scholarly journals 91. Gaps and Opportunities in Antimicrobial Stewardship Programs in Asia: A Survey of 10 Countries

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Feng-Yee Chang ◽  
Yin-Ching Chuang ◽  
Balaji Veeraraghavan ◽  
Anucha Apisarnthanarak ◽  
Maria Fe R Tayzon ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Hospital Setting ◽  
Asian Countries ◽  
Hospital Leadership ◽  
Leadership Support ◽  
Core Elements ◽  
Control And Prevention ◽  
Core Components ◽  
Country Differences ◽  
Gold Standards

Abstract Background Most studies on hospital antimicrobial stewardship (AMS) status and practices are conducted in the west, and there is a lack of such data from Asian countries. The objective of this survey was to determine existing AMS practices and gaps, and challenges in implementing AMS programs in secondary and tertiary acute-care hospitals in 10 Asian countries. Methods A 70-item questionnaire was disseminated to hospitals fulfilling inclusion criteria and responses were collected from 10 April 2020 to 9 April 2021. The survey, specific to the Asian hospital setting, enquired about hospital leadership support for AMS; AMS team membership and training; AMS interventions; AMS monitoring and reporting; hospital infrastructure; and education. These were subdivided into core and supplementary components, adapted from the Transatlantic Taskforce on Antimicrobial Resistance set of core and supplementary indicators for hospital AMS programs, and the US Centers for Disease Control and Prevention checklist for core elements of hospital AMS programs. Results A total of 349 hospitals from Cambodia, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Taiwan, Thailand and Vietnam responded. Overall, only 47 hospitals fulfilled all 12 core components, and there were inter-country differences in terms of performance. The hospitals generally did well in terms of the AMS team (ie, comprising at least a physician leader responsible for AMS activities, a pharmacist, and infection control and microbiology personnel), and access to a timely and reliable microbiology service, with mean positive response rates (PRR) of ≥ 80% for these indicators (Figure 1). In the core components of AMS program interventions, and AMS monitoring and reporting, the lower mean PRR ( > 60%) revealed that Asia has wider gaps in these areas versus gold standards. Although many hospitals had formal hospital leadership statements to support AMS (mean PPR 85.6%), this was not always matched by allocated financial support for AMS activities (mean PPR 57.1%). Figure 1 Conclusion For all core components of an AMS program, most Asian hospitals participating in this survey fell short of international gold standards. Inter-country differences in gaps highlight that country-specific solutions are needed to improve current standards in AMS. Disclosures Tetsuya Matsumoto, MD; PhD, MSD (Speaker's Bureau)Pfizer (Speaker's Bureau)

Antimicrobial Stewardship in Pediatrics

2019 ◽  
pp. 291-322
Author(s):  
Emily A. Thorell ◽  
Jared Olson
Keyword(s):  
Antimicrobial Stewardship ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Antimicrobial Stewardship Program ◽  
Global Public Health ◽  
Healthcare Facilities ◽  
Stewardship Program ◽  
Healthcare Program ◽  
Core Elements ◽  
Control And Prevention

The rapid emergence of multidrug-resistant bacteria has become a global public health crisis. As antibiotics are the only class of medications where use in one patient can compromise their efficacy in another patient, stewardship is critical to preserve this shared resource. The Centers for Disease Control and Prevention (CDC) have focused on improving antimicrobial use for many years. One effective strategy used to decrease the emergence of multi‐drug-resistant organisms (MDROs) is the antimicrobial stewardship program (ASP): a coordinated healthcare program that seeks to provide optimal antimicrobial treatment to patients to reduce the emergence of MDROs, improve patient outcomes, and decrease cost. This chapter reviews the importance of an antimicrobial stewardship program, reviews core elements of a pediatric hospital ASP, and provides guidance on tracking and reporting antimicrobial prescribing in pediatric healthcare facilities.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

scholarly journals Antimicrobial Stewardship in Acute-Care Hospitals: A Report of the California Healthcare-Associated Infections Honor Roll

2021 ◽  
Vol 1 (S1) ◽  
pp. s32-s32
Author(s):  
Jane Kriengkauykiat ◽  
Erin Epson ◽  
Erin Garcia ◽  
Kiya Komaiko
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Open Enrollment ◽  
Acute Care Hospitals ◽  
Teaching Hospitals ◽  
Healthcare Associated Infection ◽  
Community Hospitals ◽  
Honor Roll ◽  
Core Elements ◽  
Healthcare Associated

