The impact of incorporating early rapid influenza diagnosis on hospital occupancy and hospital acquired influenza

Abstract

Objective:To assess the impact of incorporating early rapid influenza diagnosis on antimicrobial usage, nosocomial influenza transmission, length of stay, and occupancy rates among hospitalized patients.Setting:A 1,100 bed tertiary-care hospital in southern Israel.Methods:We implemented early rapid detection of influenza with immediate communication of results. Using Orion methods, we compared the 2017–2018 influenza season to the prior season in our hospital and to the 2017–2018 occupancy rates at other Israeli hospitals.Results:During the intervention season, 5,006 patients were admitted; 1,824 were tested for influenza, of whom 437 (23.9%) were positive. In the previous season, 4,825 patients were admitted; 1,225 were tested and 288 (23.5%) were positive. Time from admission to test report decreased from 35.5 to 18.4 hours (P< .001). Early discharge rates significantly increased, from 21.5% to 41.6% at 36 hours, from 37.2% to 54.5% at 48 hours, and from 66% to 73.2% at 72 hours. No increase in repeat ER visits, readmission, or mortality rates was observed. Hospital occupancy decreased by 10% compared to the previous year and was 26% lower than the national rate. Hospital-acquired influenza cases were reduced from 37 (11.4%) to 12 (2.7%) (P< .001). Antibiotic usage was reduced both before and after notification of test results by 16% and 12%, respectively.Conclusions:Implementing this intervention led to earlier discharge of patients, lower occupancy in medical wards, reduced antibiotic administration, and fewer hospital-acquired influenza events. This strategy is useful for optimizing hospital resources, and its implementation should be considered for upcoming influenza seasons.

Differences in Antibiotic and Antiviral Use in People With Confirmed Influenza: a Retrospective Comparison of Rapid Influenza PCR and Multiplex Respiratory Virus PCR Tests.

“…[11,[30][31][32][33] Our ndings extend on and are supported by a small number of previous studies that suggested a reduction in antibiotic usage with RPCR testing. [14,[17][18][19]23] In comparison to our study these were are mostly small studies assessing effects on ED metrics and included non-comparative cohort studies [14][15][16] or used historical controls [17][18][19][20][21][22][23] In particular, one trial found antimicrobial stewardship improvement only occurred in their paediatric and not in their adult population. [19] Notably there has been one large, UK hospital-based, open-label randomised controlled trial comparing outcomes of routine RPCR at presentation of respiratory illness versus standard clinical care.…”

“…Most of the available data on the effects of rapid in uenza testing on outcomes for people presenting to Emergency Departments include non-comparative cohort studies [14][15][16] or use historical controls. [17][18][19][20][21][22][23] These studies have generally compared a RPCR test to a multiplex PCR (MPCR) test with longer turnaround times. They have suggested the potential for reductions in antibacterial therapy prescription, increased antiviral prescription or effects on admission rates or infection control procedures.…”

Missed opportunities to use rapid influenza testing and severity assessment to avoid hospital admission: A cohort study from an East London District General Hospital

“…Despite the availability of rapid near-patient testing and low mortality in patients not requiring O 2 , less than 20% were discharged home from A&E. This is likely to represent a missed opportunity for admission avoidance T A B L E 1 Characteristics of patients with influenza who did or did not require oxygen or admission to critical care The importance of admission avoidance to the hospital can be expressed by unnecessary stays in hospital with an increased risk of nosocomial infection. In a prospective Israeli study, over a 2 year period involving 437 influenza-positive patients, 9 availability of rapid influenza diagnosis reduced hospital occupancy by 10%, antibiotic usage by 16% and nosocomial transmission by 8.7%, with no increase in A&E visits, readmission or mortality rates observed. The cost-effectiveness of a triage tool for influenza patients has been demonstrated in other papers.…”

Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis

“…27 Such rapid diagnostic testing also has an important impact on isolation procedures as a negative viral diagnosis will allow costly and inconvenient contact and droplet precautions to be discontinued. 28 Although other respiratory viruses are circulating in the winter months and are recognized as potential etiology in adult hospitalizations, multiplex molecular techniques remain expensive, with lower positivity rates that are correlated with more "background circulation patterns." The value of RT-PCR targeting these viruses (parainfluenza, human metapneumovirus, rhinovirus, enterovirus, and coronaviruses) should be investigated in the context of the development of antimicrobial stewardship.…”