Audit and Feedback Processes Among Antimicrobial Stewardship Programs: A Survey of the Society for Healthcare Epidemiology of America Research Network

2016 ◽  
Vol 37 (6) ◽  
pp. 704-706 ◽  
Author(s):  
D. J. Livorsi ◽  
B. Heintz ◽  
J. T. Jacob ◽  
S. L. Krein ◽  
D. J. Morgan ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interquartile Range ◽  
Infect Control Hosp ◽  
Audit And Feedback ◽  
Research Network ◽  
Hospital Beds ◽  
Healthcare Epidemiology ◽  
Optimal Implementation

Optimal implementation of audit-and-feedback is an important part of advancing antimicrobial stewardship programs. Our survey demonstrated variability in how 61 programs approach audit-and-feedback. The median (interquartile range) number of recommendations per week was 9 (5–19) per 100 hospital-beds. A major perceived barrier to more comprehensive stewardship was lack of resources.Infect Control Hosp Epidemiol 2016;37:704–706

scholarly journals 1980. Variability in Antifungal Stewardship Strategies Among Society for Healthcare Epidemiology of America (SHEA) Research Network Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S662-S663
Author(s):  
Margaret A Fitzpatrick ◽  
Fritzie S Albarillo ◽  
Aaron Ochoa ◽  
Katie J Suda ◽  
Charlesnika T Evans
Keyword(s):  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Organ Transplant ◽  
Audit And Feedback ◽  
Research Network ◽  
Solid Organ ◽  
Antifungal Stewardship ◽  
Cross Sectional ◽  
Diverse Range ◽  
Healthcare Epidemiology

Abstract Background The incidence of invasive fungal infections (IFI) and antifungal utilization is increasing in many healthcare settings. Little is known regarding antifungal stewardship strategies within broader antimicrobial stewardship programs (ASPs). This survey aimed to identify the use of antifungal stewardship at a diverse range of hospitals. Methods A cross-sectional electronic survey of the SHEA Research Network (SRN) was completed August–September 2018 by a physician or pharmacist ASP leader. The SRN is a consortium of >100 hospitals participating in multicenter healthcare epidemiology research projects. Survey questions pertained to various aspects of antifungal stewardship, including audit and feedback, laboratory testing, and surveillance. Chi-square tested associations between ASP and hospital characteristics and use of antifungal stewardship strategies. Results 45/111 (41%) facilities responded, including 10 international sites. Most facilities are academic medical centers (64.6%) and care for stem cell (73.3%) and solid-organ transplant (80.0%) patients. Most facilities have large, well established ASPs (60.0% > 5 members; 68.9% duration ≥6 years). 43 (95.6%) facilities use antifungal stewardship strategies in their ASP; most commonly prospective audit and feedback (33/43, 73.3%) performed by a pharmacist (23/33, 71.4%). Only half of ASPs (51.1%) create guidelines for IFI management. Most (71.1%) facilities offer rapid laboratory tests to diagnose IFI, but availability of PCR for fungal speciation and antifungal susceptibility testing varies (Figure 1). 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31.0%) report data to CDC’s National Healthcare Safety Network (NHSN). ASP size, ASP duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > 0.05 for all). Conclusion Use of antifungal stewardship strategies is high at SRN hospitals, but mainly involves audit and feedback. ASPs should be encouraged to disseminate guidelines for IFI management, to promote access to laboratory-based tests for rapid and accurate IFI diagnosis, and to perform surveillance for antifungal utilization with data reporting to NHSN. Disclosures All authors: No reported disclosures.

Implementation of a Pharmacist-Led Antimicrobial Management Team in a Community Teaching Hospital

2010 ◽  
Vol 23 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Brad R. Laible ◽  
Jawad Nazir ◽  
Aris P. Assimacopoulos ◽  
Jennifer Schut
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Clinical Pharmacist ◽  
Audit And Feedback ◽  
Infectious Disease Physician ◽  
Surgical Ward ◽  
Antimicrobial Management ◽  
Prospective Audit And Feedback ◽  
Healthcare Epidemiology ◽  
Improve Patient

Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease–trained clinical pharmacist. Due to limited resources, our institution chose to implement a pharmacist-led antimicrobial stewardship service on 1 medical/surgical ward, with the existing clinical pharmacist and 3 infectious disease physicians as core members. This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.

