scholarly journals Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS)

2012 ◽  
Vol 33 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Neil Fishman ◽  
◽  
◽  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Safety Issue ◽  
The United States ◽  
Position Statement ◽  
Policy Statement ◽  
Antimicrobial Use ◽  
Patient Safety Issue ◽  
Healthcare Epidemiology

Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

scholarly journals Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

2018 ◽  
Vol 66 (7) ◽  
pp. 987-994 ◽  
Author(s):  
L Clifford McDonald ◽  
Dale N Gerding ◽  
Stuart Johnson ◽  
Johan S Bakken ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Adults And Children ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

scholarly journals 1331. Learning Experiences Within Infectious Diseases Pharmacy Residency Programs Demonstrate High Degrees of Consistency

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S406-S407
Author(s):  
Jonathan Cho ◽  
Matthew Crotty ◽  
Wesley Kufel ◽  
Elias Chahine ◽  
Amelia Sofjan ◽  
...  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Academic Medical Center ◽  
Travel Medicine ◽  
Learning Experiences ◽  
The United States ◽  
Parasitic Infections ◽  
Residency Programs ◽  
Research Grant

Abstract Background Pharmacists with residency training in infectious diseases (ID) optimize antimicrobial therapy outcomes in patients and support antimicrobial stewardship programs. The purpose of this study was to describe the learning experiences currently being offered in post-graduate year-2 (PGY-2) ID pharmacy residency programs. Methods A 19-item, cross-sectional, multi-centered, electronic survey was distributed via e-mail to pharmacy residency program directors (RPDs) of all 101 accredited and nonaccredited PGY-2 ID residency programs in the United States. Programs were identified via the ASHP, ACCP, and SIDP residency directories. Program characteristics inquired via the survey included required and elective learning experiences, research and teaching opportunities, and ID-related committee involvement. Results Survey responses were collected from 71 RPDs (70.3%). Most programs were associated with an academic medical center (64.8%), focused primarily in adult ID (97.2%), and accepted one resident per year (91.6%). Forty-eight (67.6%) institutions also offered an ID physician fellowship program. Microbiology laboratory, adult antimicrobial stewardship (AS), and adult ID consult learning experiences were required in 98.6% of residency programs. Only 28.2% of responding programs required pediatric AS and pediatric ID consult rotations. Greater than 90% of RPDs reported that the resident managed bone and joint, lower respiratory tract, sepsis, urologic, and skin and soft-tissue infections at least once weekly. Travel medicine, parasitic infections, hepatitis B, and hepatitis C were either rarely or never encountered by the resident in 77.5%, 76%, 66.2%, and 50.7% programs, respectively. Residents were frequently involved in AS committees (97.2%), pharmacokinetic dosing of antimicrobials (83.1%), precepting pharmacy trainees (80.3%), and performing research projects (91.5%). Conclusion PGY-2 ID pharmacy residency programs in the United States demonstrated consistency in required adult ID consult, antimicrobial management activities, AS committee service, and teaching and research opportunities. Pediatric experiences were less common. PGY-2 ID residency programs prepare pharmacists to become antimicrobial stewards, particularly in adult patients. Disclosures J. Cho, Allergan: Speaker’s Bureau, Speaker honorarium. M. Crotty, Theravance and Nabriva: Consultant, Consulting fee. E. Chahine, Merck: Speaker’s Bureau, Speaker honorarium. Allergan: Scientific Advisor, Consulting fee. J. Gallagher, Allergan, Astellas, Merck, and Melinta: Speaker’s Bureau, Speaker honorarium. Achaogen, Allergan, Astellas, Cempra, Cidara, CutisPharma, Merck, Paratek, Shionogi, Tetraphase, Theravance, and The Medicines Company: Consultant, Consulting fee. Merck: Grant Investigator, Research grant. S. Estrada, Allergan, Astellas, Merck, T2Biosystems and The Medicines Company: Speaker’s Bureau, Speaker honorarium. The Medicines Company and Theravance: Grant Investigator, Research grant. Astellas, CutisPharma, Theravance, and The Medicines Company: Consultant, Consulting fee.

scholarly journals 2004. Impact of Procalcitonin Roll-out Without Antimicrobial Stewardship Guidance in a Community Hospital Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S672-S672
Author(s):  
Alfredo J Mena Lora ◽  
Samah Qasmieh ◽  
Eric Wenzler ◽  
Scott Borgetti ◽  
Naman Jhaveri ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
The United States ◽  
Healthcare Research ◽  
Antimicrobial Use ◽  
Tract Infections ◽  
The Impact

