153 Pharmacist-Initiated Culture Follow-Up in the Emergency Department Reduces Time to Treatment Optimization

Abstract

Study Objectives: Point-of-care ultrasound (POCUS) is integral to the care of patients in the emergency department. Unfortunately, ultrasound probes can act as fomites for pathogen transmission from patient to patient despite various cleaning methods and barrier precautions. It is pertinent to understand what factors contribute to this and how we can best reduce this risk. The objective of this study was to detect growth of methicillin-sensitive Staphylococcus aureus (MSSA) from POCUS probes after scanning an inoculated pork model with several types of conduction media to investigate the difference in pathogen transmission.Methods: A portion of store-bought pork shoulder was disinfected with chlorhexidine and allowed to dry. One mL of a cultured sample of abscessconcentration MSSA was used to inoculate the specimen. A linear transducer was cleansed with a sterilizing cloth and the end of the probe was then covered with a Tegaderm (3M, Maplewood, MN). One of three conduction media was applied to the pork shoulder: sterile saline, chlorhexidine, or sterile gel. The probe was then used to perform a soft tissue scan of the pork shoulder for one minute. After this, the probe was swabbed and cultured to detect transmission of MSSA. This was done four times for each of the three media types.Results: None of the four saline or four chlorhexidine probe swabs grew MSSA when cultured. Three of the four sterile gel probe swabs grew MSSA.Conclusions: These results suggest that sterile ultrasound gel may be more likely to transmit skin pathogens to the probe during POCUS in a simulated environment. However, larger studies and further exploration into this topic are necessary to draw clinical conclusions.

Pharmacist-Driven Culture and Sexually Transmitted Infection Testing Follow-Up Program in the Emergency Department

“…Optimized antimicrobial use has been widely associated with improved clinical outcomes and reduced adverse drug events (ADEs), including Clostridioides difficile infection [4][5][6]. Incorporation of a stewardship pharmacist into culture and sexually transmitted infection (STI) testing follow-up may be an effective method for ASP and pharmacy service expansion to the outpatient setting [7][8][9][10][11][12][13]. In addition to improved antimicrobial selection, culture follow-up programs that involve a pharmacist have been shown to reduce subsequent ED visits and reduce the time to result review and patient notification when compared to programs without a pharmacist [7][8][9]13].…”