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Reducing Invasive Fungal Infections and Reducing Cost

Reducing Invasive Fungal Infections and Reducing Cost. Presenter: Lee Hamley Hospital: THE ALFRED – Vic. Key problem. In 2007-08 haematologists noted increasing invasive fungal infections (IFI) in acute leukaemia and stem cell transplant patients

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Reducing Invasive Fungal Infections and Reducing Cost

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  1. Reducing Invasive Fungal Infections and Reducing Cost Presenter: Lee Hamley Hospital: THE ALFRED – Vic

  2. Key problem • In 2007-08 haematologists noted increasing invasive fungal infections (IFI) in acute leukaemia and stem cell transplant patients • This is a difficult problem to measure due to definitional issues related to IFI • At the same time, Pharmacy recorded LARGE increases in the use of anti-fungal agents, which can be extremely expensive • Alfred Health realised we had a problem!

  3. Audit definitions of IFI Proven Fungi in histology, micro from a sterile site or BC (ie need biopsy) Probable Host factors & Clinical/radiology (eg HRCT – dense lesions +/- halo) & Micro criteria (eg fungi from sputum/BAL) Possible Host factors & Clinical/radiology (eg HRCT – dense lesions +/- halo) (ie no micro results) Overall IFI = proven + probable Clinical IFI = proven + probable + possible Ascioglu et al CID 2002;34 p7-13Pauw et al 2008 CID 2008: 46 p1813

  4. Aim of this Innovation • To decrease invasive fungal infections in patients with acute leukaemia or stem cell transplantation from a baseline level of around 15% (proven & probable IFI) to best practice levels reported in the literature.

  5. Baseline Ambisome costs at The Alfred Haem & SCT use >80% of The Alfred’s Ambisome Allografts = 20 Allografts = 23

  6. Key changes implemented • Changes to clinical practice – see next slide • Changes to the environment and related systems – see next slide • Collaborative project for the introduction of in house drug levels • These were not available in Victoria • Levels either not done or sent interstate • Very slow turn around time for results

  7. Key changes to clinical practice

  8. Overall Rates IFI all groups 2007-2011

  9. Outcomes • Significant reduction in IFI in the target groups to levels reported in the literature • Large cost savings in high cost antifungal drugs, estimated to be approximately $1million per annum • On site drug monitoring now available

  10. Allo-SCT – treatment dose antifungals

  11. Lessons learned Fungal infections have significant consequences, both clinical and economic Measurement is critical – if you don’t measure you don’t know! For complex problems, solutions often cross Departments e.g. Haematology, Pharmacy, Ward, Engineering, Pathology etc Executive support is essential to facilitate this. Big gains can be made where you may least expect them, both in terms of patient safety and financial

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