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Stewardship / Resistance Scan for Sep 09, 2022
Carbapenemase screening intervention;
Telehealth-based antibiotic stewardship
Filed Under:
Antimicrobial Stewardship
Study links audit and feedback to improved screening for resistant bacteria
An audit-and-feedback intervention at a hospital in Israel was associated with improved compliance with guidelines for screening patients for carbapenemase-producing Enterobacteriaceae (CPE) and decline in CPE transmission, researchers reported today in Infection Control & Hospital Epidemiology.
In the study, researchers evaluated compliance with CPE screening at Israel's Hillel Yaffe Medical Center from 2016 through 2019. Starting in 2016, patients were screened weekly for CPE if the result on admission was negative and isolated if the result was positive. In 2017, a strategy of real-time feedback on compliance with in-hospital screening guidelines and quarterly point-prevalence interventions by infection control staff was implemented. The researchers also assessed CPE acquisition and transmission in the hospital, hand hygiene compliance, and compliance with isolation practices.
A total of 3,131 patients were eligible for CPE screening over the study period. Compliance with CPE screening increased from 67% in 2016 to 95% in 2019. A decrease in CPE transmission from 12% in 2017 to 2% in 2019 was also observed. The researchers did not find any correlation between hand hygiene and isolation practice compliance and CPE screening and acquisition.
"As far as we know, our study is the first to use real-time audit and feedback regarding appropriate CPE screening, to decrease CPE transmissions in a hospital, and this is the first time a correlation has been demonstrated quite straightforwardly," the study authors wrote. "We suggest that this tool be used in as many infection control measures as possible because we know that only a bundle of interventions can make a real difference in infection rates and thus improve patient care."
Sep 9 Infect Control Hosp Epidemiol abstract
Female physicians more likely to accept telehealth antibiotic advice
A study published last week in Open Forum Infectious Diseases found that recommendations by telehealth-based antimicrobial stewardship programs (TeleASPs) were more likely to be accepted by female physicians and less likely to be accepted by physicians with more experience.
The study looked at acceptance of TeleASP recommendations at two community hospitals in Western Pennsylvania that launched the program in 2018. The program includes remote infectious diseases (ID) physicians who review patient medical records and make antibiotic recommendations to local pharmacists and primary care teams during weekly phone calls. From February 2018 through July 2020, researchers collected data on the number and acceptance rate of TeleASP antibiotic recommendations and tracked the variables potentially affecting acceptance of those recommendations.
Over the 30-month study period, 5,333 TeleASP recommendations were made to 135 physicians, with an overall acceptance rate of 91.2%. In multivariable analysis, recommendations made to female physicians had significantly higher odds of acceptance than recommendations made to male physicians (93.1% vs 90.3% acceptance, odds ratio [OR], 1.65; 95% confidence interval [CI], 1.3 to 2.2). Compared with physicians with less than 3 years of experience, who had the highest rate of acceptance (96.3%), physicians with 21 or more years of experience had the lowest (87.1%; OR, 0.26; 95% CI, 0.15 to 0.45).
Multivariable analysis also found that recommendations for antibiotic dose/frequency adjustment (OR, 2.63; 95% CI, 1.6 to 4.3) and orders for labs/tests (OR, 3.30; 95% CI, 2.1 to 5.2) were associated with higher odds of acceptance, while recommendations for antibiotic de-escalation (OR, 0.75; 95% CI, 0.60 to 0.95) and antibiotic discontinuation (OR, 0.57; 95% CI, 0.42 to 0.76) were associated with lower odds of acceptance.
The study authors say the high rate of acceptance "helps highlight the viability of the TeleASP model as an alternative to fully on-site ASPs for facilities without sufficient local expertise." They suggest the clinician-level variables associated with acceptance of recommendations should be further explored to inform future educational initiatives and targeted interventions.
Sep 3 Open Forum Infect Dis abstract
Stewardship / Resistance Scan for Sep 09, 2022
Carbapenemase screening intervention;
Telehealth-based antibiotic stewardship
Filed Under:
Antimicrobial Stewardship
Study links audit and feedback to improved screening for resistant bacteria
An audit-and-feedback intervention at a hospital in Israel was associated with improved compliance with guidelines for screening patients for carbapenemase-producing Enterobacteriaceae (CPE) and decline in CPE transmission, researchers reported today in Infection Control & Hospital Epidemiology.
In the study, researchers evaluated compliance with CPE screening at Israel's Hillel Yaffe Medical Center from 2016 through 2019. Starting in 2016, patients were screened weekly for CPE if the result on admission was negative and isolated if the result was positive. In 2017, a strategy of real-time feedback on compliance with in-hospital screening guidelines and quarterly point-prevalence interventions by infection control staff was implemented. The researchers also assessed CPE acquisition and transmission in the hospital, hand hygiene compliance, and compliance with isolation practices.
A total of 3,131 patients were eligible for CPE screening over the study period. Compliance with CPE screening increased from 67% in 2016 to 95% in 2019. A decrease in CPE transmission from 12% in 2017 to 2% in 2019 was also observed. The researchers did not find any correlation between hand hygiene and isolation practice compliance and CPE screening and acquisition.
"As far as we know, our study is the first to use real-time audit and feedback regarding appropriate CPE screening, to decrease CPE transmissions in a hospital, and this is the first time a correlation has been demonstrated quite straightforwardly," the study authors wrote. "We suggest that this tool be used in as many infection control measures as possible because we know that only a bundle of interventions can make a real difference in infection rates and thus improve patient care."
Sep 9 Infect Control Hosp Epidemiol abstract
Female physicians more likely to accept telehealth antibiotic advice
A study published last week in Open Forum Infectious Diseases found that recommendations by telehealth-based antimicrobial stewardship programs (TeleASPs) were more likely to be accepted by female physicians and less likely to be accepted by physicians with more experience.
The study looked at acceptance of TeleASP recommendations at two community hospitals in Western Pennsylvania that launched the program in 2018. The program includes remote infectious diseases (ID) physicians who review patient medical records and make antibiotic recommendations to local pharmacists and primary care teams during weekly phone calls. From February 2018 through July 2020, researchers collected data on the number and acceptance rate of TeleASP antibiotic recommendations and tracked the variables potentially affecting acceptance of those recommendations.
Over the 30-month study period, 5,333 TeleASP recommendations were made to 135 physicians, with an overall acceptance rate of 91.2%. In multivariable analysis, recommendations made to female physicians had significantly higher odds of acceptance than recommendations made to male physicians (93.1% vs 90.3% acceptance, odds ratio [OR], 1.65; 95% confidence interval [CI], 1.3 to 2.2). Compared with physicians with less than 3 years of experience, who had the highest rate of acceptance (96.3%), physicians with 21 or more years of experience had the lowest (87.1%; OR, 0.26; 95% CI, 0.15 to 0.45).
Multivariable analysis also found that recommendations for antibiotic dose/frequency adjustment (OR, 2.63; 95% CI, 1.6 to 4.3) and orders for labs/tests (OR, 3.30; 95% CI, 2.1 to 5.2) were associated with higher odds of acceptance, while recommendations for antibiotic de-escalation (OR, 0.75; 95% CI, 0.60 to 0.95) and antibiotic discontinuation (OR, 0.57; 95% CI, 0.42 to 0.76) were associated with lower odds of acceptance.
The study authors say the high rate of acceptance "helps highlight the viability of the TeleASP model as an alternative to fully on-site ASPs for facilities without sufficient local expertise." They suggest the clinician-level variables associated with acceptance of recommendations should be further explored to inform future educational initiatives and targeted interventions.
Sep 3 Open Forum Infect Dis abstract