- Email: [email protected]
Integrating Rapid Diagnostics and Antimicrobial Stewardship for Blood Cultures Improves Antibiotic Use in a Community Hospital
Oral Abstracts / American Journal of Infection Control 47 (2019) S2−S14
RESULTS: The effect of the AMS program was noted by a statistically significant drop in the restricted antibiotics DoT ranging between 23-74% in the vancomycin, colistin and carbapenems usage (p < 0.05). No deterioration in the medical outcome of patients occurred and the infection related mortality dropped by 71.4% during the 5-month period (p < 0.05), using Cochran armitage test for linear trends for significance. On average 84% of all patients receiving antibiotics were treated according to the guidelines and financial savings were reported. CONCLUSIONS: The achievements of AMS interventions with minimal resources can be used as a model for regional countries in the fight against the spread of resistant bacteria.
Presentation Number ASR-2 Effectiveness of a Cleaning Protocol on Environmental Contamination in a Pediatric Intensive Care Unit David Levine PT, PhD, DPT, FAPTA, Professor, The University of Tennessee at Chattanooga; Henry Spratt PhD; Mark Rowin MD BACKGROUND: Recent studies have provided substantial evidence on the potential for healthcare associated infections (HAIs) due to contaminants in the environment such as floors, etc. In this study we compared environmental bacterial contamination in a pediatric intensive care unit (PICU) before and 48 hours after a terminal cleaning. METHODS: Using data from a previous study by the authors we established the 10 most contaminated sites in the PICU (bed rails, floor by sink, stethoscopes, return air ducts, bath basin, computer keyboard and mouse, cell phones, Pyxis touch screen, equipment handles, beside table). These sites were sampled in triplicate using sterile transport swabs and were use to inoculate Mannitol Salt Agar (for Staphylococci), CHROMagar (for methicillin resistant S. aureus (MRSA)), Pseudomonas Isolation Agar (for Pseudomonas sp.), Eosin Methylene Blue (for enteric bacteria), and Tryptic Soy Agar (TSA) (for non-specific bacteria). Samples were obtained before and 48 hours after a terminal cleaning. RESULTS: Of the samples collected in the PICU before the cleaning 14 (47%) were positive for S. aureus, 7 (23%) for MRSA, 6 (20%) for enterics, 0 (0%) for Pseudomonas, 13 (43%) TSA. Forty-eight hours after the terminal cleaning 7 (23%) were positive for S. aureus, 0 (0%) for MRSA, 3 (10%) for enterics, 0 (0%) pseudomonas, 11 (37%) for nonspecific bacteria. The most contaminated areas were the floors near the sink, and the return air ducts (p < 0.05). CONCLUSIONS: Overall contamination was significantly reduced by terminal cleaning (p <0.05) for S. Aureus, MRSA, enterics, and nonspecific bacteria in the majority of sites. The efficacy of cleaning however was not found in all areas; with the floors and return air ducts not being significantly changed after cleaning. The cleanliness of these two sites represent whether the dust carrying bacteria were removed in the cleaning process.
Presentation Number ASR-3 Integrating Rapid Diagnostics and Antimicrobial Stewardship for Blood Cultures Improves Antibiotic Use in a Community Hospital David Ezdon PharmD, Infectious Diseases Clinical Pharmacist, Einstein Medical Center Montgomery; Janet Cahill MT/M(ASCP), Microbiologist, Einstein Medical Center BACKGROUND: Antimicrobial stewardship aids in reducing the emergence of multi-drug resistant organisms (MDRO) and enhances
S3
clinical outcomes through optimization of antimicrobial use. Broad spectrum antibiotics are started in the case of sepsis and are often not deescalated in a timely fashion. A protocol was designed to integrate a comprehensive blood culture identification (BCID) test into our antimicrobial stewardship program to determine if we could decrease our broad spectrum antibiotic use. METHODS: Our microbiology lab in collaboration with the hospital’s antimicrobial stewardship team implemented a rapid BCID polymerase chain reaction (PCR) test. The microbiology lab would run the test in tandem with the Gram-stain when a blood culture was positive. The results were then reported to the nurse and a pharmacist. The pharmacist would make an immediate recommendation to the provider on how to manage the current antibiotic regimen based on the results using a pre-approved algorithm. Data were retrospectively reviewed and included time to antibiotic deescalation, broad-spectrum antibiotic days, length of stay, and cost avoidance. Data were collected for four months before and after implementation from 01/01/2017 to 08/31/ 2017. Descriptive statistics were utilized to analyze the data. RESULTS: A total of 99 patients before and 103 patients after were assessed. Time to antibiotic deescalation decreased by 25 hours after implementation (45% reduction). We avoided a total of 70 broadspectrum antibiotic days and observed a length of stay reduction of 1.45 days. Based on the length of stay reduction, a cost avoidance of $322,508 over the 4 months was calculated. Cost data was derived from the average cost per patient day at our institution. CONCLUSIONS: The BCID combined with antibiotic stewardship resulted in rapid antibiotic adjustment (average 25 hours sooner), decrease in broad spectrum antibiotic use, and decreased length of stay for patients with bacteremia.
