Development of a provincial interactive antibiogram tool for Ontario

2021 ◽  
pp. e20200010
Author(s):  
Jennifer Lo ◽  
Bradley J Langford ◽  
Valerie Leung ◽  
Rita Ha ◽  
Julie Hui-Chih Wu ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Public Health Issue ◽  
Regional Variability ◽  
Current State ◽  
Antibiotic Susceptibilities ◽  
Stewardship Program ◽  
Ambulatory Services ◽  
Klebsiella Spp

Background: Antimicrobial resistance (AMR) is a public health issue with significant impact on health care. Antibiogram development and deployment is a key strategy for managing and preventing AMR. Our objective was to develop an Ontario antibiogram as part of a larger provincial initiative aimed at advancing antimicrobial stewardship in the province. Methods: As part of a voluntary provincial online survey, antibiogram data from 100 of 201 (49.8%) Ontario hospitals were collected and included. All hospitals in Ontario were eligible to participate except those providing only mental health or ambulatory services. Weighted provincial and regional antibiotic susceptibilities (percentages) were conducted using descriptive statistical analyses, and an interactive antibiogram spreadsheet was developed. Respondent-identified barriers to collecting and interpreting antibiogram data are presented descriptively. Results: There was wide regional variability in antimicrobial-resistant organisms across Ontario. Provincial methicillin-resistant Staphylococcus aureus prevalence was 24.6%, ranging from 5.9% to 43.7% regionally. Provincial Escherichia coli resistance to ceftriaxone and ciprofloxacin was 13.8% (regional range 6.0%–25.1%) and 22.5% (regional range 9.8–37.8%), respectively. Klebsiella spp. resistance to ceftriaxone and ciprofloxacin was similar across all health regions, with overall provincial rates of 7.5% and 5.6%, respectively. Conclusions: We have demonstrated that integrating hospital AMR tracking and reporting as part of a larger voluntary provincial antimicrobial stewardship program initiative is a feasible approach to capturing AMR data. The provincial antibiogram serves as a benchmark for the current state of AMR provincially and across health regions.

scholarly journals India Antimicrobial Stewardship and Resistance (INTEREST): A Needs Assessment Survey

2020 ◽  
Vol 41 (S1) ◽  
pp. s297-s298
Author(s):  
Aditya Shah ◽  
John OHoro ◽  
Varun Shah ◽  
Taru Dutt ◽  
Sanjiv Shah ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Antimicrobial Stewardship ◽  
Medical Records ◽  
Online Survey ◽  
Data Access ◽  
Diagnostic Techniques ◽  
Easy Access ◽  
Hospital Inpatient ◽  
Stewardship Program ◽  
Microbiological Data

Background: The emergence and spread of antimicrobial resistance is a major problem in India with significant knowledge on whether this is a systems–based, prescriber and patient characteristic based or diagnostic technologies–based issue. Methods: An electronic survey was sent to select distribution list of intensive care units (ICU) and hospital inpatient (medicine ward) providers from India. Survey questions included antimicrobial clinical practice data, access to electronic medical records, microbiological diagnostic techniques, and access to microbiology data. The survey focused on antimicrobial prescription trends and their association with diagnostic techniques. Results: There were 90 responses from 18 states in 65 ZIP codes. They had median of 187.5 beds (IQR, 40–470). Representative responders had a median age of 40 years (IQR, 31–53). Among the responders, 73 (81%) were men. Of the 90 responses, 48 providers (52%) practiced solely in ICUs (medical and surgical) and 40 providers (45%) practiced solely on the medical ward or floor, with the rest practicing in other units. In total, 31 centers (34%) reported full access to electronic medical records, and 53 centers (59%) had access to wi-fi or Internet. Interestingly, 27 centers (30%) needed to use personal provider phone data for Internet access. Only 26 centers (29%) had electronic microbiological data. Also, 63 respondents (70%) agreed to de-escalation behavior after receiving microbiological data. In addition, 55 respondents (61%) agreed that patients have easy access to outpatient antibiotics without an appropriate prescription, over the counter. Furthermore, 58 responders (64%) said that antibiotic resistance was a major problem at their center, and 61 responders (68%) were familiar with antimicrobial stewardship programs. Among the centers, 69 (77%) had no access to formal infectious disease programs at their center. Only 27 centers (30%) had a formal Clostridium difficile–associated infection reporting and control program. Only 28 centers (31%) had a formal occupational health program. Conclusions: In a large-scale, semistructured, online survey, most issues related to easy availability of antibiotics and lack of “electronization” of medical and microbiological records. It was reassuring that most providers expressed knowledge of the existing antimicrobial stewardship program.Funding: NoneDisclosures: None

