Antibiotic stewardship program

ANTIBIOTIC Stewardship Program�ESSENTIAL LEARNING FOR MEDICAL GRADUATES

1. ANTIBIOTIC Stewardship Program ESSENTIAL LEARNING FOR MEDICAL GRADUATES Dr.T.V.Rao MD 7/5/2017 Dr.T.V.Rao MD @gmail.com 1

2. WHY WE NEED ANTIBIOTIC STEWARDSHIP Antimicrobial resistance is increasing; however, antimicrobial drug development is slowing. Now more than ever before, antimicrobial stewardship is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. 7/5/2017 Dr.T.V.Rao MD @gmail.com 2

3. Antibiotic Resistance is a emerging challenges in human care – Making the matters understand need a coordinated approach THE COMPONETNS INCLUDE ATTENTION Antimicrobial Stewardship (AS) The components of a high functioning AS program Why infection prevention is essential to efforts to improve AS Ways in which Infection Perfectionists (IPs) can collaborate with key stakeholders to improve AS efforts despite the degree of implementation of the program 7/5/2017 Dr.T.V.Rao MD @gmail.com 3

4. ➔ Misuse and over-use of antibiotics The last 50 years have witnessed the golden age of antibiotic discovery and their widespread use in hospital and community settings. Regarded as very effective, safe and relatively inexpensive, antibiotics have saved millions of lives. However, this has led to their misuse through huse without a prescription and overuse for self-limiting infections 7/5/2017 Dr.T.V.Rao MD @gmail.com 4

5. Combating antimicrobial resistance To overcome the threat of antimicrobial resistance, a three-pillar approach has been advocated: 1 Optimise the use of existing antimicrobial agents 2 Prevent the transmission of drug-resistant organisms through infection control 3 Improve environmental decontamination 7/5/2017 Dr.T.V.Rao MD @gmail.com 5

6. “ Need for Antimicrobial stewardship: is an inter-professional effort, across the continuum of care ➤ involves timely and optimal selection, dose and duration of an antimicrobial ➤ for the best clinical outcome for the treatment or prevention of infection ➤ with minimal toxicity to the patient ➤ and minimal impact on resistance and other ecological adverse events such as C. difficile” 7/5/2017 Dr.T.V.Rao MD @gmail.com 6

7. The greater Initiation to stop the misuse of Antibiotics Hospitals today straggle the demands of increasing regulation, changing technology requirements, more stringent reporting requirements and a rising number of quality initiatives in an already challenging economic environment. 7/5/2017 Dr.T.V.Rao MD @gmail.com 7

8. Need for Antibiotic Steward ship With competition for time, attention and financial resources, why does your hospital need an antimicrobial stewardship program (ASP)? 7/5/2017 Dr.T.V.Rao MD @gmail.com 8

9. Overprescribing of antibiotics wastes money : Worldwide monitoring shows an alarming increase in antibiotics prescriptions, often for conditions that do not warrant them. In U.S. hospitals, studies indicate that up to 50% of antibiotic prescriptions are inappropriate. 7/5/2017 Dr.T.V.Rao MD @gmail.com 9

10. Inappropriate Treatments costs life and economy Not only are those inappropriate prescriptions dangerous, they drive up costs for hospitals, payers and patients. In fact, overuse and inappropriate use of antibiotics costs the healthcare system 7/5/2017 Dr.T.V.Rao MD @gmail.com 10

11. Inappropriate use of antibiotics increases resistance in infectious organisms : The improper use of antibiotics directly contributes to the rising number of strains of multidrug resistant organisms (MDROs) in communities across the country, posing a significant risk to patient health. 7/5/2017 Dr.T.V.Rao MD @gmail.com 11

12. Poor prescribing practices endanger patients Receiving a broad-spectrum antibiotic triples a patient’s subsequent risk of infection with a more resistant organism, according to the Centers for Disease Control and Prevention (CDC). 7/5/2017 Dr.T.V.Rao MD @gmail.com 12

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15. MDROs increase morbidity and mortality Infections lead to more than eight million additional hospital days and are responsible for 23,000 deaths each year. According to the CDC, improved antibiotic prescription reduces rates of MDROs in hospitals and improves clinical outcomes for patients. 7/5/2017 Dr.T.V.Rao MD @gmail.com 15