Presentation Number ASR-4 Leveraging Technology to Increase Public Awareness of the Importance of Antimicrobial Stewardship Staci Kvak MPH, MSN, RN, Nurse Consultant, Washington State Department of Health; Marisa D'Angeli MD, MPH BACKGROUND: Antibiotic use is a key driver of antibiotic resistance. While 80-90% of antibiotics are initiated in ambulatory settings, where patient expectations have been shown to increase the likelihood of antibiotic prescribing, the majority of interventions are geared toward healthcare providers in hospital settings. We describe a video series created by a State Health Department (SHD) to increase antibiotic awareness among the general public and how technology was leveraged to reach the audience. METHODS: The project occurred from 2016-2018. Scripts for 6 videos were developed by SHD in partnership with local AMS experts. Topics included pharyngitis, sinusitis, acute otitis media (AOM), urinary tract infection (UTI), and bronchitis and an AMS overview. Videos were narrated by influential respected local physicians. Social media platforms (SMP) were used to promote the videos. SMP1 is a social networking site, posts with and without paid advertising were used. Advertising cost was $20 per video. SMP2 is a video platform, no paid advertising was used. RESULTS: SMP1 paid advertising resulted in higher video views: pharyngitis (n=3455), sinusitis (n=2935), AOM (n=2634), UTI (n=2435), bronchitis (n=2125), and AMS overview (n=1900). SMP1 without paid advertising resulted in fewer views: sinusitis (n=319), bronchitis (n=352), and AMS overview (n=493). Paid advertising on SMP1 resulted in 6.4 times higher viewership (range 4, 9.2) compared to SMP1 without paid advertising. Views on SMP2 was lower than SMP1 without paid advertising: pharyngitis (n=285), sinusitis (n=144), AOM (n=84), UTI (n=113), bronchitis (n=70), and AMS overview (n=168). Each video had an average 21.2 times higher viewership on SMP1 (range 11.1, 31.3)
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
RESULTS: The effect of the AMS program was noted by a statistically significant drop in the restricted antibiotics DoT ranging between 23-74% in the vancomycin, colistin and carbapenems usage (p < 0.05). No deterioration in the medical outcome of patients occurred and the infection related mortality dropped by 71.4% during the 5-month period (p < 0.05), using Cochran armitage test for linear trends for significance. On average 84% of all patients receiving antibiotics were treated according to the guidelines and financial savings were reported. CONCLUSIONS: The achievements of AMS interventions with minimal resources can be used as a model for regional countries in the fight against the spread of resistant bacteria.
Presentation Number ASR-2 Effectiveness of a Cleaning Protocol on Environmental Contamination in a Pediatric Intensive Care Unit David Levine PT, PhD, DPT, FAPTA, Professor, The University of Tennessee at Chattanooga; Henry Spratt PhD; Mark Rowin MD BACKGROUND: Recent studies have provided substantial evidence on the potential for healthcare associated infections (HAIs) due to contaminants in the environment such as floors, etc. In this study we compared environmental bacterial contamination in a pediatric intensive care unit (PICU) before and 48 hours after a terminal cleaning. METHODS: Using data from a previous study by the authors we established the 10 most contaminated sites in the PICU (bed rails, floor by sink, stethoscopes, return air ducts, bath basin, computer keyboard and mouse, cell phones, Pyxis touch screen, equipment handles, beside table). These sites were sampled in triplicate using sterile transport swabs and were use to inoculate Mannitol Salt Agar (for Staphylococci), CHROMagar (for methicillin resistant S. aureus (MRSA)), Pseudomonas Isolation Agar (for Pseudomonas sp.), Eosin Methylene Blue (for enteric bacteria), and Tryptic Soy Agar (TSA) (for non-specific bacteria). Samples were obtained before and 48 hours after a terminal cleaning. RESULTS: Of the samples collected in the PICU before the cleaning 14 (47%) were positive for S. aureus, 7 (23%) for MRSA, 6 (20%) for enterics, 0 (0%) for Pseudomonas, 13 (43%) TSA. Forty-eight hours after the terminal cleaning 7 (23%) were positive for S. aureus, 0 (0%) for MRSA, 3 (10%) for enterics, 0 (0%) pseudomonas, 11 (37%) for nonspecific bacteria. The most contaminated areas were the floors near the sink, and the return air ducts (p < 0.05). CONCLUSIONS: Overall contamination was significantly reduced by terminal cleaning (p <0.05) for S. Aureus, MRSA, enterics, and nonspecific bacteria in the majority of sites. The efficacy of cleaning however was not found in all areas; with the floors and return air ducts not being significantly changed after cleaning. The cleanliness of these two sites represent whether the dust carrying bacteria were removed in the cleaning process.
