Repeated Point Prevalence Surveys Research Articles

Point prevalence survey on healthcare-associated infections in Apulian region, Italy, 2022-2023

Abstract Background Since 2011-2012, the ECDC coordinates the measurement of Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in European acute-care hospitals through repeated point prevalence surveys (PPS) every five years. Here we present the main results of the 3rd ECDC-PPS conducted in Apulia region, Italy, during November 2022, in comparison as a benchmark with data from Italian PPS 2016-2017. Methods The ECDC protocols were applied. Prevalence of HAIs and AMU was expressed as percentages. Proportion of isolates resistant to selected AMR markers were also calculated. Results Twenty-four/39 Apulian hospitals provided data on 3,710 patients. The prevalence of patients with ≥1 HAI was 9.9% (PPS-2016-17:8.03%). The highest prevalence was recorded in rehabilitation wards (31.6%; PPS-2016-17:16.4%), in large hospitals (10.5%; PPS-2016-17:9.3%), among elderly (11.2%; PPS-2016-17:9.1%), males (11.1%; PPS-2016-17:7.9%), and patients with a rapidly fatal McCabe score (28%; PPS-2016-17:18.8%). The most reported types of HAI were pneumonia (19.8%; PPS-2016-17:22.8%) and urinary tract infections (18.3%; PPS-2016-17:18%). Prevalence of patients with ≥1 antimicrobial was 49.3% (PPS-2016-17:44.5%). At least a positive microbiological result was reported for 66.1% of the HAIs (N = 244/369; PPS-2016-17:53.8%). Klebsiella pneumoniae (14.9%; PPS-2016-17:10.4%) and Escherichia coli (9.8%; PPS-2016-17: 13%) were the most frequently isolated microorganisms. The susceptibility tests were available for 56% of microorganisms (N = 177/316) and a resistant result was reported for 50.3% (PPS-2016-17:42.3%) of tests. Conclusions HAI, AMU, and AMR prevalence estimated in Apulia region was higher, when compared with previous national PPS. Efforts in implementing antimicrobial stewardship and reducing HAIs should be established. Key messages • HAI and AMR remain a major public health threat in Apulia region, particularly for K. pneumoniae and E. coli. • Frail patients bear a greater burden of illness.

Antimicrobial use in first opinion equine practices assessed by repeated point prevalence surveys

Antimicrobial use in first opinion equine practices assessed by repeated point prevalence surveys

Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey.

Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.

Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic.

Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.

Burden of Healthcare-Associated Infections in Sicily, Italy: Estimates from the Regional Point Prevalence Surveys 2016-2018.

An assessment of the burden of healthcare-associated infections (HAIs) in terms of disability-adjusted life years (DALYs) is useful for comparing and ranking HAIs and to support infection prevention and control strategies. We estimated the burden of healthcare-associated pneumoniae (HAP), bloodstream infection (HA BSI), urinary tract infection (HA UTI), and surgical site infection (SSI) in Sicily, Italy. We used data from 15,642 patients aged 45 years and above, identified during three repeated point prevalence surveys (PPSs) conducted from 2016 to 2018 according to the European Centre for Disease Prevention and Control protocol. The methodology of the Burden of Communicable Diseases in Europe project was employed. The selected HAIs accounted for 8424 DALYs (95% uncertainty interval (UI): 7394–9605) annually in Sicily, corresponding to 344 DALYs per 100,000 inhabitants aged 45 years and above (95% UI: 302–392). Notably, more than 60% of the burden was attributable to HAP, followed by HA BSI, SSI, and HA UTI. The latter had the lowest burden despite a relatively high incidence, whereas HA BSI generated a high burden even through a relatively low incidence. Differences between our estimates and those of European and Italian PPSs encourage the estimation of the burden of HAIs region by region.

Patterns of Antimicrobial Use in Hospitalized Children: A Repeated Point Prevalence Survey From Pakistan.

