scholarly journals The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1509
Author(s):  
Adina Fésüs ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Orsolya Kungler-Gorácz ◽  
Márton Á. Fésüs ◽  
...  
Keyword(s):  
Guideline Adherence ◽  
Medical Center ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Antibacterial Prophylaxis ◽  
Antibiotic Exposure ◽  
Dose Frequency ◽  
Tertiary Care Medical Center ◽  
The Impact

Perioperative antibiotic use is a common reason for antibiotic misuse. Evidence suggests that adherence to SAP guidelines may improve outcomes. The purpose of this study was to analyze the impact of pharmacist-led antibiotic stewardship interventions on SAP guideline compliance. The study was conducted at an Orthopedic Department of a tertiary care medical center. SAP compliance and antibiotic exposure in the pre-intervention and intervention period was compared using chi-square, Fisher exact, and Mann-Whitney tests, as appropriate. Prophylactic antibiotic use in orthopedic joint arthroplasties (overall guideline adherence: agent, dose, frequency, duration), clinical outcomes (length of stay-LOS, number of surgical site infections-SSIs), antibiotic exposure and direct antibiotic costs were compared between pre-intervention and intervention periods. Significant improvement in mean SAP duration (by 42.9%, 4.08 ± 2.08 vs. 2.08 ± 1.90 days, p ˂ 0.001), and overall guideline adherence regarding antibiotic use (by 56.2%, from 2% to 58.2%, p ˂ 0.001) were observed. A significant decrease was observed in antibiotic exposure in SAP (by 41%, from 6.07 ± 0.05 to 3.58 ± 4.33 DDD/patient, p ˂ 0.001), average prophylactic antibiotic cost (by 54.8%, 9278.79 ± 6094.29 vs. 3598.16 ± 3354.55 HUF/patient), and mean LOS (by 37.2%, from 11.22 ± 6.96 to 7.62 ± 3.02 days, p < 0.001); and a slight decrease in the number of confirmed SSIs was found between the two periods (by 1.8%, from 3% to 1.2%, p = 0.21). Continuous presence of the clinical pharmacist led to significant improvement in SAP guideline adherence, which was accompanied by decreased antibiotic exposure and cost.

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

scholarly journals Impact of Bordetella pertussis Exposures on a Massachusetts Tertiary Care Medical System

2007 ◽  
Vol 28 (6) ◽  
pp. 708-712 ◽  
Author(s):  
Iva Zivna ◽  
Diana Bergin ◽  
Joanne Casavant ◽  
Sally Fontecchio ◽  
Susan Nelson ◽  
...  
Keyword(s):  
Bordetella Pertussis ◽  
Healthcare Workers ◽  
Close Contact ◽  
Medical Center ◽  
Tertiary Care ◽  
Medical System ◽  
Secondary Case ◽  
Tertiary Care Medical Center ◽  
Outbreak Investigations ◽  
The Impact

Objective.To assess the impact of outbreaks of Bordetella pertussis infection on a tertiary care medical system.Design.Retrospective study.Setting.Academic tertiary care medical center and affiliated ambulatory care settings.Subjects.All patients and healthcare workers (HCWs) who were in close contact with patients with laboratory-confirmed cases of B. pertussis infection from October 1, 2003, through September 30, 2004.Intervention.Direct and indirect medical center costs were determined, including low and high estimates of time expended in the evaluation and management of exposed patients and HCWs during outbreak investigations of laboratory-confirmed cases of B. pertussis infection.Results.During this period, 20 primary and 3 secondary laboratory-confirmed cases of B. pertussis infection occurred, with 2 primary pertussis cases and 1 secondary case occurring in HCWs. Outbreak investigations prompted screening of 353 medical center employees. Probable or definitive exposure was identified for 296 HCWs, and 287 subsequently received treatment or prophylaxis for B. pertussis infection. Direct medical center costs for treatment and prophylaxis were $13,416 and costs for personnel time were $19,500-$31,190. Indirect medical center costs for time lost from work were $51,300-$52,300. The total cost of these investigations was estimated to be $85,066-$98,456.Conclusions.Frequent B. pertussis exposures had a major impact on our facility. Given the impact of exposures on healthcare institutions, routine vaccination for HCWs may be beneficial.

scholarly journals Mindfulness at Methodist—A Prospective Pilot Study of Mindfulness and Stress Resiliency Interventions in Patients at a Tertiary Care Medical Center

