Antimicrobial resistance, the ability of microbes to become resistant to known antimicrobial medications, is a growing and serious global health concern. There are growing numbers of publications about efforts to educate nurses about antimicrobial resistance, and efforts to involve nurses in antimicrobial stewardship in acute and long-term care settings; however, this has not been the case in home care. Home care organizations are required to address infection control and surveillance, including patient, family, and staff education. Home care nurses play an important role in identifying infections, performing cultures, and teaching patients and families. This article provides an overview of antimicrobial resistance and antimicrobial stewardship and provides antimicrobial stewardship actions for home care nurses and agencies. In the interest of public health, home care agencies and nurses can, and should, educate themselves and patients about antimicrobial resistance and employ antimicrobial stewardship strategies.
Background: Influenza virus illness affects millions. The virus’s ability to change yearly and its dependence on private manufacturing leads to major challenges immunizing populations. Currently the United States expects to distribute close to 162–168 million doses of influenza vaccine to the market (CDC, October 25, 2019) to immunize the population for the 2019–2020 season. In line with international best practice, our healthcare facility mandated the seasonal influenza vaccine for all employees. We set out to introduce a novel nursing workflow to enhance our Flu Campaign utilizing our Epic Systems healthcare software. Methods: The Epic Flu Express Lane function boosts provider satisfaction and efficiency by minimizing documentation time. Nurses can document the entire flu visit on a single screen with a few clicks. Workflow: An employee presents at the flu station registration desk and a scheduler creates an appointment as a Flu Visit type. After a nurse opens the chart, the system determines whether a Flu Express Lane order is a fit for the visit, launching the Express Lane activity. The nurse updates all relevant information and finally drops in the administration charge associated with the appropriate diagnosis code for the vaccine, to sign into the Express Lane. Establishment of dedicated and mobile employee flu stations: Immunizations are provided at several stations located inside the hospital and alternate sites, including the our cafeteria. Additionally, the flu team extended immunizations off site at our administrative building and an unoccupied inpatient floor, giving hospital employees easier access. Integration of Epic and human capital resource planning systems: By integrating the Epic and Mawared Human Capital systems, the flu team developed an automated workflow to capture employee compliance. A daily extract from Epic is imported to Mawared updating employee compliance status to completed. For those with incomplete status, Mawared sends an automated notification via e-mail reminding employees to complete the flu vaccination process for the season. Results: The Epic Nursing Express Lane workflow was well received, it facilitated compliance and practice efficiency for all mobile services provided. We achieved our target to provide influenza vaccination to >95% of employees in 2019 (Fig. 2). Conclusions: The electronic health record Epic Flu Express Lane workflow is an effective tool to complement practice efficiency and to facilitate a successful mobile Flu Campaign compliance in healthcare facilities.Funding: NoneDisclosures: None
Background Compliance with influenza immunization in HCW remains a global challenge, uptake in the Middle East has been reported at 24.7% due to limited access and awareness (1). We aim to report a successful campaign by establishing a multidisciplinary Flu Team during ongoing COVID-19 pandemic. Methods A multidisciplinary Flu team taskforce was assembled representing all stakeholders to include: Occupational Health, Nursing, Operations, Infomatics, Pharmacists and Administrative staff in July 2020. A pivot was made to switch location from previous year visits to an established vaccine center (ballroom) to a mobile campaign. From July to November 1st, the team met on a regular basis with 90 stakeholders to launch and monitor the ongoing immunizations. Electronic medical record (EPIC) tools such as One Click and Express Lane facilitated nursing check-in, documentation and immunization at one stop and eliminated previously used registration by other staff. EPIC Clarity feature facilitated reporting of compliance for managers and leadership. Ongoing education and awareness of immunization were ongoing through various platforms of communication such as huddles, phone screens, elevators, lounges, virtual grand rounds and corporate intranet communication and website videos. Results Of the 3578 healthcare workers, 3,399 were immunized (95%) from September 2020 until the end of October 2020. There were 86 (2.4%) employees exempted during this period due to medical reasons or excused leaves ( e.g military, maternity), Figure 1. Compliance differed among functions, 95.86% physicians, 97.2% clinical and nursing, 92% academics, 94.96% finance, 91.15% human resources, 92.1% infomatics, 60% legal, 80.6% operations. Only 93 (2.6%) were non-compliant. Employee Flu Immunization Hospital Overall Compliance in 2020 Compliance by Function in 2020 Conclusion Influenza illness adds an additional burden to the healthcare workforce during COVID-19. A multidisciplinary and collaborative team of teams approach delivered higher compliance for flu immunization than reported in the Middle East and enhanced by the use of state of the art technology. Convenience, educational awareness, free and safe access supported further the compliance with vaccination. To our knowledge, our 2020 flu campaign is the first successful experience reported in the Middle East during the current pandemic. Disclosures All Authors: No reported disclosures
Gastrointestinal tract (GIT) in human plays an important role in providing habitat to various microbial communities including numerous prokaryotic cells numbering over 100 trillion. This study was aimed at accessing the multidrug resistance (MDR) of E. coli among patients with GIT infections seeking health care at Dalhatu Araf Specialist Hospital (DASH), Lafia, Nasarawa state, Nigeria. A total of one hundred and fifty (150) stool samples were collected using sterile sample containers from patients with symptoms of GIT infections in search of medical care in this hospital. The samples collected were processed using standard microbiological methods. Out of the total samples collected, 35.3% (53/150) revealed the presence of E. coli whereas 64.7% did not. Extended spectrum beta-lactamases (ESBL) were found in 45.3% of E. coli obtained in this study, which were further used for the antimicrobial susceptibility test. E. coli were more resistant to ampicillin (75.51%), followed by amoxycillin/clavulanic acid (61.22%) and were least resistant to imipenems (12.25%). In conclusion, MDR E. coli producing ESBL are abundant among patients with GIT infections visiting DASH, Lafia. Thus, it is important to determine the genes responsible for this MDR as well as dissemination of adequate information to the masses visiting the hospital for treatment on the possible effects caused by the antibiotics abuse Keywords: Escherichia coli, Multiple-Drug Resistance, Antimicrobial, Gastrointestinal tract, Extended Spectrum Beta-Lactamases, Microbiological methods
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