scholarly journals Antimicrobial stewardship initiatives throughout Europe: proven value for money

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Edwin J.M. Oberjé ◽  
Marit A.C. Tanke ◽  
Patrick P.T. Jeurissen
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
National Level ◽  
Real Life ◽  
Cost Savings ◽  
Cost Effective ◽  
Success Stories ◽  
Effective Interventions ◽  
Ward Level ◽  
Level Institution

Antimicrobial stewardship is recognized as a key component to stop the current European spread of antimicrobial resistance. It has also become evident that antimicrobial resistance is a problem that cannot be tackled by single institutions or physicians. Prevention of antimicrobial resistance needs rigorous actions at ward level, institution level, national level and at supra-national levels. Countries can learn from each other and possibly transplant best practices across borders to prevent antimicrobial resistance. The aim of this study is to highlight some of the success stories of proven cost-effective interventions, and to describe the actions that have been taken, the outcomes that have been found, and the difficulties that have been met. In some cases we came across substantial scope for real-life cost savings. Although the best approach to effectively hinder the spread of antimicrobial resistance remains unclear and may vary significantly among settings, several EU-wide examples demonstrate that cost-effective antimicrobial stewardship is possible. Such examples can encourage others to implement (the most cost-effective) elements in their system.

scholarly journals Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252407
Author(s):  
Daniel Doyle ◽  
Gerald McDonald ◽  
Claire Pratt ◽  
Zahra Rehan ◽  
Tammy Benteau ◽  
...  
Keyword(s):  
Decision Support ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Support Tool ◽  
Survey Tool ◽  
Before And After ◽  
The Impact

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

scholarly journals Antimicrobial Stewardship Programmes in Saudi Hospitals: Evidence from a National Survey

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 193 ◽  
Author(s):  
Saleh Alghamdi ◽  
Ilhem Berrou ◽  
Zoe Aslanpour ◽  
Alaa Mutlaq ◽  
Abdul Haseeb ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Treatment Success ◽  
National Level ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Healthcare Facilities

Saudi hospitals and healthcare facilities are facing increasing rates of antimicrobial resistance and the emergence of new multi-drug resistant strains. This is placing an unprecedented threat to successful treatments and outcomes of patients accessing those facilities. The inappropriate use of antimicrobials is fueling this crisis, warranting urgent implementation of interventions to preserve antimicrobials and reduce resistance rates. Antimicrobial stewardship programmes (ASPs) can improve antimicrobial use, treatment success rates and reduce the levels of antimicrobial resistance. The Saudi Ministry of Health (MOH) devised a national antimicrobial stewardship plan to implement ASPs in hospitals, but little is known about the progress of implementation and the factors affecting it. This study aims to assess the level and the factors affecting the adoption and implementation of ASPs in Saudi hospitals at a national level. A nationwide cross-sectional survey was conducted in 2017 using an online questionnaire sent to all MOH hospitals. Overall, 147 out 247 MOH hospitals responded to the survey (54%). Only 26% of the hospitals reported the implementation of ASPs. Hospitals lack the knowledge, technological and staff resources to adopt and implement ASPs. Alternative models of ASP adoption could be explored to improve the rates of implementation of ASPs.

Reducing inappropriate rasburicase use to promote cost-effective care.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 312-312
Author(s):  
Arjun Gupta ◽  
Komal Patel ◽  
Taylor Roberts ◽  
Eileen M. Marley ◽  
Hsiao Ching Li ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Cost Savings ◽  
Cost Effective ◽  
Baseline Period ◽  
Hospital System ◽  
Effective Interventions ◽  
Quality Improvement Interventions

