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Impact of Successful Implementation of an Antimicrobial Stewardship Program in an Inpatient Rehabilitation Setting
S16
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
specific, and antigen detection, which uses a two-step testing algorithm. While molecular tests do provide rapid identification, they do not differentiate between colonization and infection, and as a result patients may be unnecessarily treated for CDI. The objective of this initiative was to simplify the decision-making process for the frontline staff, by creating an algorithm to aid in proper CDI testing. METHODS: A CDI algorithm was implemented in January 2017 and it consisted of a flowchart with check boxes. If all boxes were checked, then patient met criteria for testing. All specimens sent to the laboratory required the algorithm filled out appropriately with two signatures. If the algorithm was not submitted with the specimen, the laboratory called the unit to request a completed algorithm. The study compared the total number of tests performed and hospital-onset (HO) cases (Pre: January-December 2016, Post: January-December 2017). RESULTS: During the pre-intervention period, a total of 1873 tests were performed, and of those, 70 were HO cases. During the postintervention period, a total of 1358 tests were performed, and of those, 39 were HO cases. Total number of tests performed was reduced by 27% and overall HO cases was reduced by 44% as a result of the intervention. CONCLUSIONS: This initiative demonstrates that creating a CDI algorithm, increases compliance with CDI testing. The results were validated with a decrease in the overall number of tests performed and in HO cases. Use of the CDI algorithm decreases unnecessary testing, decreases unnecessary treatment for colonized patients, and increases patient safety.
Presentation Number ASR-36 Impact of Successful Implementation of an Antimicrobial Stewardship Program in an Inpatient Rehabilitation Setting Kayla Peoples RN, BSN, CRRN BACKGROUND: Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. METHODS: This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. RESULTS: Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. CONCLUSIONS: Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospitalonset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider
implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety.
Presentation Number ASR-37 Carbapenmase-producing Carbapenemresistant Enterobacteriaceae (CP-CRE) investigation and containment in an acute-care inpatient physical rehabilitation hospital mandates a multi-faceted approach Marian P. Salamon RN, CIC, MainLine Health System, Bryn Mawr Rehabilitation Hospital; Judith A. Latham MSN, CRRN, BMRH/Main Line Health; Bernadette Abate BSN, CRRN, Bryn Mawr Rehabilitation Hospital/Main Line Health; Rosadele Plumari MSW, Bryn Mawr Rehabilitation Hospital; David N. Horwich MD, MBA, Bryn Mawr Rehabilitation Hospital; Caitlin Fasano MPH, Main Line Health BACKGROUND: Patients admitted from an outside acute-care facility, to an acute-care inpatient rehabilitation facility (IRF), are considered at-risk-populations for undiagnosed Carbapenem-resistant Enterobacteriaceae (CRE). Potential intra-facility transmission could result in a facility-wide outbreak. Various diagnosed carbapenemase organisms challenged staff to prevent person-to-person transmission while providing optimal rehabilitative therapy. METHODS: Over three months, point prevalent studies (PPS) were conducted by staff, county, and state representatives at an acutecare IRF. Input/consultation from a national health agency was provided. PPS were specific to the source patient's 41 bed unit. PPS consisted of increased hand hygiene audits (HH) and patient rectal swabbing. Prior to discontinuing PPS, two consecutive negative PPS were necessary. Patient's right-to-refusal to participate in any PPS was honored. Isolation precautions, personal protective equipment (PPE) and environmental services (EVS) procedures were observed and enhanced. RESULTS: Five PPS were conducted. HH audits showed 78.7% compliance. Rectal swab results for census totaled 119 patients with 94 patients screened. Three various types of CRE were identified. Enhanced isolation precautions were instituted for CRE positive patients who were incontinent of bowel/bladder. IRF and EVS staffs were taught how to properly don/doff PPE, along with additional education around appropriate cleaning of shared equipment. Proper methods for isolation cleaning were reinforced with all EVS staff. CONCLUSIONS: Prevention of intra-facility or person-to-person transmission of CRE is possible. Consistent reinforcement of HH in all disciplines is paramount. Adopting targeted interventions, including EVS cleaning to control transmission, instituting enhanced precautions to maintain optimal therapies and treatments, result in greatest patient outcomes. Screening incoming patients from other facilities, on admission, is a reserved option. Screening increases cost to patients, as well as debatably unnecessary testing. Administration, medical, nursing, therapeutic staff and EVS, must support one another to avert transmission of CRE.
Presentation Number ASR-38 What do Infection Preventionists know about antimicrobial stewardship: a pilot study Sandra F. Hanson MPH, RN, CIC, LDS Hospital / Intermountain Healthcare; Sharon Sumner RN, BSN, CIC, Intermountain Medical Center; Katreena C. Merrill PhD, RN, Brigham Young University
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
specific, and antigen detection, which uses a two-step testing algorithm. While molecular tests do provide rapid identification, they do not differentiate between colonization and infection, and as a result patients may be unnecessarily treated for CDI. The objective of this initiative was to simplify the decision-making process for the frontline staff, by creating an algorithm to aid in proper CDI testing. METHODS: A CDI algorithm was implemented in January 2017 and it consisted of a flowchart with check boxes. If all boxes were checked, then patient met criteria for testing. All specimens sent to the laboratory required the algorithm filled out appropriately with two signatures. If the algorithm was not submitted with the specimen, the laboratory called the unit to request a completed algorithm. The study compared the total number of tests performed and hospital-onset (HO) cases (Pre: January-December 2016, Post: January-December 2017). RESULTS: During the pre-intervention period, a total of 1873 tests were performed, and of those, 70 were HO cases. During the postintervention period, a total of 1358 tests were performed, and of those, 39 were HO cases. Total number of tests performed was reduced by 27% and overall HO cases was reduced by 44% as a result of the intervention. CONCLUSIONS: This initiative demonstrates that creating a CDI algorithm, increases compliance with CDI testing. The results were validated with a decrease in the overall number of tests performed and in HO cases. Use of the CDI algorithm decreases unnecessary testing, decreases unnecessary treatment for colonized patients, and increases patient safety.
Presentation Number ASR-36 Impact of Successful Implementation of an Antimicrobial Stewardship Program in an Inpatient Rehabilitation Setting Kayla Peoples RN, BSN, CRRN BACKGROUND: Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. METHODS: This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. RESULTS: Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. CONCLUSIONS: Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospitalonset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider
implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety.
Presentation Number ASR-37 Carbapenmase-producing Carbapenemresistant Enterobacteriaceae (CP-CRE) investigation and containment in an acute-care inpatient physical rehabilitation hospital mandates a multi-faceted approach Marian P. Salamon RN, CIC, MainLine Health System, Bryn Mawr Rehabilitation Hospital; Judith A. Latham MSN, CRRN, BMRH/Main Line Health; Bernadette Abate BSN, CRRN, Bryn Mawr Rehabilitation Hospital/Main Line Health; Rosadele Plumari MSW, Bryn Mawr Rehabilitation Hospital; David N. Horwich MD, MBA, Bryn Mawr Rehabilitation Hospital; Caitlin Fasano MPH, Main Line Health BACKGROUND: Patients admitted from an outside acute-care facility, to an acute-care inpatient rehabilitation facility (IRF), are considered at-risk-populations for undiagnosed Carbapenem-resistant Enterobacteriaceae (CRE). Potential intra-facility transmission could result in a facility-wide outbreak. Various diagnosed carbapenemase organisms challenged staff to prevent person-to-person transmission while providing optimal rehabilitative therapy. METHODS: Over three months, point prevalent studies (PPS) were conducted by staff, county, and state representatives at an acutecare IRF. Input/consultation from a national health agency was provided. PPS were specific to the source patient's 41 bed unit. PPS consisted of increased hand hygiene audits (HH) and patient rectal swabbing. Prior to discontinuing PPS, two consecutive negative PPS were necessary. Patient's right-to-refusal to participate in any PPS was honored. Isolation precautions, personal protective equipment (PPE) and environmental services (EVS) procedures were observed and enhanced. RESULTS: Five PPS were conducted. HH audits showed 78.7% compliance. Rectal swab results for census totaled 119 patients with 94 patients screened. Three various types of CRE were identified. Enhanced isolation precautions were instituted for CRE positive patients who were incontinent of bowel/bladder. IRF and EVS staffs were taught how to properly don/doff PPE, along with additional education around appropriate cleaning of shared equipment. Proper methods for isolation cleaning were reinforced with all EVS staff. CONCLUSIONS: Prevention of intra-facility or person-to-person transmission of CRE is possible. Consistent reinforcement of HH in all disciplines is paramount. Adopting targeted interventions, including EVS cleaning to control transmission, instituting enhanced precautions to maintain optimal therapies and treatments, result in greatest patient outcomes. Screening incoming patients from other facilities, on admission, is a reserved option. Screening increases cost to patients, as well as debatably unnecessary testing. Administration, medical, nursing, therapeutic staff and EVS, must support one another to avert transmission of CRE.
Presentation Number ASR-38 What do Infection Preventionists know about antimicrobial stewardship: a pilot study Sandra F. Hanson MPH, RN, CIC, LDS Hospital / Intermountain Healthcare; Sharon Sumner RN, BSN, CIC, Intermountain Medical Center; Katreena C. Merrill PhD, RN, Brigham Young University
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019