Engaging patients in antimicrobial resistance and stewardship

2016 ◽  
Vol 21 (3) ◽  
pp. 180-193 ◽  
Author(s):  
Ioana Popescu ◽  
Kim Neudorf ◽  
Sandi N. Kossey
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Care Providers ◽  
Content Type ◽  
Current State ◽  
And Control ◽  
Public Campaigns

Purpose – The purpose of this paper is to provide an overview of the perspectives of patient advisors (PAs) on the current state of antimicrobial resistance (AR) and stewardship in Canada and identifies next steps, with the goal of stimulating further collaboration for action between leaders and PAs as well as research. Design/methodology/approach – The perspectives of PAs were gathered using an electronic online survey of 72 respondents. A search of peer reviewed literature and publicly available reports informed the development of the survey and the articulation of a more comprehensive viewpoint in this paper. Findings – PAs view AR as a serious and growing public health threat. They believe sharing the responsibility for infection prevention and control and antimicrobial stewardship will help to control the problem. They see healthcare professionals as the most appropriate stakeholders to influence behaviors associated with appropriate antibiotic use, however, they also see value in public campaigns. Importantly, they identify several opportunities for PA contribution: education of care providers, patients, families, and the public; co-design and development of materials, policies, improvement initiatives, and research; and participation in and promotion of public campaigns. Practical implications – Engaging PAs as partners at all system levels is becoming common practice. PAs bring a unique and complementary perspective that could contribute to antimicrobial stewardship efforts. Originality/value – This paper begins to bridge a gap between literature and practice, and proposes that PAs can contribute to antimicrobial stewardship efforts.

scholarly journals 1051. The Use of Survey-Driven Feedback to Improve Antimicrobial Stewardship Efforts at a Single Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S370-S371
Author(s):  
Fritzie S Albarillo ◽  
Cara J Joyce ◽  
Maressa Santarossa
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Medical Center ◽  
Order Entry ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Baseline Knowledge ◽  
Formulary Restriction

Abstract Background Antimicrobial stewardship (AS) efforts have led to improved patient outcomes, reduction in unnecessary costs, and decrease in antimicrobial resistance (AR). Loyola University Medical Center (LUMC) is a quaternary care system that has primarily employed a formulary restriction and preauthorization process as the foundation of its Antimicrobial Stewardship Program (ASP). Methods In January 2018, a voluntary online survey was created and disseminated to all providers at LUMC to evaluate their baseline knowledge and perception of AS and AR, as well as to solicit feedback on current AS practices at LUMC. Based on the results of the survey, our AS team implemented the following changes to the AS program: removed prior-authorization of cefepime, piperacillin–tazobactam and vancomycin; required documentation of antimicrobial indications and duration upon order entry in the electronic medical record; and provided education to all providers via newsletters and lectures. In January 2019, a second survey was distributed to all providers with the primary goal of evaluating changes in the providers’ knowledge and perception of AS and AR post-program modifications. The secondary goal was to gather feedback on the major changes we have implemented in our program. Results A total of 167 providers completed the first survey and 173 completed the second survey. Over 95% of providers were aware that inappropriate use of antimicrobials can be harmful to patients, and that AS can decrease AR. Unfamiliarity with AS practices remains an issue. More than half agreed that unrestricting antibiotics improved their workflow, though almost half agreed that it led to inappropriate use by providers in general but not their own. Finally, most providers agreed that documenting indications and duration of antibiotics facilitated antibiotic optimization with no interference in their workflow. Conclusion Hospital-specific surveys on providers’ perception and knowledge on AS and AR can be used to guide future ASP interventions, as well as to evaluate the effectiveness of these interventions. Our ASP at LUMC implemented strategies to improve antimicrobial utilization based on our providers’ feedback. Our team will continue to use surveys to further guide our AS efforts. Disclosures All authors: No reported disclosures.

scholarly journals 1066. Antimicrobial Stewardship Program: Audit and Feedback for Continued Improvement

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S377-S378
Author(s):  
Joseph Wang ◽  
Bryan Alexander ◽  
Scott Bergman ◽  
Jihyun Ma ◽  
Erica J Stohs ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Text Message ◽  
Audit And Feedback ◽  
Phone Call ◽  
Categorical Variables ◽  
Antibiotic Overuse ◽  
Phone Calls ◽  
Stewardship Program ◽  
Order Sets