312 Background: Rasburicase is recommended for treating established Tumor lysis syndrome (TLS) and patients at high-risk for TLS. Unfortunately, it is an expensive medication and unnecessary use contributes to expenses. Methods: A multidisciplinary quality improvement team reviewed the process of ordering rasburicase and its prescription patterns at Parkland Heath and Hospital System, Dallas, TX between 10/2015-9/2017. Use was determined as appropriate/ inappropriate based on internally approved indications (laboratory TLS, at-risk for TLS, acute kidney injury and hyperuricemia, failure of or inability to administer allopurinol). Quality improvement interventions were implemented based on weaknesses identified. Results: 65 doses of rasburicase were administered during the 2-year baseline period; 21 (32.3%) of these were grossly inappropriate. The most common ordering providers were oncologists (23 orders, 35%), hospitalists (16 orders, 25%), intensivists (11 orders, 17%), and emergency physicians (8 orders, 12%). Ordering process review identified several pitfalls: one-click ready to sign order, auto-population of dosage, no hard-stop requiring providers to review rasburicase indications, and no pharmacy oversight. We aimed to reduce the percentage of inappropriate rasburicase orders from a baseline of 32.3% to 10% over 3 months. In 2/2018, we implemented PDSA cycle 1 including introducing a best practice advisory requiring providers to select an approved indication for medication use and changed auto-population of rasburicase dosage to 3 mg. A mandatory secondary review by pharmacy prior to dispensing the medication was implemented. Over a 3-month period post-change (2/2018- 5/2018), 11 of 11 rasburicase administered doses have been appropriate (0% inappropriate). Conclusions: A multidisciplinary team and classic quality improvement methodology was able to reduce inappropriate rasburicase use from 32.3% to 0%, with significant cost savings. Straightforward electronic medical record interventions and increased pharmacy oversight are effective interventions in curbing medication overuse. We will periodically re-assess utilization patterns and refine PDSA cycles as needed.

Mineral/microfibrillated cellulose composite materials: High performance products, applications, and product forms

TAPPI Journal ◽  
2018 ◽  
Vol 17 (09) ◽  
pp. 507-515 ◽  
Author(s):  
David Skuse ◽  
Mark Windebank ◽  
Tafadzwa Motsi ◽  
Guillaume Tellier
Keyword(s):  
Composite Materials ◽  
High Performance ◽  
Aqueous Suspension ◽  
Production Capacity ◽  
Cost Savings ◽  
Cost Effective ◽  
New Materials ◽  
Wet Strength ◽  
Product Forms ◽  
Cellulose Composite

When pulp and minerals are co-processed in aqueous suspension, the mineral acts as a grinding aid, facilitating the cost-effective production of fibrils. Furthermore, this processing allows the utilization of robust industrial milling equipment. There are 40000 dry metric tons of mineral/microfbrillated (MFC) cellulose composite production capacity in operation across three continents. These mineral/MFC products have been cleared by the FDA for use as a dry and wet strength agent in coated and uncoated food contact paper and paperboard applications. We have previously reported that use of these mineral/MFC composite materials in fiber-based applications allows generally improved wet and dry mechanical properties with concomitant opportunities for cost savings, property improvements, or grade developments and that the materials can be prepared using a range of fibers and minerals. Here, we: (1) report the development of new products that offer improved performance, (2) compare the performance of these new materials with that of a range of other nanocellulosic material types, (3) illustrate the performance of these new materials in reinforcement (paper and board) and viscosification applications, and (4) discuss product form requirements for different applications.

Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study

2018 ◽  
Vol 2 (4) ◽  
pp. 39-45
Author(s):  
A.G. Salmanov ◽  
O.M. Verner
Keyword(s):  
Antimicrobial Resistance ◽  
Multicenter Study ◽  
Antimicrobial Susceptibility ◽  
National Level ◽  
Surgical Site Infections ◽  
Hospital Record ◽  
Antimicrobial Susceptibility Test ◽  
Local Data ◽  
Epidemiologic Surveillance ◽  
Medical Institutions

Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.

Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

2011 ◽  
Vol 14 (2) ◽  
Author(s):  
Thomas G Koch
Keyword(s):  
Weight Loss ◽  
Cost Savings ◽  
Cost Effective ◽  
Economic Consequences ◽  
Health Care Spending ◽  
Order Of Magnitude ◽  
Dynamic Measures ◽  
The Cost ◽  
The Impact ◽  
The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

The Future of Plasma-Based Surface Engineering Techniques in Tribology (Keynote)

2005 ◽  
Author(s):  
Allan Matthews ◽  
Adrian Leyland
Keyword(s):  
Surface Engineering ◽  
Performance Enhancement ◽  
Bulk Material ◽  
Cost Savings ◽  
Cost Effective ◽  
Ceramic Coatings ◽  
Performance Improvements ◽  
Treatment Techniques ◽  
Wide Range ◽  
Macro Scale

