- Email: [email protected]
Poster Abstracts
E28
Vol. 33 No. 5
K Bamburg K Strelczyk Methodist Health System, Dallas, Texas BACKGROUND: SSIs develop in up to 5% of surgical patients in the United States, with half of these being preventable if SAP is used judiciously. Overuse and misuse of SAP has a potential to contribute significantly to the emerging problem of antimicrobial resistance. To increase compliance with evidence-based guidelines, the Centers for Disease Control and Prevention (CDC) has launched a campaign to Prevent Antimicrobial Resistance in Surgical Patients, emphasizing wise use of antimicrobials as one of the key strategies. OBJECTIVES: To participate in Texas Medical Foundation Surgical Infection Prevention (SIP) Medicare Quality Improvement Project, with a goal of achieving .90% compliance with three core measures: 1) administration of antibiotic within 1 hour preceding surgical incision, 2) use of appropriate antibiotic and dosing, and 3) discontinuation of prophylactic antibiotic within 24 hours of surgery. METHODS: A multidisciplinary team consisting of the following departments: infection control (IC), clinical outcomes, nursing, operating room (OR) nurse educator, pharmacy, and physicians (infectious diseases, anesthesia, and surgery) was formed to develop practical ways to implement the SIP measures in the orthopedic and neurosurgical populations. Recommendations for appropriate SAP based on national guidelines were discussed with the surgeons and anesthesiologists. A laminated page with the protocol was made available on each anesthesia cart. IC and OR participated in ongoing education campaigns to the nursing staff. A data collection tool to be completed by the peri-operative team was formulated, and OR nurse educator followed-up daily to ensure accurate documentation. Rates were analyzed by IC, discussed in monthly SIP meetings, and posted on a showcase in a conspicuous OR location. Reasons for fall-out were scrutinized, and individual feedback on outliers provided to the physicians. RESULTS: Compliance rates from November 2003 (baseline) to November 2004, improved for all three indicators: 1) timely administration of prophylactic antibiotic, 84.6% to 91.1% (p=0.5); 2) appropriate antibiotic and dosage, 69.2% to 97.8% (p , 0.01); and 3) discontinuation of antibiotic within 24 hours of surgery, 67.3% to 91.1% (p , 0.01). CONCLUSIONS: A multidisciplinary approach focusing on practical strategies for implementation of evidencebased practices for SAP led to our programs success and recognition in 2004 by Texas Medical Foundation for achieving .90% compliance for all three SIP measures.
Poster Abstracts Exhibit Hall Monday, June 20 11:30 AM–2:30 PM Tuesday, June 21 10:30 AM–1:30 PM All posters will be available for viewing Monday and Tuesday. The authors will be attending their posters on the days indicated. The posters are arranged by topic (see below) and then numerically by Abstract ID number within each category.
Poster Topics Antimicrobial Resistance Antiseptics, Disinfection, Sterilization
June 2005
E29
Bioterrorism/Disaster Preparation Cost-Effectiveness Device-Related Infections Healthcare Worker Safety Infection Control Programs Infections in the Immunocompromised Host Infectious Diseases Long-Term Care Other Outbreak Investigation Patient Safety Pediatrics Product Evaluation Quality/Process Improvement/Adverse Outcomes Regulatory Compliance Site-Specific Infections Surveillance
Antimicrobial Resistance Abstract ID 49735 Tuesday, June 21
Infection control practitioner as advocate for the antibiogram: Launching local interventions to prevent antimicrobial resistance I Bakunas-Kenneley Case Western Reserve University/Frances Payne Bolton School of Nursing, Cleveland, Ohio ISSUE: Antimicrobial susceptibility data are often aggregated into ‘‘antibiograms,’’ which provide a summary picture of common organisms and their susceptibility to many antimicrobial agents. Local antibiograms (e.g., by unit, hospital, or facility) provide a starting point for making decisions about empiric antimicrobial treatment. Clinicians are not making use of the antibiogram information, nor taking into account the local patterns of resistance and the further increase of resistant strains resulting from inappropriate antibiotic therapy. PROJECT: The antibiotic imipenem is used within the acute care areas as a last resort medication for the treatment of serious infections. Current surveillance systems monitoring emerging drug resistance detect susceptibility patterns for each acute care entity. In this study, four hospitals that comprise part of a network were used to compare their resistance patterns to imipenem for the organism Pseudomonas aeruginosa, using their respective antibiograms. The dependent variable is the resistance of the organism; independent variables are the hospitals themselves and the time elapsed. A full model two-way ANOVA analysis was performed, with a subsequent one-way ANOVA performed as the reduced model. RESULTS: Retrospective review of the antibiogram resistance patterns for three time periods were analyzed from each of the four hospitals. Full model: Two-way ANOVA analysis indicates that Hu Hospital has the largest average resistance. Hi Hospital has a small average, indicating a higher percentage of susceptible isolates of Pseudomonas aeruginosa. Over time, the mean value of resistance did not change very much. Resistance patterns for one of the four hospitals were quite distinctly different (p=0.012), illustrating the need to monitor local data even when working within a multisite system.
