scholarly journals Optimizing Envitonmental Hygiene to Successfully Decrease Clostridiun Difficile Transmission

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S404-S405
Author(s):  
Philip Carling ◽  
Mary Scott
Keyword(s):  
Intervention Program ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Intervention Period ◽  
Cleaning Efficiency ◽  
Use Patterns ◽  
Quasi Experimental ◽  
Environmental Surface ◽  
Hygiene Compliance ◽  
Time Of Admission

Abstract Background In light of the challenges involved in reducing healthcare onset colstridium Difficile infection (HO-CDI), we implemented a multifaceted hospital wide intervention program to optimize environmental hygiene in our 197 bed regional referral hospital. Methods Following an 18 month period during which HO-CDI rates were monitored, we simultaneously replaced routine quartinary ammodium cleaning of patient rooms with an environmentally non-damaging sporicidal peroxyacetic acid/hydrogen peroxide disinfectant, implemented an educational program for environmental services staff which included ongoing objective monitoring of the thoroughness of disinfection cleaning (TDC). We also evaluated cleaned environmental surface bioburden elimination. terminal room cleaning efficiency and HO-CDI rates. Results During the 33 month intervention period, TDC rapidly improved from 81% to 92% and remained greater than 88% during the remainder of the study (P = . 01)(Figure 1.) Bioburden elimination of cleaned surfaces improved from 24% to 84% (P = .03) with sporacide use. Efficiency of terminal room cleaning improved by 33% (36minutes to 27 minutes)(P = .02). HO-CDI rates fell significantly during the intervention period from an average of 8.9 to 3.2 /10,000 patient-days (P =.0001, 95% CI 3.48 to 7.81)(Figure 2.) as did months without documented CDI cases (P .02). No changes in potential confounders including antibiotic use patterns, intensive care unit days, prevalence density of CDI at the time of admission, hand hygiene compliance rates, isolation practices and over all patient-days were identified. Conclusion In the context of a single site, quasi-experimental study design, this 44 month study documented a significant impact (P = .0001) of an objectively monitored hospital-wide sporicidal disinfection cleaning program on endemic HO-CDI. The program was also associated with significantly improved efficiency of cleaning and post cleaning bioburden elimination of cleaned patient zone surfaces. Assuming a continued incidence of HO-CDI without intervention, the program resulted in an average non-reimbursed cost savings of approximately $ 10,000./month during the intervention period. Disclosures P. Carling, Ecolab: Consultant, Royalty; M. Scott, Ecolab, Inc.: Research Contractor, Research support

scholarly journals 150. Using audit-and-feedback to improve antibiotic-prescribing in Emergency Departments: a quasi-experimental study across 4 sites in the Veterans Health Administration

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S85-S85
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Andrew Dysangco ◽  
Andrea Aylward ◽  
Bruce Alexander ◽  
...  
Keyword(s):  
Experimental Study ◽  
Emergency Departments ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
Quasi Experimental ◽  
Ed Visits ◽  
Research Grant

Abstract Background Antibiotic-prescribing in Emergency Departments (EDs) is often inappropriate. In this study, we evaluated whether audit-and-feedback could improve antibiotic use in EDs. Figure 1. Comparison of antibiotic-prescribing between the pretest and intervention periods at 2 intervention EDs and 2 control EDs Methods We pilot tested an audit-and-feedback intervention using a quasi-experimental study design at 2 intervention and 2 matched-control EDs with a 12-month pretest and a 12-month intervention period. At intervention sites, 27 of 31 (87.1%) clinicians were enrolled; at baseline, they received 1) one-on-one education about antibiotic-prescribing and 2) individualized feedback with comparisons to local peers. Feedback included personalized antibiotic-prescribing data for all ED visits and specifically for viral acute respiratory infections (ARIs); feedback was updated quarterly. The primary outcome was the antibiotic-prescribing rate for ED visits not resulting in hospitalization, and it was assessed using a segmented regression analysis of monthly time series data. Manual chart reviews were performed to assess guideline-concordant management (i.e. prescribing an antibiotic when indicated and not prescribing when not indicated) for 5 ARIs plus cystitis. Results In the pre-test and intervention periods, intervention sites had 28,146 and 27,396 visits compared to 31,439 and 32,295 visits at control sites. After implementation started, intervention sites saw an immediate decrease in antibiotic use (-10.3%, p=0.15) compared to a 1.5% increase (p=0.88) at control sites. By the end of the intervention period, there was an 8.9% decrease in antibiotic use at intervention sites compared to a 3.4% decrease at control sites [relative risk ratio (RRR) -3.3% (95% CI, -8.4 to +1.7), Figure 1]. Guideline-concordant management improved from 52.1% to 72.2% (p< 0.01) at intervention sites compared to 51.3% to 58.2% (p=0.13) at control sites. Intervention and control sites had similar changes in 30-day outcomes, including late antibiotic prescriptions and hospitalizations. Conclusion After the implementation of audit-and-feedback at 2 EDs, antibiotic use did not significantly decrease compared to 2 control EDs but guideline-concordant management improved. Future studies should include more study sites to improve statistical power and also evaluate the effectiveness of more frequent and specific feedback. Disclosures Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support) Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)