Over the past twenty years or so, there have been major steps forward both in the understanding of tribological mechanisms and in the development of new coating and treatment techniques to better “engineer” surfaces to achieve reductions in wear and friction. Particularly in the coatings tribology field, improved techniques and theories which enable us to study and understand the mechanisms occurring at the “nano”, “micro” and “macro” scale have allowed considerable progress to be made in (for example) understanding contact mechanisms and the influence of “third bodies” [1–5]. Over the same period, we have seen the emergence of the discipline which we now call “Surface Engineering”, by which, ideally, a bulk material (the ‘substrate’) and a coating are combined in a way that provides a cost-effective performance enhancement of which neither would be capable without the presence of the other. It is probably fair to say that the emergence and recognition of Surface Engineering as a field in its own right has been driven largely by the availability of “plasma”-based coating and treatment processes, which can provide surface properties which were previously unachievable. In particular, plasma-assisted (PA) physical vapour deposition (PVD) techniques, allowing wear-resistant ceramic thin films such as titanium nitride (TiN) to be deposited on a wide range of industrial tooling, gave a step-change in industrial productivity and manufactured product quality, and caught the attention of engineers due to the remarkable cost savings and performance improvements obtained. Subsequently, so-called 2nd- and 3rd-generation ceramic coatings (with multilayered or nanocomposite structures) have recently been developed [6–9], to further extend tool performance — the objective typically being to increase coating hardness further, or extend hardness capabilities to higher temperatures.

scholarly journals A survey of the knowledge and attitudes of Egyptian healthcare professionals towards the application of Health Information Technology to optimize antibiotic therapy

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i28-i28
Author(s):  
N Hassan ◽  
R Slight ◽  
S P Slight
Keyword(s):  
Information Technology ◽  
Developing Countries ◽  
Antimicrobial Resistance ◽  
Health Information Technology ◽  
Health Information ◽  
Antimicrobial Stewardship ◽  
Healthcare Professionals ◽  
Response Rate ◽  
Public Healthcare ◽  
P Value

Abstract Introduction Antimicrobial resistance is a global health problem, especially in developing countries. Antimicrobial Stewardship Programmes (AMS) have been shown to be effective at reducing antimicrobial resistance and hospital patient stays. Health information technology (HIT) can support Outpatient Parenteral Antimicrobial Therapy (OPAT) through more accurate diagnosis and management of infectious diseases. Aim To evaluate the knowledge and attitude of Egyptian healthcare professionals towards the application of HIT to optimize OPAT. Methods Healthcare professionals who worked in either private or public sectors of Egyptian healthcare system were emailed and asked if they would be willing to complete an electronic questionnaire (using google forms). One reminder was sent by email each week for two weeks (two in total) from the first invitation. The survey was laid out in four sections. The first section included specific details about the healthcare professional’s current employment and role, the second related to HIT services available in their organisations, the third covered their training in HIT and antimicrobial stewardship programmes, and the fourth included their use of HIT to optimize OPAT. Ethical approval was obtained from National Heart Institute, Egypt. Descriptive analysis was carried out for all the variables. One-way ANOVA testing at level of significance P-value <0.05, was used to compare numerical variables. SPSS version 26 was used for statistical analysis. Results Three hundred and eighty-five healthcare professionals were invited to respond to the questionnaire. (The response rate was 75.34% (290)). Of these, 152 (52.6%) were pharmacists, 134 (46.4%) physicians, and 3 (1%) nurses, and many participants (30.8%) had between 6 to 10 years of experience working in either outpatient or in-patient units. Only 15.2% of respondents mentioned that they have access to OPAT in their organizations, 51.2% did not have the service, while 33.6% responded that they did not know if the service was available. However, 27.3% had a training on ASP and 18.3% had a training on HIT. Mean scores for both knowledge (14.31±5.49) and attitude (14.67±2.53) were significantly higher in professionals who had received training in HIT (p = 0.003 & 0.006 respectively). However, scores for attitude were better than scores for knowledge. Conclusions In developing countries, HIT applications in OPAT are still in their infancy with only a few organisations adopting them. Egyptian healthcare professionals showed positive attitudes towards HIT use, especially when their knowledge was improved through training. Two strengths of this study include our high response rate and the wide breadth of different healthcare professionals who responded from both private and public healthcare settings. However, being a questionnaire, some questions were left unanswered and some respondents may not have been aware of their reasons for a particular answer. That said, this study has important implications for practice, with more awareness amongst healthcare professionals required on the availability of HIT services in their hospitals and how further training may be needed on the applications of HIT in optimizing OPAT.

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