Background: Antimicrobial stewardship has been demonstrated to improve patient outcomes and reduce unwanted consequences, such as antimicrobial resistance and Clostridioides difficile infection. The California Department of Public Health (CDPH) Healthcare-Associated Infection (HAI) Program developed an honor roll to recognize facilities with the goal of promoting antimicrobial stewardship programs and encouraging collaboration and research. Methods: The first open enrollment period in California was from August 1 to September 1, 2020, and was only open to acute-care hospitals (ACHs). Enrollment occurs every 6 months. Applicants completed an application and provided supporting documentation for bronze, silver, or gold designations. The criteria for the bronze designation were at least 1 item from each of CDC’s 7 core elements for ACHs. The criteria for silver were bronze criteria plus 9 HAI program prioritized items (based on published literature) from the CDC Core Elements and demonstration of outcomes from an intervention. The criteria for gold designation were silver criteria plus community engagement (ie, local work or collaboration with healthcare partners). Applications were evaluated in 3 phases: (1) CDPH reviewed core elements and documentation, (2) CDPH and external blinded antimicrobial stewardship experts reviewed outcomes as scientific abstracts, and (3) CDPH reviewed each program for overall effectiveness in antimicrobial stewardship and final designation determination. Designations expire after 2 years. Results: In total, 119 applications were submitted (30% of all ACHs in California), of which 100 were complete and thus were included for review. Moverover, 33 facilities were from northern California and 67 were from southern California. Also, 85 facilities were part of a health system or network, 14 were freestanding, and 1 was a district facility. Facility types included 68 community hospitals, 17 long-term acute-care (LTAC) facilities, 17 academic or teaching hospitals, 4 critical-access hospitals, and 4 pediatric hospitals. There was an even distribution of hospital bed size: 35 facilities had <250 beds. The final designations included 19 gold, 35 silver and 43 bronze designations. There was 44% incongruency in applicants not receiving the designation for which they applied. Community hospitals were 63%–74% of all designations, and no LTACs received a gold designation. Moreover, 63% of hospitals with gold designations had >250 beds, and 47% of hospitals with bronze designations had <1 25 beds. Conclusions: The number of applicants was higher than expected because the open enrollment period occurred during the COVID-19 pandemic. This finding demonstrates the high importance placed on antimicrobial stewardship among ACHs. It also provides insight into how facilities are performing and collaborating and how CDPH can support facilities to improve their ASP.Funding: NoDisclosures: None

scholarly journals Assessing Robustness of Antimicrobial Stewardship in Colorado Hospitals and Barriers to Improvement

2021 ◽  
Vol 1 (S1) ◽  
pp. s15-s15
Author(s):  
Daniel Dodson ◽  
Matthew Kronman ◽  
Sarah Parker ◽  
Christopher Czaja
Keyword(s):  
Public Health ◽  
Antimicrobial Stewardship ◽  
Pediatric Patients ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Defined Daily Dose ◽  
Health Departments ◽  
Web Based ◽  
Public Health Departments ◽  
Core Elements

Background: Adherence to core elements of antimicrobial stewardship programs (ASPs) is increasing nationally but the robustness of programs and inclusion of pediatrics is poorly understood. We describe the details of ASP in Colorado hospitals and identify steps by which academic centers and public health departments can assist community ASPs. Methods: We invited ASP leaders at the 102 acute-care hospitals (ACHs) and critical-access hospitals (CAHs) in Colorado to participate in a web-based survey regarding their ASPs. Questions related to adherence to Centers for Disease Control and Prevention (CDC) core elements, barriers to improvement, desired resources, and extension to pediatrics. Enrollment began in August 2020. Hospital types were compared using the Fisher exact test. Results: As of January 1, 2021, 31 hospitals (30% of targeted hospitals) completed the web-based survey including 19 ACH and 12 CAH. Hospitals were distributed across the state. Median number of beds was 52 (range, 11–680). Of the responding hospitals, 87% were adherent to all CDC core elements. However, if action was defined as prospective audit and feedback or prior authorization, tracking was defined as measuring antibiotic use in days of therapy (DOT) or defined daily dose (DDD) quarterly, and reporting was defined as providing unit- or provider-specific antibiotic use reports annually. Overall adherence fell to 35% including 81% for action, 58% for tracking, and 58% for reporting. CAHs were less likely to adhere to these strict criteria than ACHs (Figure 1). In the 27 hospitals (87% of hospitals) caring for pediatric patients, adherence to a strict action for at least 1 pediatric population was 59%. Reported barriers to improved ASP were available time and personnel, information technology support, perceived concerns about provider attitudes, and education gaps (Figure 2). CAHs were less likely to use the NHSN antibiotic use or resistance modules or have a data analyst than ACHs (Figure 3). Pediatric pharmacy expertise and guidelines were often not available in hospitals caring for pediatric patients. Desired ASP resources included assistance with data analysis, access to stewardship expertise and education, and treatment guidelines, including for pediatrics. Conclusions: Adherence to CDC core elements of an ASP was excellent but fell dramatically when stricter criteria were used and was worse in pediatric patients. Academic centers and public health departments can assist community hospitals by providing educational resources, assistance in analyzing data including using the NHSN ED: /AR modules, and ASP expertise and clinical care guidelines including those for pediatrics.Funding: NoDisclosures: None