Three repeated point prevalence surveys (PPSs) were conducted in pediatric wards of 5 hospitals using the methodology developed by Global-PPS to identify key targets for interventions and antibiotic stewardship programs. Out of the 916 hospitalized patients, 865 (94.6%) were treated with at least 1 antibiotic.

Repeated point prevalence survey on antimicrobial use in a university hospital: what have we learned?

To evaluate the quality of antimicrobial prescribing, at the Department of Internal Medicine University Hospital Centre Rijeka, by assessing the necessity for antimicrobial treatment and adherence to the local Guidelines for hospital antimicrobial drug use and to compare results with previously conducted point prevalence surveys (PPSs). A PPS was conducted on 7th May 2019. Demographic and relevant clinical data of each patient receiving systemic antimicrobials were recorded anonymously in a patient-specific form. The appropriateness of antibiotic prescribing was assessed as adherence to the fourth edition of the Guidelines for hospital antimicrobial drug use. One hundred and seventy-one patients were hospitalized at the Department of Internal Medicine; 37.4% (n = 64) of patients received 102 prescriptions for an antimicrobial drug [62.8% (n = 64) of prescriptions were for intravenous and 37.2% (n = 38) for oral administration]. Of these, 52 were treated for an identified existing infection, 5 were treated for an unknown indication and 7 received antibiotics as prophylaxis. The necessity for antimicrobial treatment was unclear in 19.3% (n = 11) of cases. The antimicrobials were prescribed according to the Guidelines in 65.4% (n = 34) of cases. Adherence to the Guidelines when treating lower respiratory tract infections, urinary tract infections and gastrointestinal tract infections was 47.8%, 55.6% and 92.9%, respectively. Our study revealed antibiotic prescription frequency similar to EU/EEA average and high percentage of unjustified antimicrobial treatment introduction. The rate of adherence to the Guidelines was lower than those observed in western countries. The results lay a basis for tailoring antimicrobial stewardship programs/activities.

Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys

Optimising antimicrobial prescribing in hospitals through antimicrobial stewardship (AMS) is essential in addressing the global threat of antimicrobial resistance. The objective of this study was to evaluate the impact of a hospital-wide programme, delivered by a multidisciplinary AMS team, on antimicrobial prescribing outcomes. The AMS programme consisted of a combination of persuasive, restrictive, and structural components and was implemented in two phases. We used data from the Global-PPS, collected every six months between September 2017 and December 2019, to measure the antimicrobial use prevalence and monitor selected antibiotic prescribing quality indicators. A significantly increasing trend (P < 0.001) was observed for the indicators related to documentation of prescribing, that is the reason for treatment and stop or review date. We observed a significantly decreasing trend (P < 0.001) in the number of prescriptions for surgical antibiotic prophylaxis (SAP) prescribed for more than 24 h; however, sample sizes for surgical patients were small. For these three indicators, a sudden and pronounced improvement was seen after the second set of interventions, which consisted of (i) an antibiotic documentation policy, (ii) a 24-h automatic stop order for SAP, and (iii) dissemination of new SAP guidelines. A significantly decreasing trend was also observed for hospital-wide antimicrobial use prevalence (P < 0.001). The implementation of a multidisciplinary antimicrobial stewardship programme positively influenced antibiotic prescribing practices. Further research should address long-term trends in antibiotic prescribing to establish whether these coordinated activities have led to a sustained behaviour change among prescribers, thereby also evaluating clinical outcomes and antimicrobial resistance rates.

Establishment of a French surveillance system of Clostridiodes difficile infection: Comparison of patient’s characteristics with other national and European data

