Impact of Successful Implementation of an Antimicrobial Stewardship Program in an Inpatient Rehabilitation Setting

Abstract

BACKGROUND Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. METHODS This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. RESULTS Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. CONCLUSIONS Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospital-onset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety. Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospital-onset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety.