The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.121 ◽

2018 ◽

Vol 39 (8) ◽

pp. 941-946 ◽

Cited By ~ 2

Author(s):

Bradley J. Langford ◽

Julie Hui-Chih Wu ◽

Kevin A. Brown ◽

Xuesong Wang ◽

Valerie Leung ◽

...

Keyword(s):

Observational Study ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prospective Audit ◽

Defined Daily Doses ◽

Prospective Audit And Feedback ◽

The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

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Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.324 ◽

2017 ◽

Vol 38 (4) ◽

pp. 476-482 ◽

Cited By ~ 24

Author(s):

Irene K. Louh ◽

William G. Greendyke ◽

Emilia A. Hermann ◽

Karina W. Davidson ◽

Louise Falzon ◽

...

Keyword(s):

Systematic Review ◽

Hand Hygiene ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Grey Literature ◽

Quality Criteria ◽

Acute Care Hospitals ◽

Cochrane Library ◽

Chlorhexidine Bathing ◽

The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

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The State of Antimicrobial Stewardship in Michigan: Results of a Statewide Survey on Antimicrobial Stewardship Efforts in Acute Care Hospitals

Hospital Pharmacy ◽

10.1310/hpj5003-180 ◽

2015 ◽

Vol 50 (3) ◽

pp. 180-184 ◽

Cited By ~ 4

Author(s):

Curtis D. Collins ◽

Dianne E. Miller ◽

Rachel M. Kenney ◽

Ryan P. Mynatt ◽

Michael D. Tiberg ◽

...

Keyword(s):

Acute Care ◽

Antimicrobial Stewardship ◽

Acute Care Hospitals ◽

The State

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Hospital-acquired infections in Belgian acute-care hospitals: an estimation of their global impact on mortality, length of stay and healthcare costs

Epidemiology and Infection ◽

10.1017/s0950268811000100 ◽

2011 ◽

Vol 140 (1) ◽

pp. 126-136 ◽

Cited By ~ 23

Author(s):

F. VRIJENS ◽

F. HULSTAERT ◽

S. DEVRIESE ◽

S. VAN DE SANDE

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Excess Mortality ◽

National Level ◽

Acute Care Hospitals ◽

Public Healthcare ◽

Hospital Acquired Infections ◽

Number Of Patients ◽

Hospital Acquired ◽

The Impact

SUMMARYAssessing the overall burden of disease which can be attributed to hospital-acquired infections (HAIs) remains a challenge. A matched cohort study was performed to estimate excess mortality, length of stay and costs attributable to HAIs in Belgian acute-care hospitals, using six matching factors (hospital, diagnosis-related group, age, ward, Charlson score, estimated length of stay prior to infection). Information was combined from different sources on the epidemiology and burden of HAIs to estimate the impact at national level. The total number of patients affected by a HAI each year was 125 000 (per 10·9 million inhabitants). The excess mortality was 2·8% and excess length of stay was 7·3 days, corresponding to a public healthcare cost of €290 million. A large burden was observed outside the intensive-care unit setting (87% of patients infected and extra costs, 73% of excess deaths).

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Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.446 ◽

2020 ◽

pp. 1-7

Author(s):

Alessandra B. Garcia Reeves ◽

Sally C. Stearns ◽

Justin G. Trogdon ◽

James W. Lewis ◽

David J. Weber ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Fixed Effects ◽

Acute Care Hospitals ◽

The United States ◽

Methicillin Resistant ◽

Clostridioides Difficile ◽

Stewardship Program ◽

The Impact

Abstract Objective: To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals. Population: Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States. Data Sources: 2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports. Methods: Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate. Results: In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017. Conclusions: The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.

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Evaluating the Impact of Patient Social Deprivation on the Level of Symptom Severity at Carpal Tunnel Syndrome Presentation

Hand ◽

10.1177/1558944720928487 ◽

2020 ◽

pp. 155894472092848

Author(s):

David N. Bernstein ◽

Etka Kurucan ◽

Kathleen Fear ◽

Warren C. Hammert

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Symptom Severity ◽

Social Deprivation ◽

National Level ◽

State Level ◽

The State ◽

Multivariable Regression ◽

Tunnel Syndrome ◽

The Impact

Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores. Results: All PROMIS domain scores were significantly worse in the most deprived cohort at the national level ( P < .05) but not at the state level ( P > .05). In multivariable regression at the national level, ADI values were associated with PROMIS UE (β = −0.06, P < .01) and PROMIS PI (β = .05, P < .01) but not PROMIS PF or PROMIS Depression. In multivariable regression at the state level, ADI values were associated with PROMIS UE (β = −0.79, P = .03) and PROMIS PI (β = 0.58, P < .05) but not PROMIS PF or PROMIS Depression. Conclusions: Higher levels of social deprivation are associated with worse PROMIS UE and PROMIS PI scores on both the state and national levels when initially seeking care for carpal tunnel syndrome.

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State Interest Group Research and the Mixed Legacy of Belle Zeller

State Politics & Policy Quarterly ◽

10.1177/153244000200200404 ◽

2002 ◽

Vol 2 (4) ◽

pp. 388-410 ◽

Cited By ~ 4

Author(s):

Virginia Gray ◽

David Lowery

Keyword(s):

National Level ◽

State Level ◽

The State ◽

National Literature ◽

Theoretical Contribution ◽

Interest Representation ◽

Group Research ◽

The Impact ◽

Interest Organizations ◽

Cross Fertilization

How well are the state- and national-level literatures on interest representation connected? We identify landmark studies at both levels and conclude that there is little cross-fertilization between them. Rather, the landmark state studies are more descriptive, and focus on a trade-off between group and party power, reflecting the legacy of Belle Zeller, while the national-level studies are embedded in theories used in the broader discipline and, therefore, focus on different processes. One consequence of this is that the national literature does not cite state-level studies very often. We conclude with recommendations for enhancing the impact and theoretical contribution of the state literature on interest organizations and the politics of interest representation.

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To Study the impact of Gabbar Singh tax or Goods & services tax for Restaurant and Food Services Business in India

Restaurant Business ◽

10.26643/rb.v118i12.13070 ◽

2019 ◽

Vol 118 (12) ◽

pp. 32-48

Author(s):

Mr. Arun Gautam ◽

Dr. Saurabh Sharma ◽

CA Narendra Kumar Bansal

Keyword(s):

State Level ◽

The State ◽

Assessment Framework ◽

Food Services ◽

Goods And Services ◽

Single Tax ◽

The Impact

GST that is Goods and Services Tax has been in compel since first July, 2017 and which is, in constrain on numerous countries globally and they all were thinking about it as their business assessment framework. The principle reason for GST is to realize single tax on products at both centre and the state level in the nation.

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Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽

10.3390/vaccines9050444 ◽

2021 ◽

Vol 9 (5) ◽

pp. 444

Author(s):

Charles Stoecker

Keyword(s):

Positive Impact ◽

National Level ◽

State Level ◽

The United States ◽

Scope Of Practice ◽

Patient Specific ◽

Behavioral Risk ◽

Influenza Immunization ◽

Immunization Rates ◽

The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

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