adamuz-Tomás ◽

Sònia Cadenas-González ◽

Maribel Gonzalez-Samartino ◽

...

Keyword(s):

Cardiac Arrest ◽

Acute Care ◽

Vital Signs ◽

Cross Sectional ◽

Care Plans ◽

Care Facilities ◽

Cross Sectional Design ◽

Acute Care Facilities ◽

Ongoing Assessment ◽

Nursing Diagnoses

ABSTRACT Objective The purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether differences exist in terms of patients’ profiles, surveillance measurements and outcomes. Method A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results Almost 60% of the analyzed patients’ e-charts had surveillance nursing diagnoses charted in the electronic care plans. Significant differences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and final outcomes. Conclusion Surveillance nursing diagnoses may play a significant role in preventing acute deterioration of adult in-patients in the acute care setting.

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Carbapenem-ResistantKlebsiella pneumoniaein Post-Acute-Care Facilities in Israel

Infection Control and Hospital Epidemiology ◽

10.1086/661279 ◽

2011 ◽

Vol 32 (9) ◽

pp. 845-853 ◽

Cited By ~ 71

Author(s):

Debby Ben-David ◽

Samira Masarwa ◽

Shiri Navon-Venezia ◽

Hagit Mishali ◽

Ilan Fridental ◽

...

Keyword(s):

Risk Factors ◽

Acute Care ◽

Case Control Study ◽

Case Control ◽

Antibiotic Exposure ◽

Care Facilities ◽

History Of ◽

Independent Risk Factors ◽

Acute Care Facilities ◽

Control Study

Objective.To assess the prevalence of and risk factors for carbapenem-resistantKlebsiella pneumoniae(CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel.Design, Setting, and Patients.A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage.Results.The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001;P< .001), sharing a room with a known carrier (OR, 3.09;P= .02), and increased prevalence of known carriers on the ward (OR, 1.02;P= .013). A policy of screening for carriage on admission was protective (OR, 0.41;P= .03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66;P= .03) and colonization with other resistant pathogens (OR, 1.64;P= .03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05;P= .04), receipt of amoxicillin-clavulanate (OR, 4.18;P= .007), and screening within 90 days of the first culture growing CRKP (OR, 2.9;P= .012).Conclusions.We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization.

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Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on dissemination

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkq191 ◽

2010 ◽

Vol 65 (8) ◽

pp. 1807-1818 ◽

Cited By ~ 127

Author(s):

F. Perez ◽

A. Endimiani ◽

A. J. Ray ◽

B. K. Decker ◽

C. J. Wallace ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Acinetobacter Baumannii ◽

Acute Care ◽

Hospital System ◽

Carbapenem Resistant ◽

Care Facilities ◽

Acute Care Facilities ◽

System Impact ◽

Post Acute Care

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MUST-Plus: A Machine Learning Classifier That Improves Malnutrition Screening in Acute Care Facilities

Journal of the American College of Nutrition ◽

10.1080/07315724.2020.1774821 ◽

2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Prem Timsina ◽

Himanshu N. Joshi ◽

Fu-Yuan Cheng ◽

Ilana Kersch ◽

Sara Wilson ◽

...

Keyword(s):

Machine Learning ◽

Acute Care ◽

Learning Classifier ◽

Care Facilities ◽

Acute Care Facilities

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CIHI Survey: Dying of Cancer in Canada's Acute Care Facilities

Healthcare Quarterly ◽

10.12927/hcq..17169 ◽

2005 ◽

Vol 8 (3) ◽

pp. 26-28 ◽

Cited By ~ 2

Author(s):

Kira Leeb ◽

Kathleen Morris ◽

Naomi Kasman

Keyword(s):

Acute Care ◽

Care Facilities ◽

Acute Care Facilities

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Infection Control in Acute Care Facilities: Evidence-Based Patient Safety

Canadian Journal of Infectious Diseases ◽

10.1155/2001/826915 ◽

2001 ◽

Vol 12 (3) ◽

pp. 131-132 ◽

Cited By ~ 1

Author(s):

Lindsay E Nicolle

Keyword(s):

World War Ii ◽

Infection Control ◽

Acute Care ◽

Epidemiological Analysis ◽

Control Programs ◽

Care Facilities ◽

Surveillance Programs ◽

Acute Care Facilities ◽

Program Components ◽

And Control

Infection control in acute care facilities has a noble history. These programs were born of the nosocomial penicillin-resistantStaphylococcus aureusoutbreaks in the post-World War II era. Over the past four decades, an impressive body of evidence has emerged that documents the effectiveness of infection control programs and systematically evaluates specific program components. Fumigation, tacky floor mats, shoe covers and 'reverse' isolation have disappeared. They are replaced by focused surveillance programs, prophylactic antimicrobial therapy, outbreak investigation and control, routine barrier practices and molecular typing of organisms for epidemiological analysis.

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