scholarly journals 513. Use of Antimicrobial Stewardship Program in Operationalizing Monoclonal Antibody Therapy in SARS-CoV-2 Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S358-S358
Author(s):  
Jessica Abrantes-Figueiredo ◽  
Stephanie Nalewyko ◽  
Dora E Wiskirchen
Keyword(s):  
Monoclonal Antibody ◽  
Antimicrobial Stewardship ◽  
Multidisciplinary Approach ◽  
Antibody Therapy ◽  
Dual Therapy ◽  
Monoclonal Antibody Therapy ◽  
Hospital Leadership ◽  
Stewardship Program ◽  
Frequent Monitoring ◽  
Post Infusion

Abstract Background Antimicrobial stewardship programs (ASP) have been essential during the coronavirus disease 2019 (COVID-19) pandemic response. Use of monoclonal antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has proven difficult to operationalize, despite being available through emergency use authorization (EUA). Utilizing existing ASP and multidisciplinary approach to lead the effort, we aim to describe our experience in operationalizing monoclonal antibody therapy. Methods Retrospective study of SARS-CoV-2 infected adults receiving monoclonal antibody therapy under EUA (December 2020-April 2021). An algorithm developed by the ASP provided education and an interactive online tool allowing referring physicians and patients to assess eligibility prior to hospital arrival. Patients were screened and approved by existing ASP which included; Infectious Disease (ID) physicians, pharmacist, and ID Nurse. A multidisciplinary approach with ER staff and development of pharmacy workflow with order set were utilized as eligible patients received infusion in dedicated ER location. Data such as demographics, co-morbid condition, infusion related complications, hospitalization, and death were reviewed and collected regularly by the ASP team with frequent monitoring and regulatory reporting. Primary patient outcome was preventing hospitalization. Results 107 patients received monoclonal antibody therapy. 47% patients were male, 50% White, and 79% non-Hispanic. 87% received monotherapy (bamlanivimab) and 13% received dual therapy (bamlanivimab/etesevimab). 17 patients required hospitalization post infusion. 1 death occurred. COVID-19 related hospitalization within 30-days was avoided in 84% of treated patients. No adverse event directly related to infusion were seen. Conclusion Use of monoclonal antibody therapy under EUA for patients for SARS-CoV-2 infection led to decrease in hospitalization in this cohort. An existing ASP using an algorithmic approval process, frequent monitoring, and multidisciplinary approach successfully operationalized the use of monoclonal antibody therapy. ASP’s provide benefit and versatility beyond monitoring of antimicrobials alone and should continue to receive support by hospital leadership. Disclosures All Authors: No reported disclosures

The impact of digital interventions on antimicrobial stewardship in hospitals: A qualitative synthesis of systematic reviews (Preprint)

2021 ◽  
Author(s):  
Bethany A Van Dort ◽  
Jonathan Penm ◽  
Angus Ritchie ◽  
Melissa T Baysari
Keyword(s):  
Systematic Reviews ◽  
Antimicrobial Stewardship ◽  
Digital Health ◽  
Hospital Setting ◽  
Antimicrobial Use ◽  
Qualitative Synthesis ◽  
Large Variability ◽  
Antimicrobial Prescribing ◽  
Digital Interventions ◽  
The Impact

BACKGROUND Antimicrobial stewardship (AMS) programs aim to optimize antimicrobial use by utilizing a suite of coordinated strategies. With the increased use of health information technology in hospitals, AMS processes that were traditionally paper-based are becoming computerized and streamlined. A number of reviews on digital interventions supporting AMS have been performed, so we performed a review of reviews to consolidate findings OBJECTIVE To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. METHODS Databases: Medline, Embase, Scopus, CINAHL and the Cochrane Database of Systematic Reviews were searched from 2010 onwards. Papers were eligible if they included studies that examined the effectiveness of digital health interventions related to antimicrobial prescribing and monitoring, in an inpatient hospital setting. Papers were excluded if they did not include a clearly defined search strategy, if they were limited to a pediatric setting, or they were not in English. RESULTS Seven systematic reviews were included for data extraction. Five reviews were of moderate quality and two of low quality. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. There was a large variability in outcome measures used. Six reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. CONCLUSIONS The results of this review indicate digital interventions, regardless of type, reduce antimicrobial use and improve antimicrobial appropriateness in hospitals. We recommend hospitals consider implementing one or more digital interventions to facilitate AMS programs.

