_______________________________________________________________ Healthcare-Associated Infections
• Reduction of inappropriate antibiotic use by 50% in outpatient settings and by 20% in inpatient settings • Establishment of Antibiotic Resistance Prevention Programs in all 50 states The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use engaged in establishing or improving antimicrobial stewardship programs in 389 ambulatory care practices throughout the United States [319]. This program involves webinars, audio presentations, educational tools, and office hours to engage stewardship leaders and clinical staff to address attitudes and cultures that challenge judicious antibiotic prescribing and incorporate best practices for the management of common infections. Over the period of one year (December 2019 through November 2020), antibiotic prescribing at participating clinics was cut overall by nearly 48%, while prescribing for acute respiratory infections was reduced by 37% [319]. EDUCATION FOR HEALTHCARE PROFESSIONALS Education on best practices is a crucial aspect of preventing HAIs and is a recommendation in all infection control guide- lines. Education should highlight the effect of prevention measures on the rates of HAIs, enhance knowledge about cur- rently available guidelines, and provide instruction on carrying out guideline recommendations. Research has also suggested that education about prevention strategies may be more effec- tive if patterns of care and levels of risk are incorporated into recommendations [320]. Numerous studies have shown that knowledge and practices related to HAIs and guidelines are improved after educational programs. The combination of a self-study module (with pretest and post-test), inservice lectures, posters, and fact sheets on the prevention of intravascular device-related bloodstream infections and appropriate prac- tices led to substantial reductions in the prevalence of such infections [268; 321; 322]. A small study showed that ICU nurses’ knowledge and practices were enhanced by education
on the prevention of ventilator-associated pneumonia [200]. A Canadian study demonstrated that rates of nosocomial MRSA infection significantly decreased after a mandatory infection control education program on MRSA that included discussion of hospital-specific MRSA data and case-based practice [323]. Because increasing knowledge is not sufficient for effecting behavior change, theoretical models for behavior change should be considered when designing improvement initiatives [300; 324]. Among effective model-related strategies are the following [300; 324]: • Education and discussion of barriers to adherence (cognitive model) • External reinforcements, incentives, and reminders (behavioral model) • Consensus, leadership, and role models (social influence model) • Quality improvement teams, process redesign, and fostering of a safety-oriented culture (organizational model) Healthcare facilities should explore innovative ways to develop quality improvement initiatives. In an effort to enhance adher- ence to the CDC guidelines on hand hygiene, a group of three hospitals used the Six Sigma approach with success. Six Sigma is a process established in the business world to achieve and sustain excellence in general operations and service [325]. One healthcare facility used the process to organize the knowledge, opinions, and actions of physicians, nurses, and other staff in four ICUs at the facilities, resulting in an increase in compli- ance from 47% to 80% [326]. Given the suboptimal rates of influenza vaccination among healthcare workers, education on the importance of this mea- sure is also needed. Two literature reviews have shown high rates of misconceptions or lack of knowledge about influenza, the role of healthcare professionals in transmitting influenza
CDC’S CORE ELEMENTS FOR ANTIBIOTIC STEWARDSHIP PROGRAMS IN HOSPITALS, NURSING HOMES AND OUTPATIENT FACILITIES
Core Element
Definition
Leadership commitment
Dedicating necessary human, financial and information technology resources
Accountability
Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective Appointing a single pharmacist leader responsible for working to improve antibiotic use Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e., “antibiotic time out” after 48 hours)
Drug expertise
Action
Tracking
Monitoring antibiotic prescribing and resistance patterns
Reporting
Regular reporting of information on antibiotic use and resistance to doctors, nurses and other relevant staff
Education Source: [2]
Educating clinicians about resistance and optimal prescribing
Table 20
102
EliteLearning.com/Dental
Powered by FlippingBook