scholarly journals Strategies to Reduce Inappropriate Laboratory Blood Test Orders in Intensive Care Are Effective and Safe: A Before-And-After Quality Improvement Study

2018 ◽  
Vol 46 (3) ◽  
pp. 313-320 ◽  
Author(s):  
J. A. Dhanani ◽  
A. G. Barnett ◽  
J. Lipman ◽  
M. C. Reade
Keyword(s):  
Intensive Care ◽  
Intervention Program ◽  
Cost Savings ◽  
Patient Harm ◽  
Intervention Period ◽  
Post Intervention ◽  
Multimodal Intervention ◽  
Post Intervention Period ◽  
Before And After ◽  
Test Ordering

Unnecessary pathology tests performed in intensive care units (ICU) might lead to increased costs of care and potential patient harm due to unnecessary phlebotomy. We hypothesised that a multimodal intervention program could result in a safe and effective reduction in the pathology tests ordered in our ICU. We conducted a single-centre pre- and post-study using multimodal interventions to address commonly ordered routine tests. The study was performed during the same six month period (August to February) over three years: 2012 to 2013 (pre-intervention), 2013 to 2014 (intervention) and 2014 to 2015 (post-intervention). Interventions consisted of staff education, designing new pathology forms, consultant-led pathology test ordering and intensive monitoring for a six-month period. The results of the study showed that there was a net savings of over A$213,000 in the intervention period and A$175,000 in the post-intervention period compared to the pre-intervention period. There was a 28% reduction in the tests performed in the intervention period (P <0.0001 compared to pre-intervention period) and 26% in the post-intervention period (P <0.0001 compared to pre-intervention period). There were no ICU or hospital mortality differences between the groups. There were no significant haemoglobin differences between the groups. A multimodal intervention safely reduced pathology test ordering in the ICU, resulting in substantial cost savings.

scholarly journals Prevent Antibiotic overUSE (PAUSE): Impact of a Provider Driven Antibiotic-Time out on Antibiotic Use and Prescribing

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S20-S20 ◽  
Author(s):  
Kerri Thom ◽  
Pranita D Tamma ◽  
Anthony D Harris ◽  
Daniel Morgan ◽  
Kathryn Dzintars ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Base Period ◽  
Intervention Period ◽  
Front Line ◽  
Antibiotic Overuse ◽  
Time Out ◽  
Empiric Antibiotic ◽  
Quasi Experimental ◽  
The Impact ◽  
Study Inclusion

Abstract Background Empiric antibiotic (abx) therapy is often not readdressed after clinical progress becomes apparent and the results of diagnostic studies become available. We sought to evaluate whether an antibiotic time out (ATO) by front-line clinicians after 3–5 days of abx therapy could lead to a reduction in unnecessary abx use. Methods A quasi-experimental study to evaluate the impact of an ATO on decreasing abx use was performed over a 6-month base period and 9-month intervention period in 11 units across 6 hospitals in the greater Maryland region was conducted. Patients who received abx for at least 3 calendar days were eligible for study inclusion. Outcomes included days of abx therapy (DOT) per admission to cohort as well as percent of patients with a change in abx regimen on day 3–5 and appropriateness of abx regimens on days 3–5. Appropriateness of abx therapy was adjudicated by infectious diseases (ID) clinicians using prespecified criteria. Regression analysis was used to compare outcomes between the base and intervention periods. Results A total of 3,448 abx courses were reviewed, including 1,541 during the base and 1,907 during the intervention period. Overall DOT per cohort admission was similar between the two periods (12.7 vs. 12.2 hospital DOT per admission in the base and intervention periods, respectively, and was not statistically significant after controlling for unit and season (P = 0.18). After adjusting for season, unit, ID consultation, and comorbidities, there was a 36% increase in the odds of changing or discontinuing abx on days 3–5 in the intervention period compared with the base period (48% vs. 54%, P &lt; 0.05). Similarly, there was an 89% increase in the odds of receiving an appropriate abx regimen on days 3–5 in the intervention period compared with the base period (53% vs. 68%, P &lt; 0.01). There was no difference in the rate of Clostridium difficile lab-events in the two study periods. Conclusion In this multicenter study, we found that performance of an ATO by front-line providers was effective at improving the appropriateness of abx therapy 3–5 days after initiation, but did not change the amount of abx use, suggesting that additional interventions, perhaps later during hospitalization or at discharge, are needed to impact duration of abx therapy. Disclosures All authors: No reported disclosures.