Presentation Number ASR-3 Integrating Rapid Diagnostics and Antimicrobial Stewardship for Blood Cultures Improves Antibiotic Use in a Community Hospital David Ezdon PharmD, Infectious Diseases Clinical Pharmacist, Einstein Medical Center Montgomery; Janet Cahill MT/M(ASCP), Microbiologist, Einstein Medical Center BACKGROUND: Antimicrobial stewardship aids in reducing the emergence of multi-drug resistant organisms (MDRO) and enhances
S3
clinical outcomes through optimization of antimicrobial use. Broad spectrum antibiotics are started in the case of sepsis and are often not deescalated in a timely fashion. A protocol was designed to integrate a comprehensive blood culture identification (BCID) test into our antimicrobial stewardship program to determine if we could decrease our broad spectrum antibiotic use. METHODS: Our microbiology lab in collaboration with the hospital’s antimicrobial stewardship team implemented a rapid BCID polymerase chain reaction (PCR) test. The microbiology lab would run the test in tandem with the Gram-stain when a blood culture was positive. The results were then reported to the nurse and a pharmacist. The pharmacist would make an immediate recommendation to the provider on how to manage the current antibiotic regimen based on the results using a pre-approved algorithm. Data were retrospectively reviewed and included time to antibiotic deescalation, broad-spectrum antibiotic days, length of stay, and cost avoidance. Data were collected for four months before and after implementation from 01/01/2017 to 08/31/ 2017. Descriptive statistics were utilized to analyze the data. RESULTS: A total of 99 patients before and 103 patients after were assessed. Time to antibiotic deescalation decreased by 25 hours after implementation (45% reduction). We avoided a total of 70 broadspectrum antibiotic days and observed a length of stay reduction of 1.45 days. Based on the length of stay reduction, a cost avoidance of $322,508 over the 4 months was calculated. Cost data was derived from the average cost per patient day at our institution. CONCLUSIONS: The BCID combined with antibiotic stewardship resulted in rapid antibiotic adjustment (average 25 hours sooner), decrease in broad spectrum antibiotic use, and decreased length of stay for patients with bacteremia.
Presentation Number ASR-4 Leveraging Technology to Increase Public Awareness of the Importance of Antimicrobial Stewardship Staci Kvak MPH, MSN, RN, Nurse Consultant, Washington State Department of Health; Marisa D'Angeli MD, MPH BACKGROUND: Antibiotic use is a key driver of antibiotic resistance. While 80-90% of antibiotics are initiated in ambulatory settings, where patient expectations have been shown to increase the likelihood of antibiotic prescribing, the majority of interventions are geared toward healthcare providers in hospital settings. We describe a video series created by a State Health Department (SHD) to increase antibiotic awareness among the general public and how technology was leveraged to reach the audience. METHODS: The project occurred from 2016-2018. Scripts for 6 videos were developed by SHD in partnership with local AMS experts. Topics included pharyngitis, sinusitis, acute otitis media (AOM), urinary tract infection (UTI), and bronchitis and an AMS overview. Videos were narrated by influential respected local physicians. Social media platforms (SMP) were used to promote the videos. SMP1 is a social networking site, posts with and without paid advertising were used. Advertising cost was $20 per video. SMP2 is a video platform, no paid advertising was used. RESULTS: SMP1 paid advertising resulted in higher video views: pharyngitis (n=3455), sinusitis (n=2935), AOM (n=2634), UTI (n=2435), bronchitis (n=2125), and AMS overview (n=1900). SMP1 without paid advertising resulted in fewer views: sinusitis (n=319), bronchitis (n=352), and AMS overview (n=493). Paid advertising on SMP1 resulted in 6.4 times higher viewership (range 4, 9.2) compared to SMP1 without paid advertising. Views on SMP2 was lower than SMP1 without paid advertising: pharyngitis (n=285), sinusitis (n=144), AOM (n=84), UTI (n=113), bronchitis (n=70), and AMS overview (n=168). Each video had an average 21.2 times higher viewership on SMP1 (range 11.1, 31.3)
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019