scholarly journals Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study

2014 ◽  
Vol 69 (8) ◽  
pp. 2265-2273 ◽  
Author(s):  
E. Fleet ◽  
G. Gopal Rao ◽  
B. Patel ◽  
B. Cookson ◽  
A. Charlett ◽  
...  
Keyword(s):  
Pilot Study ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Randomized Control ◽  
Cluster Randomized

Antimicrobial stewardship in rural nursing homes: Impact of interprofessional education and clinical decision tool implementation on urinary tract infection treatment in a cluster randomized trial

2019 ◽  
Vol 40 (4) ◽  
pp. 432-437 ◽  
Author(s):  
Darren K. Pasay ◽  
Micheal S. Guirguis ◽  
Rhonda C. Shkrobot ◽  
Jeremy P. Slobodan ◽  
Adrian S. Wagg ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Hospital Admissions ◽  
Urine Culture ◽  
Intervention Group ◽  
Clinical Decision ◽  
Rural Nursing ◽  
Antimicrobial Prescribing ◽  
Cluster Randomized

AbstractObjectives:To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI.Design:Cluster randomized controlled trial.Setting:Nursing homes in rural Alberta, Canada.Participants:The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention.Results:Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (−2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], −2.5 to −1.7;P< .001) and antimicrobial prescribing for UTIs (−0.7 prescriptions per 1,000 RD; 95% CI, −1.0 to −0.4;P< .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, −0.4 to 0.3;P= .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, −0.5 to −0.1;P= .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases.Conclusion:A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.

scholarly journals Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Marvin AH Berrevoets ◽  
Jaap ten Oever ◽  
Tom Sprong ◽  
Reinier M van Hest ◽  
Ingeborg Groothuis ◽  
...  
Keyword(s):  
Pilot Study ◽  
The Netherlands ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use

scholarly journals Evaluating and prioritizing antimicrobial stewardship programs for nursing homes: A modified Delphi panel

2020 ◽  
Vol 41 (9) ◽  
pp. 1028-1034
Author(s):  
Shaul Z. Kruger ◽  
Susan E. Bronskill ◽  
Lianne Jeffs ◽  
Marilyn Steinberg ◽  
Andrew M. Morris ◽  
...  
Keyword(s):  
Nursing Home ◽  
Antimicrobial Resistance ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Audit And Feedback ◽  
Delphi Panel ◽  
Scientific Merit ◽  
Modified Delphi

AbstractBackground:Antibiotic use in nursing homes is often inappropriate, in terms of overuse and misuse, and it can be linked to adverse events and antimicrobial resistance. Antimicrobial stewardship programs (ASPs) can optimize antibiotic use by minimizing unnecessary prescriptions, treatment cost, and the overall spread of antimicrobial resistance. Nursing home providers and residents are candidates for ASP implementation, yet guidelines for implementation are limited.Objective:To support nursing home providers with the selection and adoption of ASP interventions.Design and Setting:A multiphase modified Delphi method to assess 15 ASP interventions across criteria addressing scientific merit, feasibility, impact, accountability, and importance. This study included surveys supplemented with a 1-day consensus meeting.Participants:A 16-member multidisciplinary panel of experts and resident representatives.Results:From highest to lowest, 6 interventions were prioritized by the panel: (1) guidelines for empiric prescribing, (2) audit and feedback, (3) communication tools, (4) short-course antibiotic therapy, (5) scheduled antibiotic reassessment, and (6) clinical decision support systems. Several interventions were not endorsed: antibiograms, educational interventions, formulary review, and automatic substitution. A lack of nursing home resources was noted, which could impede multifaceted interventions.Conclusions:Nursing home providers should consider 6 key interventions for ASPs. Such interventions may be feasible for nursing home settings and impactful for improving antibiotic use; however, scientific merit supporting each is variable. A multifaceted approach may be necessary for long-term improvement but difficult to implement.

scholarly journals 894. Universal Decolonization in Nursing Homes: Effect of Chlorhexidine and Nasal Povidone–Iodine on Prevalence of Multi-Drug-Resistant Organisms (MDROs) in the PROTECT Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S24-S24 ◽  
Author(s):  
Loren G Miller ◽  
James A McKinnell ◽  
Raveena Singh ◽  
Gabrielle Gussin ◽  
Ken Kleinman ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Cluster Randomized Trial ◽  
Antibiotic Use ◽  
Routine Care ◽  
Post Intervention ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Nasal Swabs ◽  
The Difference ◽  
Cluster Randomized

