scholarly journals Assessment of antimicrobial use in private and government hospitals, a comparative study in central kerala, using who indicators

2021 ◽  
pp. 88-92
Author(s):  
Chinnu Roy ◽  
Shaji George ◽  
Aleena Issac ◽  
Arya Ponnappan ◽  
Dhanya Paul
Keyword(s):  
Broad Spectrum ◽  
Average Cost ◽  
Private Hospital ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Government Hospital ◽  
Prescribing Pattern ◽  
Government Hospitals ◽  
The Government ◽  
Who Indicators

Background: Irrational use of antimicrobial can cause various unwanted and untoward events. It may diminish the quality of patient care, increase the cost of therapy, and involvement in various side effects. Thus, the appropriateness of antimicrobial use in hospitals plays a pivotal role in patient safety. Objective: To analyze and assess the prescribing pattern of antimicrobials in private and government hospitals as per the WHO indicators. Methodology: A prospective comparative observational study was carried out for 6 months, with the patient diagnosed with an infectious disease admitted to the medical ward of both the hospitals during the study period. The data obtained from the study sites were Compared and analyzed using WHO indicators described in WHO’s “How to Investigate Antimicrobial use in Hospitals: Selected Indicators, Feb 2012”. Results: The study involved 216 patients and the average number of antimicrobials prescribed was found to be 1.73 in a private hospital and 2.07 in the government hospital, average cost of antimicrobials was found to be 86.48 INR in private and 31.04 INR in the government hospital, average duration of antimicrobial treatment was 4.8 in private and 5.2 in the government hospital, and the percentage of antimicrobials prescribed in generic was 33.33% in private and 87.83% in the government hospital. Considering the spectrum of antibiotics, both private (94.7%) and government (88.8%) used broad-spectrum antimicrobials. In both hospitals, cephalosporins were the most frequently prescribed class of antimicrobials. Comparing the dosage of antimicrobials given, injection usage is at the highest in government (59.5%) as well as in the private hospital (68.4%). Conclusion: This study indicates that the average cost of antimicrobials was more in a private hospital than that in a government hospital and other indicators such as the number of antimicrobials per hospitalization, duration of antimicrobial treatment, and the percentage of generic antimicrobials prescribed were all found to be more in a government hospital. In both private and government hospitals broad-spectrum antimicrobials were widely used, with cephalosporin as the most prescribed class.

scholarly journals AN ANALYSIS ON THE POLICY IMPLEMENTATION OF ANTIBACTERIAL RESISTANCE CONTROL AT THE HOSPITAL

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Nani Indriana ◽  
Wiku Bakti. B Adisasmito
Keyword(s):  
Private Hospital ◽  
Control Program ◽  
Descriptive Study ◽  
Limited Resources ◽  
Red Cross ◽  
Antibiotics Resistance ◽  
Antibacterial Resistance ◽  
Government Hospital ◽  
Government Hospitals ◽  
The Government

Abstract. In order to control Antibacterial Resistance at the hospital in Indonesia, the Government of Indonesia established an Antibiotics Resistance Control Committee and issued a Regulation from the Ministry of Health, regulation no 8/2015 on an antibiotics resistance control program at the hospital. This is an investigation on the Antibacterial Resistance Control Program (ARCP) at the Hospital, which compares its implementation at a government hospital and a private hospital, Persahabatan Central General Hospital (CGH) and Bogor Indonesian Red Cross Hospital (BIRCH). This was a descriptive study with a qualitative analysis obtained through indepth interviews and documentary research. We discovered that the ARCP was implemented better at Persahabatan CGH compared to BIRCH. Problems include ineffective communication, limited resources, lack of an antibiotic guideline (at BIRCH), lack of coordination between organizations, lack of supervision from the government, and the lack of motivation to implement the policy. These issues can be solved by intensifying the socialization of the policy, conducting more workshops and trainings for private and government hospitals that has not received any, providing an incentive for them to implement the program, such as including ARC into hospital accreditation indicators, and clarifying the benefits of the program to the stakeholders. Abstrak. Salah satu upaya pengendalian resistensi antibiotika di Indonesia adalah pembentukan pembentukan Komite Pengendalian Resisten Antibiotika (KPRA) dan diterbitkannya Permenkes no. 8 Tahun 2015 tentang program pengendalian resistensi antibiotika (PPRA) di rumah sakit (RS). Penelitian ini bertujuan untuk menggali lebih dalam terhadap implementasi kebijakan PPRA di RS dibandingkan antara RS pemerintah dengan RS swasta yaitu RS Persahabatan dan RS PMI. Metode penelitian merupakan studi deskriptif dengan analisis kualitatif melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menyimpulkan bahwa pelaksanaan PPRA di RS Pemerintah lebih baik dari RS Swasta. Saran yang diajukan adalah mempercepat peningkatan kesadaran akan pentingnya PPRA, terutama bagi RS.

scholarly journals Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

2020 ◽  
Author(s):  
Jiaojiao Song ◽  
Rongsheng Zhu ◽  
Leiqing Li ◽  
Lingcheng Xu ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Second Generation ◽  
Antimicrobial Treatment ◽  
Clinical Isolates ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Lactamase Inhibitor

Abstract Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

scholarly journals Research on the Construction of Precision Medical System Under the Background of Big Data-The Roles and Responsibilities of Government, Hospitals and Medical Workers

