Oral Abstracts / American Journal of Infection Control 42 (2014) S3-S28
best practices were adopted to create the protocols. Preliminary trials were conducted to streamline processes to optimize patient outcomes and comfort. Education was provided to designated staff to ensure minimal protocol variation. As the program evolved, alternative routes of administration were added as options to accommodate various patient populations, including the addition of an outpatient component. RESULTS: Within 30-days, 83 percent of patients had resolution of rCDI. Patients that received FMT had minimal side effects the most common being: loose stools (64%), anxiety (50%) and nausea (50%). There was no readmissions within 30 days (0%) related to CDI. LESSON LEARNED: Literature supports a small window of time for viability of bacterial flora from the donor to be transplanted into the recipient. Because of this time urgency, processes must be well defined with any conflicts or variances remedied in a most expeditious manner. Interdepartmental communication is critical in the coordination of activities from receipt of donor fecal specimen to completion of transplant to ensure successful treatment.
Programatic Support of Infection Prevention Publication Number 404 Impact of an Antimicrobial Stewardship Program on the Length of Stay of Patients Admitted to Hospital with Community-acquired Pneumonia Giulio DiDiodato MSc, MD, MPH, Doctor, Royal Victoria Regional Health Centre; Leslie McArthur BSc Pharm (RPh), ASP Pharmacist, Lead, Royal Victoria Regional Health Centre BACKGROUND/OBJECTIVES: Community-acquired pneumonia (CAP) treatment accounts for 30-50% of total antibiotic utilization. Despite CAP guidelines, up to 50% of these patients receive unwarranted antibiotic treatment. Unwarranted variation from guidelines can result
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in prolonged hospital lengths of stay (LOS). Antimicrobial stewardship programs (ASP) have not been able to demonstrate any impact on CAP LOS. The purpose of this study is to determine if a focused hospitalbased ASP can reduce LOS in CAP patients. METHODS: Prospective, experimental cohort study with contemporaneous controls at a single-site, 319 bed community-based hospital. Enrollment of all consecutive patients with CAP starting April 1, 2013 with ongoing enrollment until March 31, 2015. After a 3 month baseline data collection period, the ASP intervention was implemented in a staggered fashion by ward, with each new ward being included at 2 month intervals. The wards that were not exposed to the ASP intervention provided the contemporaneous control patients. Impact of ASP on LOS was assessed with proportional hazards models with time to ASP intervention as a timevarying covariate. RESULTS: N¼228 CAP patients have been included in the analysis, with N¼77 patients exposed to the ASP intervention. The mean time to ASP intervention is 2.69 days (sd 1.06; range 0 to 7 days). Discharge hazard for ASP exposed group was increased (hazard ratio [HR] ¼ 1.309; 95% confidence interval [CI]: 0.965 to 1.777; p¼0.084) after accounting for differences in CURB-65 score, charlson comorbidity index, time to clinical resolution of symptoms and signs, age, gender, complicated CAP and presence or absence of clinical criteria for the diagnosis of CAP on admission to hospital. CONCLUSIONS: The interim analysis suggests that a focused ASP for CAP can potentially reduce length of stay by up to 30%. This is the first study to model the ASP as a time-varying covariate thus eliminating the possible time-dependent bias that may have invalidated the findings in other similar studies.
Publication Number 405 Multifaceted Antimicrobial Stewardship Targets Education, Prescriber Guidelines & Medication Use Evaluation For Clinical & Economic Impacts in a Community Hospital Adrian J. Gonzales PharmD BCPS, Director of Pharmacy Services, San Joaquin Community Hospital; Steven Dzierba PharmD MS FASHP, Clinical Pharmacist Coordinator, San Joaquin Community Hospital; Jamil Wehbe BS RPh, Pharmacist Intern, San Joaquin Community Hospital; Oscar Guiterres PharmD RPh, Clinical Pharmacist, San Joaquin Community Hospital; Shankar Raman MD, Infectious Disease Medicine, San Joaquin Community Hospital; Stephen Huynh PharmD RPh, Clinical Pharmacist, San Joaquin Community Hospital; May Abdalla MPH, CIC, CIPHI, Director Infection Prevention, San Joaquin Community Hospital ISSUE: Our facility experienced trends in increased antimicrobial resistance along with higher fiscal year antibiotic expenses. Infection prevention efforts throughout our hospital rose to a high level of awareness. Financial resources for a comprehensive antimicrobial stewardship (AS) program were limited. Our annual efforts to achieve system wide improvements are described. PROJECT: Our 255 bed not-for-profit community hospital is affiliated with a system corporation. We provide basic emergency services as well as secondary & tertiary care in an acute setting.
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014