scholarly journals Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship

2016 ◽  
Vol 37 (6) ◽  
pp. 627-628
Author(s):  
Daniel J. Morgan ◽  
Nasia Safdar ◽  
Aaron M. Milstone ◽  
Deverick J. Anderson
Keyword(s):  
Research Methods ◽  
Antimicrobial Stewardship ◽  
Infect Control Hosp ◽  
Limited Resources ◽  
Research Committee ◽  
Scientific Methods ◽  
Critical Components ◽  
Healthcare Epidemiology

Research in Healthcare Epidemiology and Antimicrobial Stewardship (HE&AS) is rapidly expanding with the involvement of researchers from varied countries and backgrounds. Researchers must use scientific methods that will provide the strongest evidence to advance healthcare epidemiology, but there are limited resources for information on specific aspects of HE&AS research or easy ways to access examples of studies using specific methods with HE&AS. In response to this need, the SHEA Research Committee has developed a series of white papers on research methods in HE&AS. The objective of this series is to promote rigorous healthcare epidemiology research by summarizing critical components, practical considerations, and pitfalls of commonly used research methods.Infect Control Hosp Epidemiol 2016;37:627–628

Variable Screening and Decolonization Protocols for Staphylococcus aureus Carriage Prior to Surgical Procedures

2014 ◽  
Vol 35 (7) ◽  
pp. 880-882 ◽  
Author(s):  
Susan Kline ◽  
Maya Highness ◽  
Loreen A. Herwaldt ◽  
Trish M. Perl
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Surgical Procedures ◽  
Infect Control Hosp ◽  
Research Network ◽  
Variable Screening ◽  
Healthcare Epidemiology ◽  
Minnesota Hospital

We surveyed the Society for Healthcare Epidemiology of America Research Network, the Minnesota Association for Professionals in Infection Control and Epidemiology, and the Minnesota Hospital Association to assess presurgical Staphylococcus aureus screening and decolonization practices. The practices varied widely among responding facilities. The majority of respondents (63%) did not screen for S. aureus preoperatively.Infect Control Hosp Epidemiol 2014;35(7):880–882

Variability in antifungal stewardship strategies among Society for Healthcare Epidemiology of America (SHEA) Research Network facilities

2020 ◽  
Vol 41 (5) ◽  
pp. 585-589 ◽  
Author(s):  
Margaret A. Fitzpatrick ◽  
Fritzie Albarillo ◽  
Maressa Santarossa ◽  
Charlesnika T. Evans ◽  
Katie J. Suda
Keyword(s):  
Laboratory Tests ◽  
Antifungal Susceptibility ◽  
Audit And Feedback ◽  
Research Network ◽  
Solid Organ ◽  
Cross Sectional Survey ◽  
Antifungal Stewardship ◽  
Diverse Range ◽  
Healthcare Epidemiology ◽  
Hospital Characteristics

AbstractObjective:To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.Design:Cross-sectional survey.Participants:ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.Methods:An electronic survey administered August–September 2018 via the SRN to 111 hospitals. The χ2 test was used to test associations between ASP and hospital characteristics and use of antifungal stewardship strategies.Results:Of 111 hospitals, 45 (41%) responded; most were academic medical centers (65%) caring for stem-cell patients (73.3%) and solid-organ transplant patients (80.0%). Most hospitals have large, well-established ASPs: 60% had >5 team members and 68.9% had a duration ≥6 years. In 43 hospitals (95.6%), ASPs used antifungal stewardship strategies, most commonly prospective audit and feedback (73.3%) by a pharmacist (71.4%). Half of ASPs (51.1%) created guidelines for invasive fungal infection (IFI) management. Most hospitals (71.1%) offered rapid laboratory tests to diagnose IFI, but polymerase chain reaction (PCR) testing and antifungal susceptibility testing varied. Also, 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31%) reported to the CDC National Healthcare Safety Network. ASP size, duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > .05 for all).Conclusions:The use of antifungal stewardship strategies was high at SRN hospitals, but they mainly involved audit and feedback. ASPs should be encouraged (1) to disseminate guidelines for IFI management, (2) to promote access to laboratory tests for rapid and accurate IFI diagnosis, and (3) to perform surveillance for antifungal utilization with reporting to the CDC.