2021 ◽  
Vol 8 (2) ◽  
pp. 60-63
Author(s):  
Xin Wang ◽  
Lizhang Xu ◽  
Bin Liu ◽  
Fangxiang Zhang
Keyword(s):  
Big Data ◽  
Medical System ◽  
Main Body ◽  
Government Hospital ◽  
Medical Field ◽  
Main Research ◽  
Roles And Responsibilities ◽  
Government Hospitals ◽  
The Government ◽  
Big Data Technology

This article explores the roles and responsibilities of government, hospital and medical workers in the construction of precision medical system under the background of big data, which provide reference advices for setting out big data-related policies by the government, promoting the applications of big data technology in the medical field by the hospital, and using big data technology to help improve the efficiency of clinical diagnosis and treatment or make precise medical practice by medical workers. The main research contents are followed. It presents some problems and countermeasures in setting out big data-related policies by the government. This article studies the work tips of hospitals, as the main body of the implementation of the responsibility and obligation, and how to use big data technology in application. Meanwhile, it tries to analyze the problems and difficulties which hospitals and medical workers need to pay attention to applying big data technology in precision medicine.

scholarly journals Patient Preference between Private and Government Hospital in Hyderabad Region

2020 ◽  
Vol 5 (8) ◽  
pp. 1400-1406
Author(s):  
Dr. B Lakshmi ◽  
Dr. BNV Parthasarathi ◽  
Shubham Jain ◽  
Monika Bhalerao ◽  
Devanshi Saini ◽  
...  
Keyword(s):  
Urban Population ◽  
Private Hospital ◽  
Public Hospitals ◽  
Government Hospital ◽  
Cost Of Treatment ◽  
Rural And Urban ◽  
Government Hospitals ◽  
Male Patients ◽  
Structured Questionnaire

Health is most primary factor than money, if people are focused for the treatment of various disorders. As per NSSO report, 72% and 79% of rural and urban population using private hospital than government hospital even though private hospital having more cost of treatment than government hospital. Most of people are not using public hospitals mainly due to hygienic condition and low quality of their services. This paper basically deals with the patient perception towards the private and government hospitals in Hyderabad Region. The survey was done using a structured questionnaire for a sample size of 299 outpatients, out of which 130 female and 169 male patients. On basis of this data, we will analyze factor such as demographic, social and economic that responsible for choosing private and government hospital.

scholarly journals Contributions of interpersonal conflict management on performance of government hospitals in Nigeria

2021 ◽  
Vol 12 (7) ◽  
pp. 1785-1807
Author(s):  
Kelechi Johnmary Ani ◽  
Chigozie Onu ◽  
Ijeoma Genevieve Anikelechi
Keyword(s):  
Conflict Management ◽  
Interpersonal Conflict ◽  
Hospital Staff ◽  
Mortality Rates ◽  
Working Environment ◽  
Teaching Hospitals ◽  
Collaborative Approach ◽  
Government Hospital ◽  
Government Hospitals ◽  
The Government

This study investigated the place of interpersonal conflict management on performance of government hospitals in Nigeria and specifically. The purpose is to ascertain how collaborative approach of interpersonal conflict management affect mortality rates reduction in government hospitals and investigate if avoidance technique in conflict management improves the working relationships in the government hospital within Nigeria. The study adopted survey research design and was conducted in National Hospital Abuja, and University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla, Enugu State, Nigeria. The study population is 1629, which includes all health professionals employed in selected public- owned teaching hospitals. A sample size of 312 was drawn from the population. The study used descriptive statistics (frequency, charts, tables and simple percentage) to calculate, analyse, show or summarize responses to the research questions. The hypotheses were tested using ordinal logistic regression. Findings showed that collaborative approach has significantly contributed in reducing mortality rates in government hospitals in Nigeria, and avoidance as a means of interpersonal conflict management helped improve the working relations of selected government hospital staff in Nigeria. The study recommended that they should be improved communication, and collaboration between management, clerks, nurses, doctors and workers representatives in running the affairs of the hospitals. Again, conflicting tendencies should always be avoided by workers for more efficient, peaceful, coordinated and minimal conflicts in working environment within the healthcare industry.

scholarly journals Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?

2020 ◽  
Vol 71 (10) ◽  
pp. 2736-2743 ◽  
Author(s):  
Cornelius J Clancy ◽  
M Hong Nguyen
Keyword(s):  
Antimicrobial Resistance ◽  
Broad Spectrum ◽  
Prospective Studies ◽  
Case Series ◽  
Empiric Therapy ◽  
Antimicrobial Treatment ◽  
Market Reform ◽  
Antimicrobial Use ◽  
Limited Data ◽  
Institutional Ecology

Abstract Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19–associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.

Reducing Broad Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation (ECMO): Reduce AMMO Study

2021 ◽  
Author(s):  
Aditya Shah ◽  
Priya Sampathkumar ◽  
Ryan W Stevens ◽  
John K Bohman ◽  
Brian D Lahr ◽  
...  
Keyword(s):  
Time Series ◽  
Extracorporeal Membrane Oxygenation ◽  
Broad Spectrum ◽  
Antimicrobial Prophylaxis ◽  
Current Evidence ◽  
Antimicrobial Use ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
Membrane Oxygenation ◽  
The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System

2020 ◽  
Vol 41 (S1) ◽  
pp. s321-s321
Author(s):  
Stephanie Shealy ◽  
Joseph Kohn ◽  
Emily Yongue ◽  
Casey Troficanto ◽  
Brandon Bookstaver ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Healthcare Providers ◽  
The United States ◽  
Antimicrobial Use ◽  
Gram Positive ◽  
Specific Patient ◽  
Antimicrobial Administration

Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

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