16. MDROs increase hospital costs: Approximately 70% of healthcare associated infections (HAIs) involve organisms resistant to at least one drug. As Medicare and other payers do not reimburse for HAIs, every hospital has a significant interest in reducing the number of MDROs present in the facility and in the broader community 7/5/2017 Dr.T.V.Rao MD @gmail.com 16

17. Few new antibiotics are in development : In the last 20 years, the number of antibiotics in development has dropped sharply. Since 2008, pharmaceutical companies have introduced four new antibiotics, compared to 16 approved from 1983 to 1987—and no new classes of antibiotics to treat gram-negative bacilli have been released in more than 40 years. 7/5/2017 Dr.T.V.Rao MD @gmail.com 17

18. How stewardship program helps Consequently, hospitals must do everything possible to maintain the efficacy and extend the useful life of the antibiotics currently available. An antimicrobial stewardship program helps ensure that the narrowest spectrum antimicrobial known to be effective is used for each infection, reducing the development of resistant strains. 7/5/2017 Dr.T.V.Rao MD @gmail.com 18

19. Point-of-care interventions can include: appropriate use of guidance, ➤ indication for antibiotic, ➤ choice of agent, ➤ route [IV vs. oral] of administration of treatment, ➤ timeliness of treatment, ➤ likelihood of on-going infection or not, ➤ use of investigation, ➤ interpretation of microbiology with a view tode -escalation or stopping therapy, ➤ duration of therapy. 7/5/2017 Dr.T.V.Rao MD @gmail.com 19

20. Data collection for quality improvement Antimicrobial stewardship is part of many patient safety programs. To measure the performance of these programs, data is primarily used for 3 purposes [Solberg et al., 1997]: l Accountability (e.g. targets) l Improvement l Research. A range of such measures for antimicrobial stewardship programs have been proposed. They can be summarized as four types structural, process, outcomes and balancing (are the changes causing new problems?) 7/5/2017 Dr.T.V.Rao MD @gmail.com 20

21. . Who should receive education in hospitals? Prescribers and other healthcare staff with modules adapted to their background including: l Undergraduate curriculum l Internship l Professional training for new staff l Continuing professional development for all prescribers l Postgraduate education 7/5/2017 Dr.T.V.Rao MD @gmail.com 21

22. The content of education should be adapted to each profession and include Basic knowledge of infection management, l Basic microbiology l Importance of prudent prescribing in tackling antimicrobial resistance. l Best practices for prescribing to support safe and effective prescribing, administration and monitoring of antimicrobial therapy. The training is usually delivered by the antimicrobial management team and may include competency assessment 7/5/2017 Dr.T.V.Rao MD @gmail.com 22

23. THE KEYS TO SUCCESS A number of interventions are key to the success of a hospital-based Antimicrobial Stewardship Program. ➤ Establish a clear aim/vision that is shared by all the stakeholders and that conveys a sense of urgency. Stewardship should be a patient safety priority . 7/5/2017 Dr.T.V.Rao MD @gmail.com 23

24. THE KEYS TO SUCCESS Seek management support, accountability and secure funding. ➤ Assemble a strong coalition including a multi-professional antimicrobial stewardship team with a strong influential clinical leader. 7/5/2017 Dr.T.V.Rao MD @gmail.com 24

25. THE KEYS TO SUCCESS Establish effective communication structures within your hospital. ➤ Start with core evidence-based stewardship interventions depending on local needs, geography and resources and plan measurement to demonstrate their impact. 7/5/2017 Dr.T.V.Rao MD @gmail.com 25

26. THE KEYS TO SUCCESS Ensure all healthcare staff are aware of the importance of stewardship. Empower them to act and support with education using a range of effective strategies. ➤ Ensure early or short term wins and then consolidate success/gains while progressing with more change or innovation. 7/5/2017 Dr.T.V.Rao MD @gmail.com 26

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28. References Why Your Hospital Needs an Antimicrobial Stewardship Program Pharmacy OneSource Blog Practical Guide TO ANTIMICROBIAL STEWARDSHIP IN HOSPITALS BioMérieux 7/5/2017 Dr.T.V.Rao MD @gmail.com 28

29. Program Created by Dr.T.V.Rao MD for benefit of Medical and Paramedical Professionals on Universal education on Antibiotic Stewardship Email.com [email protected] 7/5/2017 Dr.T.V.Rao MD @gmail.com 29