Abstract Background Audit and feedback is a foundational approach used by antimicrobial stewardship programs (ASP) and has been our primary method for ASP intervention for over 7 years. We sought to evaluate and improve our ASP methods as well as identify barriers to effective antimicrobial management. Methods We distributed an online survey at our institution, to clinicians (prescribers and pharmacists). Results compared their perceptions of the ASP and barriers to antimicrobial stewardship. Descriptive statistics include counts and percentages for categorical variables. Fisher’s exact test was performed to describe the comparison groups for each survey response. We reviewed survey comments and categorized according to themes. Results We distributed the survey to 459 clinicians over 4 months with 110 surveys completed for a response rate of 24%. Prescribers comprised 77.3% of respondents. 74.5% of clinicians reported that antibiotic overuse is a problem at our institution. Prescribers were more likely to agree that conflicting priorities to core measures was a barrier to stewardship as well as disagree with current guidelines (P < 0.05) compared with pharmacists. Figure 1 demonstrates other barriers. Prescribers found ASP more helpful than pharmacists in antimicrobial dose adjustments (P < 0.05). Figure 2 demonstrates other scenarios where ASP provided input with varying degrees of perceived helpfulness. Pharmacists used the ASP website more than prescribers (P < 0.05). Text message and phone call were preferred methods of contact with prescribers favoring messages and pharmacists favoring phone calls. Clinicians infrequently used order-sets; Figure 3 demonstrates reasons for lack of use. 17.2% of participants commented about the ASP; of these, 42% were positive and 32% contained suggestions to improve communication and education. Comments are summarized in Figure 4. Conclusion Overall, clinicians agree that antimicrobial overuse is a concern at our institution. ASP is generally well received; however, after 7 years of operation, this survey shows that continued improvement is needed, notably in communication, education, and EMR order-sets. Results will be used to refine methods of effective communication and information delivery to nurture an effective relationship. Disclosures All authors: No reported disclosures.

scholarly journals 2027. What Are the Views Among Pakistani Physicians Toward Antimicrobial Resistance and Hospital Antimicrobial Stewardship Programs? A Multi-Site Qualitative Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S681-S681
Author(s):  
Khezar Hayat ◽  
Meagen Rosenthal ◽  
Ali Hassan Gillani ◽  
Panpan Zhai ◽  
Wenjing Ji ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Public Hospitals ◽  
Teaching Hospitals ◽  
Public Health Issue ◽  
Antibiotic Prescribing ◽  
Healthcare Facilities ◽  
Face To Face ◽  
Stewardship Program

Abstract Background Antimicrobial resistance (AMR) is a major public health issue that the world is facing in the 21st century and implementation of antimicrobial stewardship program (ASP) is one of the recognized approaches to combat AMR. Little is known on the views among Pakistani physicians regarding AMR and the benefits of hospital ASP implementation. This study was aimed to investigate the perception and attitude of physicians about AMR and ASP. Methods Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio-recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis conducted. Results Three major themes were identified: (1) the growing concern of AMR in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing and infection control, and (3) managing antibiotic resistance in hospitals. Poor healthcare facilities, insufficient trained medical staff, and inadequate resources were the key barriers in the implementation of ASP in Pakistan. Conclusion Physicians of public sector tertiary care teaching hospitals have shown poor familiarity toward hospital ASPs but the concept of hospital ASPs in Pakistan can be established by using the distinct themes that originated during this study. Overall, the attitude of physicians was positive toward its enforcement in all types of hospital settings including teaching hospitals. Disclosures All authors: No reported disclosures.

scholarly journals 2036. A Quasi-Experimental Survey Study of Antimicrobial Stewardship Education for Registered Nurses

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S684-S685
Author(s):  
Maressa Santarossa ◽  
Christina Walk ◽  
Cara J Joyce ◽  
Fritzie S Albarillo
Keyword(s):  
Nursing Education ◽  
Registered Nurses ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Medical Center ◽  
Survey Study ◽  
Stewardship Program ◽  
Quasi Experimental ◽  
Baseline Knowledge ◽  
Strongly Agree