2021 ◽  
Vol 18 (8) ◽  
pp. 4034
Author(s):  
Elaina Vivian ◽  
Hellen Oduor ◽  
Preeti Girisha ◽  
Parvez Mantry
Keyword(s):  
Pilot Study ◽  
Cancer Patients ◽  
Perceived Stress ◽  
Stress Reduction ◽  
Physical Therapist ◽  
Medical Center ◽  
Tertiary Care ◽  
Medical Decision ◽  
Tertiary Care Medical Center ◽  
The Impact

Individuals with chronic medical conditions like cancer often experience heightened stress levels that can impact medical decision-making. The aim of this study was assess the impact of mindful stress-reduction interventions in cancer patients and support group participants (which included current and former cancer patients and their caregivers). A pilot study was conducted in which participants were provided a mindful stress-reduction intervention to determine whether they reduced stress, anxiety, and communication issues. Participants were provided a one-hour mindful stress-reduction intervention by a licensed physical therapist. Surveys were given to participants immediately before and after, and again 7-days after the intervention. Perceived stress was ascertained by asking participants: “Which emotional/mental state do you most frequently find yourself in?” Anxiety and communication abilities were measured using Neuro-QoL™ Anxiety and Communication v.1 instruments. Fifty-nine participants with a mean age of 60.6 years completed the study. Of these, 30.5%, 6.8%, 23.7%, and 39% were diagnosed (or were a caregiver to someone diagnosed) with pancreas, liver, breast, or unknown cancers, respectively. The surveys showed that participants’ perceived stress scores (p < 0.001), anxiety levels (p = 0.0067), and pain scores (p < 0.0001) were reduced after the mindful stress-reduction intervention. Larger studies with control groups are needed to confirm the interventions’ benefits.

The Trend of Cleft Care at a Children’s Referral Center in Thailand

2020 ◽  
Vol 57 (9) ◽  
pp. 1100-1104
Author(s):  
Dhave Setabutr ◽  
Thanakrit Sathavornmanee ◽  
Polpatt Jitpakdee ◽  
Songphon Nudchawong ◽  
Penpak Krergmatukorn
Keyword(s):  
Cleft Lip ◽  
Medical Center ◽  
Tertiary Care ◽  
Developed Countries ◽  
Senior Author ◽  
Timing Of Surgery ◽  
Referral Center ◽  
Tertiary Care Medical Center ◽  
Significant Difference ◽  
The Impact

Objective: To investigate the trend in cleft care at a major children’s referral center in Bangkok, Thailand. Study Design: Retrospective chart review. Patients and Methods: A review of 129 patients under 18 years of age who had underwent care by the senior author for cleft treatment between January 2015 and October 2017 was done. The impact of varying factors on patient care was analyzed. We compare our demographics and treatment timeline to that of previously published literature in more developed countries. Setting: Tertiary care medical center. Results: One hundred and two patient charts were reviewed with 53% male patients. Most patients had both cleft lip and cleft palate, 44%. Cleft lips most commonly were complete and occurred on the left side. In all, 77.4% of clefts were nonsyndromic. On average, primary cleft lip surgery was delayed being performed about 11 months of age. Sixteen percent of patients were treated with an obturator, while 11 patients had nasoalveolar molding use. Hearing screenings occurred on average at around 6 months of age. Abnormal tympanograms were evident in 32% of individuals. There was a significant difference in timing of surgery for patients who lived a distance greater than 30 kilometers from the hospital versus those from the Bangkok metropolis ( P < .05). Conclusion: Reviewing data from a high-volume referral center in Thailand reveals mild variance with regard to cleft care timing compared to published literature from the developed world. Distance traveled was found to impact timing of surgery.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Factors Associated ◽  
Tertiary Care Medical Center

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

scholarly journals Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

2021 ◽  
Vol 09 (06) ◽  
pp. E888-E894
Author(s):  
Nichol S. Martinez ◽  
Sumant Inamdar ◽  
Sheila N. Firoozan ◽  
Stephanie Izard ◽  
Calvin Lee ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Medical Center ◽  
Tertiary Care ◽  
Plastic Stents ◽  
Metal Stents ◽  
Limited Data ◽  
Sems Group ◽  
Tertiary Care Medical Center ◽  
Stent Type ◽  
Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

Utility of electroencephalography: Experience from a U.S. tertiary care medical center

2016 ◽  
Vol 127 (10) ◽  
pp. 3335-3340 ◽  
Author(s):  
Kapil Gururangan ◽  
Babak Razavi ◽  
Josef Parvizi
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center
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