Abstract Background The prevalence of MDROs in nursing homes (NH) is much higher than that of hospitals. Decolonization to reduce the reservoir of MDRO carriage in NH residents may be a strategy to address MDRO spread within and among healthcare facilities. Methods PROTECT is an 18-month cluster randomized trial of 1:1 universal decolonization vs. routine care in 28 NHs in California. Decolonization consists of chlorhexidine (CHG) bathing plus twice daily nasal iodophor on admission and Monday–Friday biweekly. We assessed pre- vs. post-intervention MDRO prevalence by sampling 50 randomly selected residents at each NH as an outcome unrelated to the trial’s primary intent (infection, hospitalization reduction). NH residents had nasal swabs cultured for methicillin-resistant S. aureus (MRSA), and skin (axilla/groin) swabs taken for MRSA, vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase producers (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models (GLM) assessed the difference in differences of MDRO prevalence using an arm by period interaction term, clustering by NH. Results Four NHs dropped from the trial. Among the 24 NHs that remained, MDRO colonization at baseline was 49.4% and 47.5% of residents in control (N = 650) vs. decolonization (N = 550) NHs, with no difference in MRSA, VRE, ESBL, and CRE (Table 1). Among remaining NHs, decolonization was associated with 28.8% raw decrease in MDRO prevalence in decolonization sites (GLM OR = 0.51, P < 0.001), 24.3% raw decrease in MRSA (OR = 0.66, P = 0.03), 61.0% raw decrease in VRE (OR = 0.17, P < 0.001), and 51.9% raw decrease in ESBL (OR = 0.40, P < 0.001). CRE increased, but numbers were small (Control arm: 10 in baseline, 4 in intervention; intervention arm: 1 in baseline, 2 in intervention, P = NS). Conclusion Universal NH decolonization with CHG bathing and nasal iodophor resulted in a marked decrease in Gram-positive and Gram-negative MDRO prevalence. This decrease may lower MDRO acquisition, infection, and antibiotic use within NHs, as well as regional MDRO spread to other healthcare facilities. Disclosures All Authors: No reported Disclosures.

scholarly journals Antimicrobial stewardship programmes in nursing homes: a systematic review and inventory of tools

2020 ◽  
Vol 75 (6) ◽  
pp. 1390-1397
Author(s):  
Martin Belan ◽  
Nathalie Thilly ◽  
Céline Pulcini
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Outcome Measurement ◽  
Antibiotic Use ◽  
The Internet ◽  
Home Setting ◽  
Microbiological Testing ◽  
Nursing Home Setting ◽  
Multifaceted Interventions

Abstract Background Antimicrobial overuse/misuse is common in nursing homes and although the effectiveness of antimicrobial stewardship (AMS) programmes has been well explored and demonstrated in hospitals, data are scarce for the nursing-home setting. Our objectives for this systematic review were to make an inventory of: (i) all interventions that could be considered as part of AMS programmes in nursing homes; and (ii) all stewardship tools and guidance that are freely available. Methods We performed a systematic review using the MEDLINE database from inception to June 2018, including all interventional studies, reviews, opinion pieces and guidelines/guidance exploring AMS programmes in nursing homes. For the inventory of freely available tools and guidance to help implement an AMS programme, we also performed screening of professional societies and official agencies’ websites and a questionnaire survey among a panel of international experts. Results A total of 36 articles were included in our systematic review. Most interventions took place in North America and have explored education or persuasive interventions within multifaceted interventions, showing that they can improve guideline adherence and decrease antibiotic use and unnecessary microbiological testing. Most reviews also highlighted the importance of accountability, monitoring and feedback. A large number of tools (156) available for free on the internet were identified, mostly about education, patient assessment and outcome measurement. Conclusions Although high-quality interventional studies are lacking, multifaceted interventions including education, monitoring and feedback seem the most promising strategy. Many tools are available on the internet and can be used to help implement AMS programmes in nursing homes.

scholarly journals Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes

2017 ◽  
Vol 65 (5) ◽  
pp. 1073-1078 ◽  
Author(s):  
Rebecca R. Carter ◽  
Michelle M. Montpetite ◽  
Robin L. P. Jump
Keyword(s):  
Mixed Methods ◽  
Pilot Study ◽  
Nursing Homes ◽  
Antimicrobial Stewardship

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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