scholarly journals 87. Effectiveness of a Best Practice Advisory in Reducing Inappropriate Urine Cultures

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Margaret Cooper ◽  
Katherine C Shihadeh ◽  
Cory Hussain ◽  
Timothy C Jenkins
Keyword(s):  
Pregnant Women ◽  
Best Practice ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urinary Symptoms ◽  
Intervention Period ◽  
Post Intervention ◽  
Absolute Increase ◽  
Practice Advisory ◽  
The Impact

Abstract Background Inappropriate urine cultures can contribute to overutilization of antibiotic treatment for asymptomatic bacteriuria. The objective of this study was to evaluate the appropriateness of urine cultures and the impact of a clinical decision support (CDS) intervention. Methods The CDS intervention involved embedding three questions in the urine culture order: whether the patient has fever, leukocytosis or urinary symptoms. When the answer to all three questions is no, a best practice advisory (BPA) alerts the provider that the patient may not meet criteria for a urine culture and suggests cancellation of the order. Cultures obtained in patients experiencing fever, leukocytosis, or urinary symptoms, and those who were pregnant, undergoing invasive urologic procedure, or < 3 years old were classified as appropriate. We performed a quasi-experimental study assessing appropriateness of urine cultures before and after implementation of the BPA. The pre-intervention period was 5/9/19 to 7/31/20 and the intervention period was 2/3/21 to 4/27/21. Random samples of 100 cases from pre- and post-intervention were reviewed to assess appropriateness. Results There were 12,679 and 8,270 urine cultures performed pre-intervention and post-intervention, respectively. In 100 cases reviewed pre-intervention, 74% of the cultures were appropriate. Of these, 54% were ordered due to fever or leukocytosis, 50% due to urinary symptoms, and 12% in pregnant women. Post-intervention, the BPA fired on 458 orders and 106 (23%) were subsequently discontinued. Of the 100 cases reviewed post-intervention, 5 orders were discontinued after the BPA fired. Of the remaining 95 cultures, 78% were appropriate. Of these, 41% were ordered for fever or leukocytosis, 69% for urinary symptoms, and 11% in pregnant women. The change in the proportion of appropriate cultures pre- and post-intervention was not statistically significant (74% vs 78%, respectively, p=0.906). Conclusion In nearly one quarter of urine cultures performed, there was not an appropriate indication. Our intervention led to cancellation of 23% urine culture orders and resulted in an absolute increase in 4% of the cultures being ordered appropriately. However, the change in appropriateness was not statistically significant. Disclosures All Authors: No reported disclosures

scholarly journals 83. Impact of a Urine Culture Best Practice Advisory on Collection of Urine Cultures and Subsequent Antibiotic Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S158
Author(s):  
Logan White ◽  
Andrea Dooley-Wood ◽  
Hien Nguyen ◽  
Aiman Bandali
Keyword(s):  
Antibiotic Therapy ◽  
Adverse Drug Reactions ◽  
Best Practice ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Resistant Bacteria ◽  
Drug Reactions ◽  
Practice Advisory ◽  
Tract Infections ◽  
The Impact

Abstract Background In the acute care setting, urinary tract infections (UTIs) may be over diagnosed in up to 40% of cases. In most scenarios, asymptomatic bacteriuria (ASB) is not an indication for antibiotic therapy; inappropriate therapy is associated with a higher incidence of antibiotic-resistant bacteria and adverse drug reactions. Limiting inappropriate collection of urine cultures may decrease unnecessary treatment of ASB. The objective of this study is to assess the impact of a urine culture best practice advisory (BPA) on collection of unnecessary urine cultures. Methods This retrospective, observational, single-center study included adult inpatients with an order for urinalysis/urine culture. Those who were pregnant, had a concomitant infection other than UTI and/or were taking antimicrobials for a non-UTI indication, and were undergoing urological procedures were excluded. Duplicate urine culture collections and/or admissions were excluded. Incorporation of a BPA into computerized provider order entry, allowing providers to assess need and document indication for urine culture collection, was implemented on July 2019. The following clinical outcomes were assessed: number of unnecessary urine cultures collected, number of antibiotic treatments, and antibiotic-associated adverse reactions. Results Two hundred met criteria for inclusion; 96 in the pre-BPA group (Aug – Oct 2018) and 104 in the post-BPA group (Aug – Oct 2019). Seventy-four (37%) were male and the mean age was 64 and 70 years (p=0.249), respectively. The Charlson Comorbidity Index (CCI) was similar between groups (4 vs. 5, p=0.162) and majority were admitted to a general medical ward (94.5%). Seventy patients (72.9%) in the pre-BPA group and 47 (51.6%) in the post-BPA group had inappropriately ordered urinalysis/urine cultures (OR 0.40; 95% CI 0.22-0.73; p=0.003). Of these patients, 15 (21.4%) and 9 (19.1%) from the pre- and post-BPA groups, respectively, were treated (p=0.077). Among those treated, only two adverse drug reactions were reported. Conclusion Implementation of a BPA significantly reduced the number of inappropriate urinalysis/urine culture orders. There was a trend towards decreased antibiotic use for ASB. Future studies are warranted to assess sustainability of these results. Disclosures All Authors: No reported disclosures