scholarly journals Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

2020 ◽  
Vol 17 (16) ◽  
pp. 5669 ◽  
Author(s):  
Asma Al-Turkait ◽  
Lisa Szatkowski ◽  
Imti Choonara ◽  
Shalini Ojha
Keyword(s):  
Drug Use ◽  
Drug Utilization ◽  
Antibiotic Use ◽  
Global Perspective ◽  
Use Patterns ◽  
Rational Prescribing ◽  
Drug Use Patterns ◽  
General Drug ◽  
The Usa ◽  
Drug Utilization Studies

Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

scholarly journals Infection Preventionist Run Clostridioides difficile Testing Diagnostic Stewardship Protocol- Experience From a Rural Community Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s484-s485
Author(s):  
Raghavendra Tirupathi ◽  
Ruth Freshman ◽  
Norma J Montoy ◽  
Melissa Gross
Keyword(s):  
Cost Savings ◽  
Antibiotic Use ◽  
First Year ◽  
Multiple Parameters ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Commercial Company ◽  
Surgical History ◽  
Test Ordering ◽  
Infection Preventionists

Background: Distinguishing active Clostridioides difficile infection (CDI) from asymptomatic colonization remains a challenging task in the era of PCR testing. Inappropriate testing leads to overtesting and overdiagnosis, inadvertent treatment, and isolation in addition to laboratory identified (LabID) events, leading to increased incidence to hospital-onset CDI (HO-CDI). The institution has a nurse-driven C. difficile test ordering protocol, and we noted a significant increase in the HO-CDI incidence in 2017 due to inappropriate testing, with rates as high as 0.94 per 1,000 patient days. Methods: In September 2017, a multidisciplinary team reviewed and initiated algorithm-based testing with mandatory audit and review by infection preventionists (IPs) under the guidance of an ID physician of all ordered tests. They reviewed the adequacy and legitimacy of order for multiple parameters, including minimum 3 loose stools in 24 hours, use of laxatives in last 24 hours, consistency of the sample, presence of at least 1 clinical parameters (ie, fever, abdominal pain, leukocytosis, sepsis, or septic shock), recent or concomitant antibiotic use, recent PCR testing in the last 14 days, and chart review for medical and/or surgical history. The IPs served as the gatekeepers to testing and rejected the samples that were deemed inappropriate. Ambiguous cases were discussed with the ID specialist. On the microscope lab side, all specimens sent were batched to be run twice a day at 8:30 a.m. and 2:30 p.m., and testing was performed only on the samples cleared by infection preventionists. Results: The number of PCR tests completed in the comparison quarter of 2016 was 220, which decreased to 157 tests in 2017 with a reduction of 28%. After a full year of implementation of the diagnostic stewardship protocol, the number of completed PCR tests decreased to 626 from 940 PCR tests in 2016, with an overall 34% decrease in testing. In the year following the implementation of diagnostic stewardship, HO-CDI decreased from 60 events in 2017 to 43 events in 2018, with a reduction of 28%. Subsequently, HO-CDI further decreased in 2019 from 43 to 28, with a reduction of 35%. Since the implementation of the project in 2017, HO-CDIs have decreased by 54% overall. The reduction in 314 C. difficile PCR tests in the first year led to a savings of $8,300 in laboratory testing supplies. The reduction of HO CDI by 17 led to cost avoidance of $293,420. Conclusions: Our experience shows that the IP-run diagnostic stewardship program was highly successful in streamlining testing, with cost savings on several fronts.Funding: NoneDisclosures: NoneDisclosures:Commercial Company : If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the funding company.DisagreeRaghavendra Tirupathi

scholarly journals Educational Video Improves Knowledge about Outpatients’ Usage of Antibiotics in Two Public Hospitals in Indonesia

