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Campaign to Prevent Antimicrobial Resistance

Campaign to Prevent Antimicrobial Resistance. Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Healthcare Quality Promotion. Clinicians hold the solution!. Link to: Campaign to Prevent Antimicrobial Resistance Online

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Campaign to Prevent Antimicrobial Resistance

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  1. Campaign to PreventAntimicrobial Resistance Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Healthcare Quality Promotion Clinicians hold the solution! • Link to: Campaign to Prevent Antimicrobial Resistance Online • Link to:Federal Action Plan to Combat Antimicrobial Resistance

  2. Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 12 Break the chain 11 Isolate the pathogen 10 Stop treatment when cured 9 Know when to say “no” to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use local data 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen 2 Get the catheters out 1 Vaccinate Prevent Transmission Use Antimicrobials Wisely Diagnose & Treat Effectively Prevent Infections 12 Steps to Prevent Antimicrobial Resistance:Hospitalized Adults

  3. 12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults Use Antimicrobials Wisely Step 5: Practice antimicrobial control Fact:Programs to improve antimicrobial use are effective.

  4. 12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults Step 5: Practice antimicrobial control Methods to Improve Antimicrobial Use • Passive prescriber education • Standardized antimicrobial order forms • Formulary restrictions • Prior approval to start/continue • Pharmacy substitution or switch • Multidisciplinary drug utilization evaluation (DUE) • Interactive prescriber education Effective and Increasingly Used Resource intensive up front • Link to:SHEA / IDSA: Guidelines for the Prevention of Antimicrobial Resistance in Hospitals

  5. Multi-prong approaches Abx management teams Computerized systems

  6. Which ASP component is most helpful?

  7. Hospitalwide Program • Bantar, CID, 2003 • ASP • ID MD • Clin Microbiologist • Lab Microbiologist • 2 Pharmacists • IM MD • No formulary restrictions

  8. Hospitalwide Program • 4 step intervention phased in every 6 mos • Optional Antibiotic order forms • Mandatory Abx forms with feedback • Review of every Abx order and education • Modification by AMT if necessary • Goal • Decrease 3rd gen Ceph • Increase BL/Blase inhibitor

  9. Hospitalwide Program

  10. Hospitalwide Program

  11. Hospitalwide Program Iams Vanco Icfp Iams Carb

  12. Hospitalwide Program • Cost savings occur most with mandatory ordering forms

  13. Hospitalwide Program • Cost savings occur most with mandatory ordering forms BUT • Impact in resistance did not occur until full program in place

  14. Computerized Systems

  15. Computerized Program • Pestotnik, Annals IM, 1996 • Evans, NEJM, 1998 • LDS hospital • Computerized guidelines • Development 1986-1994 • Intergrated information • History • Labs • Cultures • Guidelines • Abx choices • Abx dosing • Abx duration

  16. Outcomes

  17. Outcomes

  18. Outcomes 76 % few adverse drug events

  19. Longterm followup

  20. Carling, 2003 • Boston community hospital • ASP program • Outcomes • Costs • Rates of C. difficile/ R GNR infection • Antibiogram vs. NNIS data

  21. Carling, 2003

  22. Carling, 2003 VRE

  23. Carling, 2003 • Impact of ASP long-lasting • Costs • Nosocomial pathogens • Ability to handle new resistant pathogens

  24. Local example of impact

  25. Local

  26. HCSD Beginnings • Data • Pharmacy and Utilization from ILH and HCSD systems offices • MDRO from ILH and HCSD Quality Compass • ILH team • Xavier PharmD faculty (Brakta, Johnson, Bryant, Al-Dahir) • ILH Pharmacy (Cardwell, Terry) • ILH IC (Friloux, Bergeron) • ILH Microbiology Lab (Wall) • HCSD Pharmacy (Jackson) • ID/IC Faculty (Hull, Maffei, Figueroa) • CCM Faculty (deBoisBlanc) • HCSD ASP committee • ID chair (Brown) • Similar personnel from other HCSD facilities

  27. ILH ASP team

  28. Beginnings • Evaluation of drug costs and utilization • Evaluation of length of stay • Review and evaluation of order sets and protocols • Evaluation of distribution of leading diagnoses • Review of antibiograms and MDRO rates

  29. Antibiotic utilization

  30. Abx doses 5/17/10 -11/17/10

  31. Length of Stay

  32. Antibiotic Use by HCSD hospital

  33. MDRO rates

  34. ILH

  35. Next Steps for ILH • Implementation of cellulitis protocol • Daily review of broad spectrum Abx with de-escalation recommendations • Prolonged beta-lactam dosing • COPD/asthma protocol • Limited microbiology Abx reporting • Pharmacokinetic service for vancomycin and aminoglycosides

  36. Outcomes tracked • Broad spectrum Abx use • Length of stay for infectious disease diagnoses • MDRO rates

  37. Top 65 ICD9 codes by HCSD hospital

  38. Jump!

  39. 3rd gen Ceph Restriction • Empey, 2002 • 1999 formulary change • Cefepime for 3rd gen C • Encourage BL/Blase combo • Vanco 72 hr stop • Retrospective • Antibiogram 6 mos before and after change

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