Abstract TP73: Evaluation of Intervention Aimed at Reducing Alteplase Returns without Compromising Clinical Care in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Natalie Swearingen ◽  
Jillian T Myers ◽  
Alexandra Lesko
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Best Practice ◽  
Clinical Care ◽  
Cost Savings ◽  
Drug Manufacturer ◽  
Intervention Period ◽  
Post Intervention ◽  
Primary Stroke Center ◽  
The Impact

Introduction: In 2010, the AHA/ASA’s Target Stroke best practice recommendations to reduce door to needle times (DTN) included early pre-mix of intravenous alteplase, which ultimately leads to unused vials. However, hospitals have largely recouped the cost of unused, premixed vials through returns to the drug manufacturer, although this practice is unlikely to continue. As a result, we evaluated an intervention to reduce the number of returned vials and the impact on clinical care at our certified primary stroke center (PSC). Methods: A 6-month pre-intervention period (January 2015-June 2015) was compared to two 6-month post-intervention periods, July 2015-December 2015 and January 2016-May 2016. Acute ischemic stroke patients presenting at our PSC and considered for alteplase treatment were included. Inpatient strokes or those with diagnoses unrelated to stroke or uncertain treatment eligibility were excluded. Primary outcomes were as follows: 1. Percent of alteplase vials returned out of the total number mixed and the associated costs 2. Average DTN time 3. Pharmacy alteplase mix time to needle time. Average minutes (min) with associated p-values and 95% confidence intervals (95%CI) were reported. Price for replacement vials ranged from $6,400 to $8,400 per 100 mg vial. Results: Data from 95 AIS patients were included. The percentage of alteplase returns for the evaluation period were as follows: 40.6% (13/32) for the pre-intervention, 11.4% (4/35) for the first post-intervention and 6.1% (2/33) for the second post-intervention period. Total cost savings was between $128,000 and $168,000 comparing pre and post-intervention periods. Among those treated, DTN times were not significantly different between pre-intervention (55.5 min, n=19), post-1 (59.7 min, n=27) and post-2 (49.9 min, n=30) (p=.13, 95%CI: 50.6,59.1). Similarly, the pharmacy alteplase mix times to needle times were also not significantly different (16.6 min vs 14.8 min vs 11.8 min) across the three time periods (p=.14, 95%CI:12.2,15.9). Conclusion: The percentage of vials returned reduced by over 6-fold after the intervention resulting in considerable cost savings. PSCs can reduce overall waste of alteplase and decrease costs without negatively effecting clinical care.

The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis

2020 ◽  
Vol 16 ◽  
Author(s):  
Diala Alawneh ◽  
Moustafa Younis ◽  
Majdi S. Hamarshi
Keyword(s):  
Diabetic Ketoacidosis ◽  
Best Practice ◽  
Intervention Group ◽  
Post Intervention ◽  
Management Algorithm ◽  
Significant Difference ◽  
Before And After ◽  
Practice Advisory ◽  
The Impact ◽  
Post Intervention Group

Background: According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved. Methods: A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed. Results: A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group 14.8 (±7.7) vs 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3. The incidence of hypoglycemia was lower in the post-intervention group n=4 (3%) vs 17 (10%), p=0.024. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both groups (p>0.05). Conclusions: The BPA introduced in our DKA management algorithm successfully reduced total time on insulin and the incidence of hypoglycemia.