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 606
Author(s):  
Fauna Herawati ◽  
Rika Yulia ◽  
Bustanul Arifin ◽  
Ikhwan Frasetyo ◽  
Setiasih ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
General Hospital ◽  
Sampling Technique ◽  
Knowledge Score ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Educational Video ◽  
Inappropriate Use ◽  
Quasi Experimental ◽  
The Difference

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about “Responsible use of antibiotics” and “How to obtain antibiotics” is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients’ knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test—post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents’ knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous “yes” or “no” answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student’s t-test was applied. The educational videos significantly improved outpatients’ knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

scholarly journals Geology and Environment: A Problem-Based Learning Study in Higher Education

Geosciences ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 173
Author(s):  
Tânia Pinto ◽  
António Guerner Dias ◽  
Clara Vasconcelos
Keyword(s):  
Higher Education ◽  
Teaching And Learning ◽  
Intervention Program ◽  
Problem Based Learning ◽  
Convenience Sample ◽  
Post Test ◽  
Quasi Experimental ◽  
Within Subjects ◽  
Two Phases ◽  
Experimental Group

We aimed to contribute to a shift in higher education teaching and learning methods by considering problem-based learning (PBL) as an approach capable of positively affecting students from a geology and environment (GE) curricular unit. In a convenience sample from a Portuguese public university, two groups of students were defined: (1) an experimental group (n = 16), to which an intervention program (IP) based on PBL was applied, and (2) a comparison group (n = 17), subjected to the traditional teaching approach. For nine weeks, students subject to the IP faced four problem scenarios about different themes. A triangulation of methods was chosen. The study involved two phases: (1) qualitative (sustained on content analysis of driving questions raised by students, registered in a monitoring sheet) and (2) quantitative (quasi-experimental study, based on data from a prior and post-test knowledge assessment). The qualitative results point to the development of more complex cognitive-level questioning skills after increasing familiarity with PBL. The data obtained in the quantitative study, which included both a “within-subjects” and a “between-subjects” design, show higher benefits in the experimental group, documenting gains in terms of scientific knowledge when using the PBL methodology.

scholarly journals Effectiveness of a low-value financial-incentive program for increasing vegetable-rich restaurant meal selection and reducing socioeconomic inequality: a cluster crossover trial

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Wataru Nagatomo ◽  
Junko Saito ◽  
Naoki Kondo
Keyword(s):  
Intervention Program ◽  
Crossover Trial ◽  
Financial Incentive ◽  
Control Period ◽  
Healthy Food ◽  
Intervention Period ◽  
Marginal Value ◽  
Percentage Point Increase ◽  
Point Increase ◽  
Proxy Measure

Abstract Background In light of recent theories in behavioural economics, an intervention program with monetary incentives could be effective for helping patrons order healthy food, even if the incentive is small and less than one’s perceived marginal value. Methods In this single-arm cluster crossover trial at 26 local restaurants, a 1-week campaign offered a 50-yen (approximately 0.5 US dollars) cash-back payment to customers ordering vegetable-rich meals, while no pre-order incentives were offered during the control period. Results In total, 511 respondents out of 7537 customers (6.8%), and 704 respondents out of 7826 customers (9.0%), ordered vegetable-rich meals during the control and intervention periods, respectively. During the intervention period, the covariate-adjusted proportion of vegetable-rich meal orders was 1.50 times higher (95% confidence interval [CI]: 1.29 to 1.75), which increased daily sales by 1.77 times (95% CI: 1.11 to 2.83), even when subtracting the cost of cash-back payments. Respondents who reported spending the least amount of money on eating out (used as a proxy measure for income) were the least likely to order vegetable-rich meals during the control period. However, these individuals increased their proportion of purchasing such meals during the intervention period (a 3.8 percentage point increase (95% CI: 2.82 to 4.76) among those spending the least vs a 2.1 percentage point increase (95% CI: 1.66 to 2.62) among those spending the most; P for interaction = 0.001). Similarly, irregular employees exhibited a larger increase (+ 5.2 percentage points, 95% CI: 4.54 to 5.76) than did regular workers (− 1.4, 95% CI: − 1.66 to − 1.05, P for interaction = 0.001). Conclusions A program with an immediate low-value monetary incentive could be a public health measure for reducing inequalities in making healthy food choices. Trial registration UMIN Clinical Trials Registry, UMIN000022396. Registered 21 May 2016.

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