Abstract Background Antimicrobial stewardship (AS) efforts have led to improved patient outcomes, reduction in unnecessary costs, and decrease in antimicrobial resistance (AR). Loyola University Medical Center (LUMC) is a quaternary care-system that has a comprehensive multidisciplinary Antimicrobial Stewardship Program (ASP). Registered nurses (RNs) have been shown to be a vital part of ASP; however their role and engagement in ASP should continue to be investigated and explored. Methods In February 2018, a voluntary online survey was created and disseminated to all RNs at LUMC to evaluate their baseline knowledge and perception of AS and AR, as well as to further investigate their role in AS at LUMC. Based on the results of the survey, our AS team implemented a multi-faceted education program. This included a series of lectures which were emailed to all RNs, as well as live education sessions by the AS team during nursing huddles. In March 2019, a second survey was distributed to all nurses with the primary goal of evaluating changes in the knowledge and perception of AS and AR after targeted education efforts. The secondary goal was to gather feedback to target further efforts of engaging RNs in AS. Results A total of 179 RNs completed the first survey and 117 completed the second survey. In both surveys, over 90% of RNs agree that they play an important role in AS, and that AS can decrease AR and adverse effects of antimicrobials. The majority in both surveys also agreed that AR can be caused by misuse/overuse of antimicrobials and this can be harmful to patients. Unfamiliarity with AS practices among RNs remains an issue, however this increased from 70% strongly agree/agree in the first survey to 74% in the second survey. Sixty-nine percent of RNs recalled reading the PowerPoint education slides, while only 38% recalled being educated in person by the AS team. A similar number of RNs (58% and 60%, respectively) prefer to be educated in person vs. through email. Conclusion Hospital-specific surveys on nurses’ perception and knowledge on AS and AR can be used to guide future ASP interventions, as well as to evaluate the effectiveness of these interventions. Our ASP at LUMC implemented strategies to improve nursing education and engagement in AS and evaluated this strategy using a pre-/post-survey. Disclosures All authors: No reported disclosures.

scholarly journals Determining Core Element Achievement in Long-Term Care Facilities Across Tennessee

2020 ◽  
Vol 41 (S1) ◽  
pp. s89-s89
Author(s):  
Cullen Adre ◽  
Youssoufou Ouedraogo ◽  
Christopher David Evans ◽  
Amelia Keaton ◽  
Marion Kainer
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Core Element ◽  
Term Care ◽  
Current State ◽  
Stewardship Program ◽  
National Quality ◽  
Care Facilities ◽  
Core Elements

Background: In 2017, a new antimicrobial stewardship standard was established by the Joint Commission that requires long-term care facilities (LTCFs) to have an antimicrobial stewardship program (ASP) based on current scientific literature. The Tennessee Department of Health (TDH) team sought to ascertain the current state of ASPs across Tennessee and to assist programs with implementation strategies. Utilizing a Centers for Medicaid and Medicare Services’ Civil Monetary Penalties grant, the TDH purchased copies of the National Quality Partners Playbook for Antibiotic Stewardship in Post-Acute and Long-Term Care to provide to LTCFs as incentive to complete a survey that would evaluate their current adoption of core elements. Methods: A self-administered questionnaire on ASP practices was developed and distributed to LCTFs. This survey expanded upon questions from the NHSN 2018 LTCF annual survey. These questions pertained to actionable items facilities are taking to achieve core elements. Achievement of the CDC’s 7 core elements of ASPs was determined based upon a combination of 1 or more responses to the survey questions. The percentage of LTCFs achieving each ASP core element at the regional and statewide level was determined. We also calculated the percentage of LTCFs that achieved all 7 elements versus 5 or more core elements. The analyses and visualizations were performed using SAS 9.4 and Tableau software. Results: Currently, 88 of 316 licensed LTCF facilities in Tennessee have participated in the survey. All regions were represented by EMS region. Based on the results of our survey, 100% of participating facilities have achieved at least 5 core elements, and 78% of participating facilities have achieved all 7 core elements. The core element with the lowest achievement was Accountability at 89%, and reporting and action had the highest achievement (100%). Conclusions: Early results suggest that LTCFs across Tennessee have active ASPs with strong core element achievement. However, we received responses from only 27% of licensed LTCFs. Minimal data are available regarding the current state of LTCF ASPs in Tennessee, and data will continue to be collected and analyzed. Participation may be limited to those already actively engaged in public health efforts, including antimicrobial stewardship. LTCFs that have participated in the initial evaluation will be surveyed at 6 months and 12 months after receipt of playbooks to evaluate their ASP progression and NQP Playbook utilization.Funding: NoneDisclosures: None

Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

2020 ◽  
Vol 18 ◽  
Author(s):  
Humberto Guanche Garcell ◽  
Juan José Pisonero Socias ◽  
Gilberto Pardo Gómez
Keyword(s):  
Antimicrobial Stewardship ◽  
Historical Review ◽  
Original Data ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Continuous Quality ◽  
Stewardship Program ◽  
History Of ◽  
Health Organization

Background: During the last 30 years an antimicrobial stewardship program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of the sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributes to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarts in 2008 and decline in 2015, while the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.

Sign in / Sign up

Export Citation Format

Share Document