scholarly journals 141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Grace Mortrude ◽  
Mary Rehs ◽  
Katherine Sherman ◽  
Nathan Gundacker ◽  
Claire Dysart
Keyword(s):  
Patient Satisfaction ◽  
Primary Outcome ◽  
Respiratory Infections ◽  
Asymptomatic Bacteriuria ◽  
Educational Interventions ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Stepped Wedge ◽  
Post Intervention ◽  
The Impact

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance in the United States. The objective of this study was to design, implement and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the outpatient setting. Methods This randomized, stepped-wedge trial evaluated the impact of educational interventions to providers on adult patients presenting to primary care (PC) clinics for ARIs and ASB from 10/1/19 to 1/31/20. Data was collected by retrospective chart review. An antibiotic prescribing report card was provided to PC providers, then an educational session was delivered at each PC clinic. Patient education materials were distributed to PC clinics. Interventions were made in a step-wise (figure 1) fashion. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper-respiratory infection otherwise unspecified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes included individual components of the primary outcome, a composite safety endpoint of related hospital, emergency department or primary care visit within 4 weeks, antibiotic appropriateness, and patient satisfaction surveys. Figure 1 Results There were 887 patients included for analysis (405 pre-intervention, 482 post-intervention). Baseline characteristics are summarized in table 1. After controlling for type 1 error using a Bonferroni correction the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for bronchitis (20.99% vs 12.66%; p=0.0003). Appropriateness of prescriptions for sinusitis (OR 4.96; CI 1.79–13.75; p=0.0021) and pharyngitis (OR 5.36; CI 1.93 – 14.90; p=0.0013) was improved in the post-intervention group. The composite safety outcome and patient satisfaction survey ratings did not differ between groups. Table 1 Conclusion Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visit or patient satisfaction surveys. Disclosures All Authors: No reported disclosures

scholarly journals Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shigeki Koshida ◽  
Shinsuke Tokoro ◽  
Daisuke Katsura ◽  
Shunichiro Tsuji ◽  
Takashi Murakami ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Behavior ◽  
Multivariable Analysis ◽  
Perinatal Outcomes ◽  
Fetal Movement ◽  
Post Intervention ◽  
Fetal Movements ◽  
Adverse Perinatal Outcomes ◽  
The Impact ◽  
Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

scholarly journals 1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S412-S412
Author(s):  
Bhagyashri D Navalkele ◽  
Nora Truhett ◽  
Miranda Ward ◽  
Sheila Fletcher
Keyword(s):  
Infection Prevention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prevention Strategies ◽  
Intervention Period ◽  
Post Intervention ◽  
Frontline Staff ◽  
Post Intervention Period ◽  
Tract Infections ◽  
The Impact

Abstract Background High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days. Methods At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data. Results Prior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1). Conclusion At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of Reflex Urine Culture Criteria Changes and its Impact on Treatment of Asymptomatic Bacteriuria

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S346-S346 ◽  
Author(s):  
Kirre Wold ◽  
Jeff Brock ◽  
Kelly Percival ◽  
Lindsey Rearigh ◽  
Lucas Vocelka ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
Hospital Data ◽  
Post Intervention ◽  
Number Of Patients ◽  
Positive Urine ◽  
Before And After ◽  
Implementation Period ◽  
Inappropriate Antibiotics ◽  
The Impact

