Antifungal stewardship: Still catching up? Commentary on “Variability in antifungal stewardship strategies among Society for Healthcare Epidemiology of America (SHEA) Research Network facilities”

2020 ◽  
Vol 41 (5) ◽  
pp. 590-591
Author(s):  
Gregory A. Eschenauer
Keyword(s):  
Research Network ◽  
Antifungal Stewardship ◽  
Catching Up ◽  
Healthcare Epidemiology

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.

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 Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship

2016 ◽  
Vol 37 (7) ◽  
pp. 755-760 ◽  
Author(s):  
Daniel J. Morgan ◽  
Lindsay D. Croft ◽  
Valerie Deloney ◽  
Kyle J. Popovich ◽  
Chris Crnich ◽  
...  
Keyword(s):  
Delphi Method ◽  
Convincing Evidence ◽  
Choosing Wisely ◽  
Research Network ◽  
Individual Member ◽  
Medical Overuse ◽  
Hospital Epidemiology ◽  
Endotracheal Tubes ◽  
Top 40 ◽  
Healthcare Epidemiology

OBJECTIVETo identify Choosing Wisely items for the American Board of Internal Medicine Foundation.METHODSThe Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA–Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board.RESULTSNinety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don’t perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don’t continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included.CONCLUSIONSThese 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse.Infect Control Hosp Epidemiol 2016;37:755–760

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 Policies and practices of SHEA Research Network hospitals during the COVID-19 pandemic

2020 ◽  
Vol 41 (10) ◽  
pp. 1127-1135 ◽  
Author(s):  
Michael S. Calderwood ◽  
Valerie M. Deloney ◽  
Deverick J. Anderson ◽  
Vincent Chi-Chung Cheng ◽  
Shruti Gohil ◽  
...  
Keyword(s):  
The United States ◽  
Research Network ◽  
Healthcare Personnel ◽  
Personal Protection Equipment ◽  
Healthcare Facilities ◽  
Hospital Policies ◽  
Healthcare Epidemiology ◽  
Personnel Policies ◽  
Individual Healthcare ◽  
Policies And Practices

AbstractTo understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

scholarly journals Surveillance practices and air-sampling strategies to address healthcare-associated invasive mold infections in Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals—United States, 2020

2021 ◽  
pp. 1-4
Author(s):  
Jeremy A. W. Gold ◽  
Brendan R. Jackson ◽  
Janet Glowicz ◽  
Kenneth R. Mead ◽  
Karlyn D. Beer
Keyword(s):  
United States ◽  
Acute Care ◽  
Air Sampling ◽  
Acute Care Hospitals ◽  
Research Network ◽  
Sampling Strategies ◽  
Case Definitions ◽  
Healthcare Associated ◽  
Healthcare Epidemiology ◽  
Invasive Mold Infections

Abstract With this survey, we investigated healthcare-associated invasive mold infection (HA-IMI) surveillance and air sampling practices in US acute-care hospitals. More than half of surveyed facilities performed HA-IMI surveillance and air sampling. HA-IMI surveillance was more commonly performed in academic versus nonacademic facilities. HA-IMI case definitions and sampling strategies varied widely among respondents.

Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN)

2019 ◽  
Vol 40 (9) ◽  
pp. 1046-1049
Author(s):  
Kathleen Chiotos ◽  
Clare Rock ◽  
Marin L. Schweizer ◽  
Valerie M. Deloney ◽  
Daniel J. Morgan ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Research Network ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Current Infection ◽  
Healthcare Epidemiology ◽  
Carbapenem Resistant Enterobacteriaceae

AbstractWe used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.

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