Vol. 33 No. 5
K Bamburg K Strelczyk Methodist Health System, Dallas, Texas BACKGROUND: SSIs develop in up to 5% of surgical patients in the United States, with half of these being preventable if SAP is used judiciously. Overuse and misuse of SAP has a potential to contribute significantly to the emerging problem of antimicrobial resistance. To increase compliance with evidence-based guidelines, the Centers for Disease Control and Prevention (CDC) has launched a campaign to Prevent Antimicrobial Resistance in Surgical Patients, emphasizing wise use of antimicrobials as one of the key strategies. OBJECTIVES: To participate in Texas Medical Foundation Surgical Infection Prevention (SIP) Medicare Quality Improvement Project, with a goal of achieving .90% compliance with three core measures: 1) administration of antibiotic within 1 hour preceding surgical incision, 2) use of appropriate antibiotic and dosing, and 3) discontinuation of prophylactic antibiotic within 24 hours of surgery. METHODS: A multidisciplinary team consisting of the following departments: infection control (IC), clinical outcomes, nursing, operating room (OR) nurse educator, pharmacy, and physicians (infectious diseases, anesthesia, and surgery) was formed to develop practical ways to implement the SIP measures in the orthopedic and neurosurgical populations. Recommendations for appropriate SAP based on national guidelines were discussed with the surgeons and anesthesiologists. A laminated page with the protocol was made available on each anesthesia cart. IC and OR participated in ongoing education campaigns to the nursing staff. A data collection tool to be completed by the peri-operative team was formulated, and OR nurse educator followed-up daily to ensure accurate documentation. Rates were analyzed by IC, discussed in monthly SIP meetings, and posted on a showcase in a conspicuous OR location. Reasons for fall-out were scrutinized, and individual feedback on outliers provided to the physicians. RESULTS: Compliance rates from November 2003 (baseline) to November 2004, improved for all three indicators: 1) timely administration of prophylactic antibiotic, 84.6% to 91.1% (p=0.5); 2) appropriate antibiotic and dosage, 69.2% to 97.8% (p , 0.01); and 3) discontinuation of antibiotic within 24 hours of surgery, 67.3% to 91.1% (p , 0.01). CONCLUSIONS: A multidisciplinary approach focusing on practical strategies for implementation of evidencebased practices for SAP led to our programs success and recognition in 2004 by Texas Medical Foundation for achieving .90% compliance for all three SIP measures.
Poster Abstracts Exhibit Hall Monday, June 20 11:30 AM–2:30 PM Tuesday, June 21 10:30 AM–1:30 PM All posters will be available for viewing Monday and Tuesday. The authors will be attending their posters on the days indicated. The posters are arranged by topic (see below) and then numerically by Abstract ID number within each category.
Poster Topics Antimicrobial Resistance Antiseptics, Disinfection, Sterilization
June 2005
E29
Bioterrorism/Disaster Preparation Cost-Effectiveness Device-Related Infections Healthcare Worker Safety Infection Control Programs Infections in the Immunocompromised Host Infectious Diseases Long-Term Care Other Outbreak Investigation Patient Safety Pediatrics Product Evaluation Quality/Process Improvement/Adverse Outcomes Regulatory Compliance Site-Specific Infections Surveillance
Antimicrobial Resistance Abstract ID 49735 Tuesday, June 21
Infection control practitioner as advocate for the antibiogram: Launching local interventions to prevent antimicrobial resistance I Bakunas-Kenneley Case Western Reserve University/Frances Payne Bolton School of Nursing, Cleveland, Ohio ISSUE: Antimicrobial susceptibility data are often aggregated into ‘‘antibiograms,’’ which provide a summary picture of common organisms and their susceptibility to many antimicrobial agents. Local antibiograms (e.g., by unit, hospital, or facility) provide a starting point for making decisions about empiric antimicrobial treatment. Clinicians are not making use of the antibiogram information, nor taking into account the local patterns of resistance and the further increase of resistant strains resulting from inappropriate antibiotic therapy. PROJECT: The antibiotic imipenem is used within the acute care areas as a last resort medication for the treatment of serious infections. Current surveillance systems monitoring emerging drug resistance detect susceptibility patterns for each acute care entity. In this study, four hospitals that comprise part of a network were used to compare their resistance patterns to imipenem for the organism Pseudomonas aeruginosa, using their respective antibiograms. The dependent variable is the resistance of the organism; independent variables are the hospitals themselves and the time elapsed. A full model two-way ANOVA analysis was performed, with a subsequent one-way ANOVA performed as the reduced model. RESULTS: Retrospective review of the antibiogram resistance patterns for three time periods were analyzed from each of the four hospitals. Full model: Two-way ANOVA analysis indicates that Hu Hospital has the largest average resistance. Hi Hospital has a small average, indicating a higher percentage of susceptible isolates of Pseudomonas aeruginosa. Over time, the mean value of resistance did not change very much. Resistance patterns for one of the four hospitals were quite distinctly different (p=0.012), illustrating the need to monitor local data even when working within a multisite system.