scholarly journals 2045. GAIN (Generating Antimicrobial Stewardship Initiatives in Chicago Skilled Nursing Facilities) Collaborative Survey Results: CDC Core Elements of Antimicrobial Stewardship Compliance Assessment in 27 Chicago Skilled Nursing Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S688 ◽  
Author(s):  
Amy P Hanson ◽  
Massimo Pacilli ◽  
Shannon N Xydis ◽  
Kelly Walblay ◽  
Stephanie R Black
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guideline ◽  
Skilled Nursing Facilities ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Term Care ◽  
Skilled Nursing ◽  
Core Elements ◽  
Director Of Nursing ◽  
Minimum Criteria

Abstract Background Antimicrobial Stewardship Programs (ASPs) in long-term care facilities is a Centers for Medicare and Medicaid Services requirement as of 2017. The CDC recommends that ASPs in skilled nursing facilities (SNFs) fulfill 7 Core Elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Methods An electronic survey utilizing REDCap was sent to the 76 Chicago SNFs representatives (Administrator, Director of Nursing, and/or Assistant Director of Nursing). Survey questions were adopted from the CDC Core Elements of Antimicrobial Stewardship for Nursing Homes Checklist. Results Twenty-seven (36%) of Chicago SNFs responded. Bed size ranged from 36 – 307 (median 150). Although 93% of facilities had a written statement of leadership support for antimicrobial stewardship, only 22% cited any budgeted financial support for antimicrobial stewardship activities. While Pharmacist Consultants visited all SNFs (most visiting monthly), only 33% of SNFs had an Infectious Disease Provider that consulted on-site. Dedicated time for antimicrobial stewardship activities was less than 10 hours per week in 78% of facilities, with half of all respondents reporting less than 5 hours per week. Treatment guidelines were in place for 63% of SNFs, 56% had an antibiogram, and only 7% utilized the Loeb criteria to guide appropriate antibiotic prescribing. Many facilities tracked antimicrobial stewardship metrics (93%) and reported out to staff (70%). Annual nursing training on antimicrobial stewardship occurs more frequently (85%) than prescriber education (56%). The top 3 barriers identified in implementing ASPs were financial limitations (33%), lack of clinical expertise (33%), and provider opposition (30%). Facilities’ compliance in all seven core elements varied from partially compliant (65%), majority compliant (19%), and majority non-compliant (16%). Conclusion Data from this baseline survey informed focused antimicrobial stewardship initiatives for the GAIN Collaborative. Targeted areas to incorporate into facility action plans include treatment guideline development, antibiograms, annual staff antimicrobial stewardship education, and adoption of the Loeb minimum criteria for antibiotic prescribing into clinical practice. Disclosures All authors: No reported disclosures.

scholarly journals But is it Comprehensive? Unpacking the ‘comprehensive’ in comprehensive sexuality education

2020 ◽  
Vol 79 (7) ◽  
pp. 747-762 ◽  
Author(s):  
Esther Miedema ◽  
Marielle L J Le Mat ◽  
Frances Hague
Keyword(s):  
Public Health ◽  
Knowledge Production ◽  
Sexuality Education ◽  
Comprehensive Sexuality Education ◽  
The Core ◽  
Key Concepts ◽  
Core Elements ◽  
Core Components ◽  
Important Means ◽  
The Subject

Background: Comprehensive Sexuality Education (CSE) is increasingly gaining traction within the international community. CSE is regarded as an important means of informing young people about their rights and sexual health, improving public health outcomes and contributing to sustainable development. Context and objective: Considerable variation exists in understandings regarding what makes sexuality education ‘comprehensive’. To gain greater clarity on what CSE is seen to be and entails, and how this form of sexuality education compares with other approaches, a review of existing programmatic and scholarly literatures was conducted. Design: This literature review analyses a range of CSE guidelines and academic sources engaging with the subject of CSE, and sexuality education more broadly. Method: Analysis of stated goals and means of CSE to identify core components of this form of education. Results: Four sets of core CSE components are identified, yet the analysis shows that the intended breadth of this type of sexuality education leaves considerable space for interpretation, with key concepts often remaining abstract. Furthermore, addressing the core elements of CSE and achieving its ‘emancipatory’ goals can work to exclude particular perspectives and subjectivities. Conclusion: The review draws attention to the politics of knowledge production at play in decisions concerning what is deemed ‘comprehensive’, for whom, when and where. It concludes that the notion of ‘comprehensive’ is a matter of degree, and that reaching consensus on a set of universal standards regarding what can be deemed as ‘comprehensive’ may neither be possible nor desirable. The analysis will be useful for those interested in more careful engagement with CSE and, specifically, in examining features that, in practice, may run counter to the original goals.

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