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

2021 ◽  
pp. 1-8
Author(s):  
Katie J. Suda ◽  
Gosia S. Clore ◽  
Charlesnika T. Evans ◽  
Heather Schacht Reisinger ◽  
Ibuola Kale ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pathways ◽  
Statistical Significance ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Approval ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

scholarly journals Survey of Infection Prevention Informatics Use and Practitioner Satisfaction in US Hospitals

2014 ◽  
Vol 35 (7) ◽  
pp. 891-893 ◽  
Author(s):  
Max Masnick ◽  
Daniel J. Morgan ◽  
Marc-Oliver Wright ◽  
Michael Y. Lin ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Infect Control Hosp ◽  
Infection Preventionists

We surveyed hospital epidemiologists and infection preventionists on their usage of and satisfaction with infection prevention–specific software supplementing their institution’s electronic medical record. Respondents with supplemental software were more satisfied with their software’s infection prevention and antimicrobial stewardship capabilities than those without. Infection preventionists were more satisfied than hospital epidemiologists.Infect Control Hosp Epidemiol 2014;35(7):891–893

Diagnostic and antimicrobial stewardship with molecular respiratory testing across the SHEA Research Network

2020 ◽  
pp. 1-4
Author(s):  
Kimberly C. Claeys ◽  
Daniel J. Morgan ◽  
Surbhi Leekha ◽  
Kaede V. Sullivan
Keyword(s):  
Respiratory Tract ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Real World ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Research Network ◽  
Lower Respiratory Tract Infections ◽  
Panel Testing ◽  
Tract Infections

This survey investigated diagnostic and antimicrobial stewardship practices related to molecular respiratory panel testing in adults with lower respiratory tract infections at acute care hospitals. Most respondents reported use of rapid respiratory panels, but related stewardship practices were uncommon and the real-world impact of respiratory panels were difficult to quantify.

Antimicrobial Prophylaxis Use in the Neonatal Intensive Care Unit: An Antimicrobial Stewardship Target That Deserves Attention!

2021 ◽  
Author(s):  
Isabelle Viel-Thériault ◽  
Amisha Agarwal ◽  
Erika Bariciak ◽  
Nicole Le Saux ◽  
Nisha Thampi
Keyword(s):  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Audit And Feedback ◽  
Clinical Indication ◽  
Surgical Prophylaxis ◽  
Early Onset Sepsis ◽  
Days Of Therapy ◽  
Antibiotic Courses

Objective Previous analyses of neonatal intensive care units (NICU) antimicrobial stewardship programs have identified key contributors to overall antibiotic use, including prolonged empiric therapy >48 hours for early-onset sepsis (EOS). However, most were performed in mixed NICU settings with onsite birthing units, resulting in a high proportion of inborn patient admissions. The study aimed to describe and analyze the most common reasons for antimicrobial use in an outborn tertiary care NICU. Study Design This was a 10-month review of all antimicrobial doses prescribed in a 20-bed level III NICU. The primary outcome was the total days of therapy (DOT) and length of therapy (LOT) for each clinical indication. Secondary outcomes included total DOT for each antimicrobial and appropriateness of antimicrobial courses. Results Of 235 antibiotic courses and 1,899 DOT (519 DOT/1,000 patient days) prescribed in 173 infants during the study period, the most common indications were suspected EOS, followed by prophylaxis. Among the 85 DOT/1,000 patient days (PD; 38 courses) prescribed for prophylaxis, 52.5 DOT/1,000 PD (25 courses; 62%) were for surgical prophylaxis. Of 17 postoperative antibiotic courses, 15 (88.2%) were deemed to be inappropriate mostly due to a duration greater than 24 hours postoperatively (n = 13; median LOT = 3 days). Conclusion Surgical prophylaxis is a common reason for antimicrobial misuse in outborn NICU. NICU-based prospective audit and feedback between neonatologists and antimicrobial stewardship teams alone may not be impactful in this setting. Partnerships with neonatologists and surgeons will be key to achieving the target of less than 24 hours of postoperative antimicrobials. Key Points

Sign in / Sign up

Export Citation Format

Share Document