IntroductionThe magnitude and scope of Clostridioides difficile infection (CDI) has changed with an increase in incidence and severity. The epidemiology of CDI is not well known in France due to difficulties to conduct large continuous surveillance. The objectives were to compare the characteristics of patients with CDI collected through repeated point prevalence survey via DIFTEC™, a free electronic tool, with those from previous French or European studies. MethodsDIFTEC™ was developed to evaluate epidemiological burden, diagnostic strategies and management of CDI in France. National and European guidelines were used for definitions.A literature review of studies conducted in Western Europe on CDI and published between January 2008 and May 2018 was done to compare their data with those included in the DIFTEC™ database. ResultsFrom January 2016, to December 2017, 455 CDI episodes from 22 French hospitals were included. Most of CDI cases were health-care associated (HCA) (78%).The comparison between included patients and French literature data showed that the rates of previous antibiotics exposure, crude mortality and recurrence were not statistically different. However HCA-CDI was significantly more frequent in the DIFTEC™ study.Gender distribution, recurrence and crude mortality rates were not statistically different compared to European data. HCA-CDI was more frequent in the DIFTEC™ study whereas previous treatment with proton pump inhibitors and antibiotics were significantly higher in European studies. DiscussionThese results illustrated the added value of a new tool for increasing the reliable knowledge of CDI in France based on epidemiological surveillance implemented in health-care settings.

Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic.

BackgroundAlthough efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning.AimTo describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI.MethodsThe current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors.ResultsOverall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98).ConclusionContrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Three-Year Trends of Healthcare-Associated Infections and Antibiotic Use in Acute Care Hospitals: Findings from 2016-2018 Point Prevalence Surveys in Sicily, Italy.

Repeated point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of three PPSs conducted in Sicilian acute care hospitals (Italy) from 2016 to 2018, according to the European Centre for Disease Prevention and Control protocol. Overall, prevalence of patients with at least one HAI was 5.1% in 2016, 4.7% in 2017, and 5.1% in 2018, without a significant trend over years (p = 0.434). At the patient level, the most important factor associated with HAIs was antibiotic use, since patients receiving at least one antimicrobial were more likely to be infected than those who did not receive antimicrobials (OR = 18.87; 95%CI = 13.08–27.22). The analysis of the prevalence of antibiotic use indicated a significant trend across years of the PPSs: 50.5% of patients received at least one antimicrobial agent in 2016, 55.2% in 2017, and 53.7% in 2018 (p < 0.001). The most common indication for antimicrobial prescription was medical prophylaxis, while third-generation cephalosporins represented the most frequently used class of antimicrobial agents, followed by fluoroquinolones and combinations of penicillins. Our study confirms that HAIs still remain a major public health issue, which could be intensified by antibiotic abuse. This raises the need for infection prevention and control and antibiotic stewardship programs aimed to improve knowledge about appropriate antibiotic prescription and to reduce the use of broad-spectrum antimicrobials.

The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan

ABSTRACT Background Healthcare-associated infections (HAIs) are considered a major threat to public health resulting in significant morbidity, mortality, and additional costs. The present study aimed to assess the current patterns and risk factors of HAIs among hospitalized children. Materials and methods Three repeated point prevalence surveys were conducted in the pediatric inpatients of four hospitals by using the methodology developed by the European Center for Disease Prevention and Control. All patients present in the ward at 8:00 AM on the survey day and not discharged from the hospital on the same day were included. A standardized data collection form containing information on the presence of HAIs and the associated risk factors was completed for the patients. Findings Out of 888 hospitalized patients, 116 (13.1%) had the symptoms of HAIs. Most common infections were bloodstream infections (BSIs) (32.8%), pneumonia (21.0%), ear, eyes, nose and throat infections (11.8%), and skin and soft tissue infections (SSTs) (19.0%). Factors significantly associated with infections were the length of hospital stay (p = 0.000), admission to the medicine ward (p = 0.034), and male gender (p = 0.010). BSIs were most common in children belonging to the age group of less than one month (78.9%), who were admitted to intensive care units (73.7%). SSTs including surgical site infections were more prevalent in surgery wards (78.3%). Conclusions A high rate of HAIs among pediatrics was found in Pakistan. Infection control and prevention strategies are needed with a major focus on interventions to prevent the spread of most prevalent HAIs.

Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities - Detroit, Michigan, March-May 2020.

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

Appropriateness of antimicrobial prescribing in a Swiss tertiary care hospital: a repeated point prevalence survey.

Inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance and adverse events. Antimicrobial stewardship programmes may both optimise treatment of infections and reduce antimicrobial resistance but are implemented in only a minority of Swiss hospitals. In addition, data on prescribing patterns and quality are scarce. We conducted a repeated point prevalence survey to evaluate the quality of antimicrobial prescribing in a single tertiary care centre. Antimicrobial use was audited twice (summer 2017 and winter 2018) among all patients admitted to the University Hospital Basel, Switzerland. Data were collected from the electronic health record. Appropriateness of antimicrobial use was evaluated according to previously published rules and local national guidelines. We evaluated 1112 patients of whom 378 (34%) received 548 prescriptions in total (30% for prophylaxis). Penicillins with &beta;-lactamase inhibitors were most commonly used (30%), followed by cotrimoxazole (12%) and ceftriaxone (7%). Intravenous administration was chosen in 56% of patients. Prior to antimicrobial therapy, blood cultures were collected in 69% of patients. Overall, 182 (33%) prescriptions were not appropriate; reasons included lack of indication (11%), incorrect dosing (7%), delay in intravenous to oral switch (9%) or non-adherence to local guidelines (15%). A minority of patients received antimicrobials despite documented allergies (2%). Almost 38% of empirical prescriptions were inappropriate, compared with only 19% of prophylactic and 20% of targeted prescriptions. Penicillins with &beta;-lactamase inhibitors and cephalosporins were most commonly involved in inappropriate prescribing (&gt;50%) followed by carbapenems (30%), narrow-spectrum penicillins (17%) and cotrimoxazole (6%), with oral administration being involved less frequently than intravenous administration (15 vs 37%). Infectious diseases consultation and presence of immunosuppression were associated with reduced odds (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.21&ndash;0.70 and OR 0.31, 95% CI 0.17&ndash;0.54, respectively) of inappropriate prescription in the per-patient multivariable analysis, whereas being admitted to a surgical or intensive care unit was associated with increased odds (OR 1.83 and 5.67) compared with a medical unit. Almost one third of prescriptions were inappropriate in our tertiary care centre despite local guidelines and an on-demand infectious diseases consultation service. Our results underscore the need for expanding current antimicrobial stewardship efforts, including national initiatives such as stewardship and prescribing guidelines, repeated surveys and identification of areas for improvement including timely intravenous to oral switches in order to reduce the consequences of inappropriate prescribing and of multidrug resistant organisms.

A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan: findings and implications

ABSTRACTBackground: The extensive use of broad-spectrum antimicrobials in immunocompromised patients is inevitable in situations where culture and sensitivity testing is challenging. However, their overuse leads to an increase in antimicrobial resistance (AMR), which is a growing concern.Method: A repeated point prevalence survey (PPS) was conducted to assess the pattern of antimicrobial prescribing in a specialized cancer care hospital in Pakistan using the methodology employed by the European Centre of Disease Prevention and Control.Results: Out of 313 hospitalized patients, 156 (49.8%) were prescribed one or more antimicrobials, 82 (50.9) in 2017 and 74 (48.7) in 2018. The average bed occupancy in the hospital was 80.3%. Fever in neutropenic patients (20.2%), lower respiratory tract infections (17.8%), and sepsis (14.9%) were the three most common clinical indications. The total number of prescribed antimicrobials was 242, of whom, 41 (16.9%) were given orally and 201 (83.1%) were given parenterally. The most commonly used antimicrobials were piperacillin plus enzyme inhibitor (31.8%), meropenem (7.9%), ceftriaxone (6.2%) and vancomycin (6.2%). Of the total prescribed antimicrobials, 42 (17.3%) antimicrobials were used in surgical departments, 89 (36.8) in adult medical departments, 73 (30.1%) in pediatric medical departments and 38 (15.7) in the intensive care unit (ICU). In addition to these antibacterials, there was relatively high use of antivirals (acyclovir; 4.1%) and antifungals (fluconazole; 3.7%, amphotericin B; 2.9%).Conclusion: The study concluded that broad-spectrum antimicrobial usage in cancer hospitals in Pakistan is high, which can be a risk factor for the emergence of AMR. Repeated PPS is a fruitful way to maintain a focus on inappropriate antimicrobial use and develop pertinent intervention programs targeteing specific issues to improve future use.

