1014. Decreasing Antimicrobial Use by 25% via Submission to NHSN-AUR Module

Abstract

BackgroundTracking antimicrobial data are a core element of antimicrobial stewardship programs. Since 2014, the Washington State Health Association (WSHA) has tracked antimicrobial use (AU) to address and reduce C. difficile infections statewide. In 2016, WA state began promoting the National Healthcare Safety Network (NHSN) tool to upload hospital AU. Both track days of antimicrobial therapy (DOT) but WSHA uses patient-days as the denominator while NHSN uses days-present. Each measure accounts for hospital length of stay but the latter is affected by unit transfers and the former is not.MethodsObservational review of AU data submitted to NHSN and to WSHA in a 2-year period. Sixteen antibiotics selected by WSHA were reviewed and organized into 5 groups: broad-spectrum penicillins, cephalosporins, carbapenems, fluoroquinolones, and clindamycin. Data from a single center were used to compare results between each AU tracker. AU and days-present were obtained from the electronic medical record. Patient-days were obtained from the hospital quality department. The primary outcome was a difference in AU per WSHA vs. NHSN.ResultsBetween January 2017 to December 2018, the median rate of antimicrobial use was 279 days per 1000 patient-days and 201 days per 1000 days-present. The median difference in total AU reported was 25% less using NHSN vs. WSHA and ranged from 18% - 31%.ConclusionSwitching from patient-days to days-present decreased the reported rate of AU by 25%. In WA state, hospitals have nonuniformly adopted submitting antimicrobial use data to the NHSN. Until all hospitals submit their data via NHSN, both individual institutions and the state will have to contend with mismatched data. An interim solution may be to collect monthly patient-days and days-present from all hospitals and adjust the data before comparing AU among institutions. For institutions with a long history of tracking antimicrobial use, this change in denominator and resulting impact on AU represents a barrier to using the NHSN AU module. Disclosures All authors: No reported disclosures.