Abstract Background Lower respiratory tract infections (LRTIs) are one of the most common infectious disease-related emergency department (ED) visits in the United States. The ID Society of America and the Agency for Healthcare Research and Quality support the use of procalcitonin (PCT) for antimicrobial stewardship (ASP) in LRTI. Though not widely available, awareness and access to PCT is rising. At our facility, PCT became available in February 2018. The aim of our study is to assess the impact of PCT at an urban community hospital and identify possible targets for ASP interventions. Methods Retrospective review of cases from February to August 2018. Cases from the ED were selected for review. Appropriateness of testing was assessed, defined as guideline-based use for cessation of antibiotics in uncomplicated LRTIs without critical illness or immunosuppression. Demographic variables and clinical characteristics, such as, diagnosis, antimicrobial use and PCT levels were obtained. Results PCT was ordered 268 times hospital-wide, of which 160 (60%) were in the ED. Ages ranged from 0–90, with an average of 47. Most cases were male (51%). Appropriate testing for LRTI occurred in 33 (29%) cases. Antimicrobials were used in 75% of cases with low (< 0.5) PCT levels (Figure 1). Length of stay (LOS) was higher in groups that received antimicrobials (Figure 2). Testing was not appropriate in 127 cases (71%), with upper respiratory (21%), soft-tissue (17%), genitourinary (15%) and abdominal (13%) infections as the most common reasons for testing. Other diagnosis included alcohol withdrawal, seizures and altered mental status. Cumulative cost of PCT testing was $24000, of which $19050 was not consistent with guidelines. Conclusion Clinicians routinely ordered PCT in the ED. Antimicrobials were used for LRTIs despite low PCT levels. This may have contributed to higher LOS and excess antimicrobial use. Unwarranted PCT testing had a cost of $19050. As PCT becomes widely available in hospitals across the United States, education and decision support by ASP to clinicians may be needed to enhance guideline-appropriate evidence-based use of PCT. Targeted ASP interventions in the ED may have cost savings by reducing excess testing, length of stay and improving antimicrobial use. Disclosures All authors: No reported disclosures.

The Intersection of Patient Safety and Nursing Research

2006 ◽  
Vol 24 (1) ◽  
pp. 3-15
Author(s):  
Patricia H. Walker ◽  
Gaya Carlton ◽  
Lela Holden ◽  
Patricia W. Stone
Keyword(s):  
United States ◽  
Patient Safety ◽  
Human Error ◽  
Safety Issue ◽  
The United States ◽  
The Past ◽  
Safety Research ◽  
Federal Response ◽  
Patient Safety Issue ◽  
The Individual

The individual and collective discussions of the patient safety issue in the United States have mounted from a low roar to a deafening din in the past 10 years. In this chapter the authors (1) discuss the context of patient safety over the past decade and the federal response to the problem, (2) briefly present Reason’s theory of human error, which frames much of the safety research, and (3) provide a glossary of terms.

Dedicated time for antimicrobial stewardship—How much and why? Lessons learned from South Korea

2020 ◽  
Vol 41 (12) ◽  
pp. 1436-1437
Author(s):  
Payal K. Patel ◽  
Arjun Srinivasan
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
South Korea ◽  
Antimicrobial Stewardship ◽  
Large Scale ◽  
The United States ◽  
Lessons Learned ◽  
Joint Commission ◽  
Antimicrobial Use ◽  
Institutional Level

AbstractAntimicrobial resistance is a global and pressing problem that requires large-scale, federal coordination of efforts and tailored local interventions and surveillance. Given the urgency of the threat, many countries now have national policies to reduce inappropriate antimicrobial use. However, few countries have followed this with resources at the institutional level to support the implementation of practices to achieve this goal. In the United States, accreditation bodies such as Centers for Medicare and Medicaid Services and The Joint Commission have added antimicrobial stewardship standards to encourage uptake of antimicrobial stewardship programs (ASPs).

scholarly journals Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

2018 ◽  
Vol 66 (7) ◽  
pp. e1-e48 ◽  
Author(s):  
L Clifford McDonald ◽  
Dale N Gerding ◽  
Stuart Johnson ◽  
Johan S Bakken ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Adults And Children ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

scholarly journals Learning to Detain Asylum Seekers and the Growth of Mass Immigration Detention in the United States

2021 ◽  
pp. 1-29
Author(s):  
Smita Ghosh ◽  
Mary Hoopes
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Cognitive Dissonance ◽  
Media Coverage ◽  
Asylum Seekers ◽  
Ad Hoc ◽  
The United States ◽  
Critical Component ◽  
Immigration Detention ◽  
Important Shift

Drawing upon an analysis of congressional records and media coverage from 1981 to 1996, this article examines the growth of mass immigration detention. It traces an important shift during this period: while detention began as an ad hoc executive initiative that was received with skepticism by the legislature, Congress was ultimately responsible for entrenching the system over objections from the agency. As we reveal, a critical component of this evolution was a transformation in Congress’s perception of asylum seekers. While lawmakers initially decried their detention, they later branded them as dangerous. Lawmakers began describing asylum seekers as criminals or agents of infectious diseases in order to justify their detention, which then cleared the way for the mass detention of arriving migrants more broadly. Our analysis suggests that they may have emphasized the dangerousness of asylum seekers to resolve the dissonance between their theoretical commitments to asylum and their hesitance to welcome newcomers. In addition to this distinctive form of cognitive dissonance, we discuss a number of other implications of our research, including the ways in which the new penology framework figured into the changing discourse about detaining asylum seekers.

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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