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Source: https://www.cidrap.umn.edu/news-pers...an-oct-26-2020
Stewardship / Resistance Scan for Oct 26, 2020
Outpatient antibiotic stewardship; Sustainable stewardship in nursing homes
Filed Under:
Antimicrobial Stewardship
Survey: Few outpatient clinics have fully functional stewardship programs
A multicenter survey found that only 7% of ambulatory healthcare settings in the United States have fully functional antimicrobial stewardship programs (ASPs), researchers reported late last week in Open Forum Infectious Diseases.
The cross-sectional survey, sent to hospitals and healthcare systems in the Vizient network, asked respondents 51 questions about the presence of an outpatient ASP, the components of their ASP, compliance with the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship, and ASP effectiveness. Respondents were asked to characterize ASPs as either fully functional, in development, no program but considering a small project, or no program with no plans to develop one.
ASP effectiveness was defined as self-reported achievement in at least one of the following areas within the past 2 years: cost savings or avoidance related to antibiotics, decreases in antibiotic use, decreased Clostridioides difficile infection, or decreased rate of drug-resistant organisms. Survey respondents were also asked to compare their ambulatory ASPs to their inpatient ASPs, where applicable.
Overall, 129 survey responses were received from institutions across 44 states, with 9 of 129 respondents (7%) reporting a fully functional ASP in their ambulatory practice compared with 114 of 129 (88%) inpatient practices. Effectiveness in at least one antibiotic use-related outcome in the past 2 years was reported in 18 of 100 (18%) ambulatory ASPs compared with 103 of 123 (84%) inpatient ASPs. The characteristics most commonly reported in ambulatory ASPs that demonstrated effectiveness were use of institutional guidelines (89%), rapid diagnostic testing for respiratory viruses or group A Streptococcus (89%), and outpatient antibiograms (78%).
Ambulatory ASP effectiveness was shown to increase as programs met more of the CDC Core Elements of Outpatient Antibiotic Stewardship; zero reported effectiveness when meeting only one core element, compared with 59% of those that met all four core elements.
The authors say the findings should serve as a benchmark and provide areas of focus for ambulatory ASPs currently in development.
Oct 24 Open Forum Infect Dis abstract
Roadblocks, priorities noted for sustainable ASPs in nursing homes
Interviews with staff at nine non-profit nursing homes with active ASPs identified three critical areas needed for sustainability, researchers reported today in Infection Control and Hospital Epidemiology.
The interviews were conducted by researchers with the University of Rochester 5 years after a collaborative project in which staff at nine nursing homes in Monroe County, New York, formed ASPs and implemented stewardship activities to optimize antibiotic use and reduce C difficile infection. The purpose of the interviews was to examine the experiences and perceptions of staff at the nursing homes and understand the factors that influence the sustainability of ASPs.
Interviews with 48 clinical and administrative staff members at the nursing home identified seven themes that threaten sustainability. These included the belief that ASPs are resource intensive for nursing homes with limited resources and high turnover rates, that a single champion cannot sustain an ASP even when fully committed, that an ASP requires access to and interpretation of data that are not readily available at nursing homes, and that ASPs require explicit support from nursing home leadership and partnerships with external consultants.
Staff members also reported that it was hard to make progress beyond ASP implementation because urgent resident care needs always take precedence over ASP tasks, that prescribing patterns of external providers (like emergency departments) often impede stewardship efforts, and that ongoing and consistent ASP education is necessary for sustainability.
Based on these interviews, the authors of the study recommend that nursing homes with ASPs prioritize three critical areas: (1) explicit, ongoing leadership support; (2) partnerships with external stewardship experts; and (3) consistent education and training for staff.
"We believe that sustainability cannot be an afterthought and needs to be integrated into the design of ASPs," the authors write. "Future research should target how ASPs in nursing homes with limited resources can be both implemented and sustained over time."
Oct 26 Infect Control Hosp Epidemiol abstract
Stewardship / Resistance Scan for Oct 26, 2020
Outpatient antibiotic stewardship; Sustainable stewardship in nursing homes
Filed Under:
Antimicrobial Stewardship
Survey: Few outpatient clinics have fully functional stewardship programs
A multicenter survey found that only 7% of ambulatory healthcare settings in the United States have fully functional antimicrobial stewardship programs (ASPs), researchers reported late last week in Open Forum Infectious Diseases.
The cross-sectional survey, sent to hospitals and healthcare systems in the Vizient network, asked respondents 51 questions about the presence of an outpatient ASP, the components of their ASP, compliance with the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship, and ASP effectiveness. Respondents were asked to characterize ASPs as either fully functional, in development, no program but considering a small project, or no program with no plans to develop one.
ASP effectiveness was defined as self-reported achievement in at least one of the following areas within the past 2 years: cost savings or avoidance related to antibiotics, decreases in antibiotic use, decreased Clostridioides difficile infection, or decreased rate of drug-resistant organisms. Survey respondents were also asked to compare their ambulatory ASPs to their inpatient ASPs, where applicable.
Overall, 129 survey responses were received from institutions across 44 states, with 9 of 129 respondents (7%) reporting a fully functional ASP in their ambulatory practice compared with 114 of 129 (88%) inpatient practices. Effectiveness in at least one antibiotic use-related outcome in the past 2 years was reported in 18 of 100 (18%) ambulatory ASPs compared with 103 of 123 (84%) inpatient ASPs. The characteristics most commonly reported in ambulatory ASPs that demonstrated effectiveness were use of institutional guidelines (89%), rapid diagnostic testing for respiratory viruses or group A Streptococcus (89%), and outpatient antibiograms (78%).
Ambulatory ASP effectiveness was shown to increase as programs met more of the CDC Core Elements of Outpatient Antibiotic Stewardship; zero reported effectiveness when meeting only one core element, compared with 59% of those that met all four core elements.
The authors say the findings should serve as a benchmark and provide areas of focus for ambulatory ASPs currently in development.
Oct 24 Open Forum Infect Dis abstract
Roadblocks, priorities noted for sustainable ASPs in nursing homes
Interviews with staff at nine non-profit nursing homes with active ASPs identified three critical areas needed for sustainability, researchers reported today in Infection Control and Hospital Epidemiology.
The interviews were conducted by researchers with the University of Rochester 5 years after a collaborative project in which staff at nine nursing homes in Monroe County, New York, formed ASPs and implemented stewardship activities to optimize antibiotic use and reduce C difficile infection. The purpose of the interviews was to examine the experiences and perceptions of staff at the nursing homes and understand the factors that influence the sustainability of ASPs.
Interviews with 48 clinical and administrative staff members at the nursing home identified seven themes that threaten sustainability. These included the belief that ASPs are resource intensive for nursing homes with limited resources and high turnover rates, that a single champion cannot sustain an ASP even when fully committed, that an ASP requires access to and interpretation of data that are not readily available at nursing homes, and that ASPs require explicit support from nursing home leadership and partnerships with external consultants.
Staff members also reported that it was hard to make progress beyond ASP implementation because urgent resident care needs always take precedence over ASP tasks, that prescribing patterns of external providers (like emergency departments) often impede stewardship efforts, and that ongoing and consistent ASP education is necessary for sustainability.
Based on these interviews, the authors of the study recommend that nursing homes with ASPs prioritize three critical areas: (1) explicit, ongoing leadership support; (2) partnerships with external stewardship experts; and (3) consistent education and training for staff.
"We believe that sustainability cannot be an afterthought and needs to be integrated into the design of ASPs," the authors write. "Future research should target how ASPs in nursing homes with limited resources can be both implemented and sustained over time."
Oct 26 Infect Control Hosp Epidemiol abstract