Abstract Background Asymptomatic bacteriuria (ASB) is a common clinical condition identified by the presence of bacteria in the urine of a patient without signs and symptoms of a urinary tract infection (UTI). Treatment of ASB leads to unnecessary antimicrobial use and can cause more harm than benefit in many patients. This study is to determine the impact of more stringent criteria for urinalysis with culture if indicated (UAC), implemented in September 2016, on the treatment of asymptomatic bacteriuria. Methods A pre-post descriptive study of patients was conducted with an order placed for UAC in the Emergency Department (ED) or hospital. Data was collected retrospectively via chart reviews. The data on ASB patients from November 2015 to April 2016 was compared with the post-implementation period October 2016 to January 2017. The number of UAC orders and cultures were averaged for 6 months pre and post implementation of the criteria change. Results A total of 580 patient charts were assessed post-implementation of the UAC criteria change. A majority of the orders originated from the ED, (N = 430, 72.8%). ASB was treated inappropriately at a rate of 60.4% (N = 64/106) pre-implementation and a rate of 65% (N = 41/63) post implementation, P = 0.542. The total number of UAC ordered before and after implementation did not change, (N = 2852 pre-intervention vs N = 2825 post-intervention, P = 0.744), as seen in Figure 1. However, the number of reflexed urine cultures did significantly decrease post criteria change,
 (N = 1056 pre-intervention vs. N = 603 post-intervention, P < 0.0001). In addition, the number of positive urine cultures also significantly decreased, (N = 378 pre-intervention vs. N = 289 post-intervention, P = 0.0447). The impact the criteria change had on patient care is the number of potential antibiotic courses saved by reflexing fewer urine cultures off the UAC. Based on the decrease in positive urine cultures, it is estimated 702 courses of inappropriate antibiotics for ASB could be saved per year (59/month). Conclusion More stringent criteria for reflex urine cultures significantly decreases the number of urine cultures performed, therefore decreasing the number of patients treated with ASB. Additional stewardship measures are necessary to reduce the treatment of ASB for patients who have cultures performed. Disclosures All authors: No reported disclosures.

scholarly journals 1108. Impact of Implementing a Urine Culture Order Set on Antibiotic Utilization and Rates of Catheter-Associated Urinary Tract Infections in an Urban Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S394-S395
Author(s):  
Zainab Alnafoosi ◽  
Chi Doan Huynh ◽  
Mohammed Al-Sadawi ◽  
Stanley Moy ◽  
Caitlin Otto ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Intervention Period ◽  
Post Intervention ◽  
Patient Level ◽  
Antibiotic Utilization ◽  
Tract Infections ◽  
Level Analysis ◽  
Order Set

Abstract Background Overutilization of urine cultures may lead to inappropriate use of antibiotics. We implemented a computerized urine culture order set where urine specimens are not processed for culture unless there is evidence of pyuria (≥10 WBC per high power field) on urinalysis (UA), or if a patient is pregnant, neutropenic, neonate, renal transplant recipient, planned for or had a recent urologic procedure. Here we evaluated the impact of this order set on antibiotic utilization, urine culture volumes and rates of catheter-associated urinary tract infections (CAUTI). Methods We performed a retrospective chart review before and after the order set implementation (August–December 2017 and 2018, respectively). The analysis had two distinct components: first was at institution-level, where data for all adult and pediatric inpatients were compared for urine culture volumes and antibiotic use regardless of indication. The second component was done at patient-level, where we compared clinical data and days of therapy (DOT) for all adult inpatients who had urine cultures without pyuria in the specified pre-intervention period, and those with canceled urine cultures due to absence of pyuria post-intervention. Results At the institution-level analysis, a statistically significant reduction was observed in rates of urine cultures performed (P = 0.02), as well as use of penicillins, carbapenems and Trimethoprim-Sulfamethoxazole (TMP-SMX) (P < 0.05). However, the use of cephalosporins has increased post-intervention (P < 0.001). No significant change was noted for aminoglycosides or fluoroquinolones. At the patient-level analysis, DOT means in patients with negative pyuria did not change significantly (5.16 pre-intervention, 6.54 post-intervention, P = 0.202). Prevalence of treatment for bacteriuria despite absence of pyuria was 5.3% (20/380) pre-intervention, vs. 1.9% (1/53) post-intervention (P = 0.494). In the pre-intervention period, three cases met the criteria for CAUTI despite negative pyuria. This misdiagnosis could have been avoided by implementation of the urine culture order set. Conclusion Implementation of a urine culture order set in our institution led to a statistically significant reduction in rates of urine cultures performed, as well as use of penicillins, carbapenems and TMP-SMX. Disclosures All authors: No reported disclosures.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

2020 ◽  
Author(s):  
Ravena Melo Ribeiro da Silva ◽  
Ana Cláudia de Brito Câmara ◽  
Ellen Karla Chaves Vieira Koga ◽  
Iza Maria Fraga Lobo ◽  
Wellington Barros da Silva
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Polymyxin B ◽  
Intervention Period ◽  
Post Intervention ◽  
Short Period ◽  
Active Feedback ◽  
The Impact ◽  
Antimicrobial Administration

Abstract Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

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