Automated tracking and ordering of precautions for multidrug-resistant organisms

Quan, Kathleen A.; Cousins, Sarah M.; Porter, Darlene D.; Puppo, Robert A.; Huang, Susan S.

doi:10.1016/j.ajic.2014.12.019

Cited by 7 publications

(16 citation statements)

References 11 publications

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“…32.4% (11) of the studies were conducted in the United States of America 115,118,141,146,[119][120][121][122]124,126,127,136 whereas two studies each are based in Canada 112,114 and Greece 135,137…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

“…The interventions involved various cadres of professionals namely infectious disease (ID) experts 113,114,124,125,139 , consultants 117,130,139,141,145 , nurses 113,125,140,141,144,145,127,128,130,133,134,[137][138][139] , doctors 116,[123][124][125]137 , physicians 112,113,138,139,141,143,145,115,117,118,122,124,127,128,133 , pharmacists 112,[115][116][117]122,[124]...…”

Section: Interventionsmentioning

confidence: 99%

“…A single centre study combined isolation precautions with a computer generated real time notification system for toxigenic C. difficile results and a treatment protocol using vancomycin only or vancomycin and metronidazole126 . The final study on isolation precautions also incorporated an automated system that tracked C. difficile results and triggered alerts on the patient's electronic records as well as automatically ordering for the appropriate isolation precautions thus aiding the healthcare personnel's actions118 .Three standalone interventions targeted modifying the hospital environment and reduce the bioavailability of Clostridium difficile[119][120][121] . A multisite randomised controlled trial employed four disinfection strategies for environmental cleaning following the discharge of C. difficile and other MDROs patients121 .…”

mentioning

confidence: 99%

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Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Okeah

Huws

Morrison

2020

Preprint

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Background: According to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant pathogens. Infectious diseases remain top on the list of the leading causes of death globally with multi-drug resistant microorganisms (MDROs) playing a significant role. Aims: To assess the breadth of studies on antibiotics stewardship C. diff and Klebsiella pneumoniae in healthcare settings. To identify existing literature on the interventions for reducing healthcare associated C. diff and Klebsiella pneumoniae transmission. Methods: This scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided. Results: The review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). These interventions include Education, Surveillance/Screening, Consultations, Audits, Policies/Protocols, Environmental disinfection, Bundles, Isolation, and Notifications or alerts (ESCAPE-BIN). A study involving screening, alerts, staff education, and antimicrobial protocols recorded a 75% reduction in the use of targeted antimicrobials. The largest absolute reduction in antimicrobial use of 310 DDs/1000PDs was reported from an intervention that involved audits and feedback systems. The highest improvement (95%) in adherence was reported by an intervention involving the use of an infection prevention bundle and an environmental cleaning protocol. Conclusion: Antimicrobial resistance represents a global threat requiring urgent measures to protect lives. Reducing the burden of AMR entails a host of multi-level approaches aimed at curbing transmission of the resistant pathogens, and optimizing the use of antibiotics.

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Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

mentioning

confidence: 99%

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Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Okeah

Huws

Morrison

2020

Preprint

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“…Automated electronic health record systems with microbiologic data and electronic alerts may improve compliance with hospital policies for CP. In one system, discontinuation criteria are displayed to physicians when they attempt to discontinue CP, and only an infection preventionist can remove the visual alert for MRSA in the electronic health record when criteria are met per hospital protocol 41 . Carson et al 42 evaluated outpatients who were not on long-term antibiotics and who had a MRSA infection at least 3 months prior to enrollment and therefore were “MRSA flagged” in the EMR.…”

Section: Methicillin-resistant Staphylococcus Aureus (Mrsa)mentioning

confidence: 99%

“…In one system, discontinuation criteria are displayed to physicians when they attempt to discontinue CP, and only an infection preventionist can remove the visual alert for MRSA in the electronic health record when criteria are met per hospital protocol. 41 Carson et al 42 evaluated outpatients who were not on long-term antibiotics and who had a MRSA infection at least 3 months prior to enrollment and therefore were "MRSA flagged" in the EMR. Eligible subjects had surveillance cultures obtained from the nares, axilla, inguinal area, and wound if present; if all cultures were negative, patients returned at least 7 days later for testing at these body sites a second time.…”

Section: Shea Research Network Surveymentioning

confidence: 99%

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

et al. 2021

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IMPORTANCE Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement. OBJECTIVE To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. DESIGN, SETTING, AND PARTICIPANTS An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses.EXPOSURES Increasing contact precaution effectiveness, increasing interfacility communication about patients' MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities. MAIN OUTCOMES AND MEASURES MRSA and CRE prevalence and number of new carriers (ie, transmission events).RESULTS Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events).Increasing interfacility communication of patients' MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events). CONCLUSIONS AND RELEVANCEThe findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best (continued) Key Points Question Which multidrug-resistant organism (MDRO) intervention is best to implement in a set of health care facilities to reduce the spread of MDROs regionwide? Findings In this computational simulation modeling study...

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Automated tracking and ordering of precautions for multidrug-resistant organisms

Cited by 7 publications

References 11 publications

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Duration of Contact Precautions for Acute-Care Settings

Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

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