Monitoring healthcare-associated infections and antimicrobial use at regional level through repeated point prevalence surveys: what can be learnt?

Healthcare-associated infections (HAIs) surveillance is an essential part of any infection prevention and control programme. Repeated point prevalence surveys (PPSs) according to European Centre for Disease Prevention and Control (ECDC) protocol have been implemented in all Friuli Venezia Giulia (FVG) region (Italy) acute hospitals to reduce and control HAIs. Using the repeated PPSs within a regional-healthcare system (RHS) to promote and evaluate infection prevention and control (IPC) programmes. The standard versions of the ECDC PPS protocols were used in all four surveys (2011, 2013, 2015, 2017). All RHS public and private accredited hospitals were involved within the 'safe care network' programme. The numbers of surveyed patients in the four PPSs were 3172, 3253, 2969 and 3036, respectively. Prevalence of HAIs and antimicrobial use (AU) decreased significantly from 2011: HAIs (P<0.05) 7.1%, 6.3%, 5.5%, 5.8% and AU (P<0.01) 40.4%, 39.2%, 36.0%, 37.2%, respectively. The appropriateness of duration of surgical prophylaxis increased significantly (<24 h increased through surveys related to one in 2011: odds ratio (OR), 95% confidence interval (CI) 1.29, 0.92-1.81; 1.95, 1.31-2.91; 1.78, 1.20-2.64, respectively). The most frequently detected HAIs were: bloodstream, urinary tract, pneumonia and surgical site (more than the 70% of HAIs in each PPS). The FVG regional approach to HAIs and AU surveillance was able to contribute to reduce prevalence over a 7-year period. Furthermore, it was able to keep hospital attention on HAIs and AU through the years and to guarantee a standardized and comparable evaluation of HAIs and AU burden in all RHS hospitals, as well as impacting on HAIs and AU regional programmes.

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found. Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.

Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4% vs. 90.3 ± 6.6%, p = 0.0013; antibiotics documented 87.9 ± 9.0% vs. 95.6 ± 5.1%, p < 0.0001; and duration or review date documented 31.9 ± 15.4% vs. 67.7 ± 15.2%, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators.

Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units.

BackgroundVietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam.MethodsMonthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included.ResultsAmong 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively).ConclusionA high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

The use of point prevalence surveys of healthcare-associated infection to identify risk factors and facilitate infection prevention and control planning

Abstract Background Healthcare-associated infections contribute greatly to the global burden of morbidity and mortality in relation to infectious disease. Consequences impact on individuals, populations and health services. Surveillance of infection provides the information to lead infection prevention activities. However, surveillance can require a significant resource investment by healthcare organisations. Point prevalence surveys of healthcareassociated infections are a useful surveillance methodology where resources are limited. Findings provide information in relation to infection and also in relation to patient risk factors. Methods Repeated point prevalence surveys were implemented over 4 years in 2006–09 in a 345-bed acute private hospital in the Republic of Ireland. Each annual survey followed an unchanged methodology and the data were collected and analysed by the infection prevention and control team. Results The prevalence of hospital-acquired infection ranged from 1.1% to 4.4% with a mean value of 3.2% (CI: 2.09–4.62). Mean prevalence of invasive devices was as follows: peripheral venous catheters: 61.3%; urinary catheters: 19.4%; and central venous catheters: 3.9%. The findings of the studies indicated the high prevalence of risk factors associated with invasive devices, particularly peripheral venous catheters. The results supported the introduction of a bundled approach to patient care in relation to invasive devices. This integrated the use of ‘care bundles' or checklists into daily patient care and management. Conclusion A multidisciplinary approach incorporating ward staff in relation to documentation and auditing of compliance with the bundle has increased awareness regarding the risks of invasive devices and the importance of infection prevention strategies.