Articoli di riviste: "Stewardship Program"

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Blondeau, C. M. "METHYL BROMIDE STEWARDSHIP PROGRAM." Acta Horticulturae, no. 255 (October 1989): 323–26. http://dx.doi.org/10.17660/actahortic.1989.255.39.

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Cunha, Cheston B. "Antibiotic Stewardship Program Perspective." Medical Clinics of North America 102, no. 5 (2018): 947–54. http://dx.doi.org/10.1016/j.mcna.2018.05.006.

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Wimberly, Jamie, Ken Malloy, and Kent Van Liere. "The Customer Stewardship Program." Electricity Journal 12, no. 7 (1999): 32–41. http://dx.doi.org/10.1016/s1040-6190(99)00057-3.

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Miller, Michael, Heather Dion, Randy Ngelale, et al. "The Nonproliferation Stewardship Program." Nuclear Science and Technology Open Research 2 (November 11, 2024): 73. http://dx.doi.org/10.12688/nuclscitechnolopenres.17586.1.

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The National Nuclear Security Administration (NNSA)’s Office of Defense Nuclear Nonproliferation (DNN) initiated the Nonproliferation Stewardship Program (NSP) in 2020 to provide an enduring pipeline of nonproliferation subject matter experts to Department of Energy (DOE)/NNSA laboratories, sites, and plants. This program provides nonproliferation-relevant science and technology opportunities through a modernized facility infrastructure. This paper provides an overview of NSP, highlights ongoing efforts in uranium and plutonium processing, and describes examples of hands-on experimental work and associated modeling and simulation.

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Barnes, Joy M., and Pamela Bradshaw. "Interventions to Decrease Inappropriate Antibiotic Use for Non-acute Respiratory Illness in Long-Term Care Settings." International Journal of Studies in Nursing 4, no. 3 (2019): 28. http://dx.doi.org/10.20849/ijsn.v4i3.599.

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Background: The life-saving power of antibiotics could be lost forever if leaders fail to implement effective antibiotic stewardship programs at all healthcare levels. Grahams’ Knowledge to Action theory guided the development of an antibiotic stewardship program in a long-term care facility that had received a citation for having no active antibiotic stewardship program as required by federal regulations. Purpose: The purpose of this project was to develop and implement an evidence-based antibiotic stewardship program into one long-term care facility. Methods and Materials: This quality improvement project was a population-based systems charter development. The implementation intervention was designed to change the way health care professionals treat non-acute episodes of upper respiratory infections in a long-term care setting. This project utilized the suspected lower respiratory infection (LRI) Situation, Background, Assessment, Recommendation (SBAR) form to reduce the number of antibiotics given during the early part of cold and influenza season of 2018. An antibiotic stewardship policy was developed by multidisciplinary team members and then implemented into the facilities daily practice. Results: The point-prevalence rate of antibiotics within this facility dropped from 24% in 2017 to 6% in 2018 after implementation of the antibiotic stewardship program. Conclusion: This project demonstrates how long-term care facilities can successfully implement an antibiotic stewardship program and potentially improve overall healthcare outcomes for the residents.

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Martin, Caren McHenry. "Implementing an Antimicrobial Stewardship Program." Consultant Pharmacist 32, no. 5 (2017): 18–25. http://dx.doi.org/10.4140/tcp.n.2016.532.

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Thomas, Morgan, Louise Amlie-Wolf, Laura Baker, and Karen W. Gripp. "The Genetic Testing Stewardship Program:." Delaware Journal of Public Health 7, no. 5 (2021): 20–23. http://dx.doi.org/10.32481/djph.2021.12.007.

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Vassallo, Angela, Snezana Naumovsky, Tanya Elgourt, Robert Winters, Ellie Goldstein, and John Lee. "206Implementing an Antimicrobial Stewardship Program." Open Forum Infectious Diseases 1, suppl_1 (2014): S92. http://dx.doi.org/10.1093/ofid/ofu052.72.

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Richards, DeAnn, and Jill Hanson. "Successful Antimicrobial Stewardship Program Collaboration." American Journal of Infection Control 45, no. 6 (2017): S19. http://dx.doi.org/10.1016/j.ajic.2017.04.038.

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Morris, Andrew, Thomas Stewart, Maureen Shandling, Scott McIntaggart, and W. Liles. "Establishing an Antimicrobial Stewardship Program." Healthcare Quarterly 13, no. 2 (2010): 64–70. http://dx.doi.org/10.12927/hcq.2013.21672.

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Slain, Douglas, Arif R. Sarwari, Karen O. Petros, et al. "Impact of a Multimodal Antimicrobial Stewardship Program onPseudomonas aeruginosaSusceptibility and Antimicrobial Use in the Intensive Care Unit Setting." Critical Care Research and Practice 2011 (2011): 1–5. http://dx.doi.org/10.1155/2011/416426.

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Objective. To study the impact of our multimodal antibiotic stewardship program onPseudomonas aeruginosasusceptibility and antibiotic use in the intensive care unit (ICU) setting.Methods. Our stewardship program employed the key tenants of published antimicrobial stewardship guidelines. These included prospective audits with intervention and feedback, formulary restriction with preauthorization, educational conferences, guidelines for use, antimicrobial cycling, and de-escalation of therapy. ICU antibiotic use was measured and expressed as defined daily doses (DDD) per 1,000 patient-days.Results. Certain temporal relationships between antibiotic use and ICU resistance patterns appeared to be affected by our antibiotic stewardship program. In particular, the ICU use of intravenous ciprofloxacin and ceftazidime declined from 148 and 62.5 DDD/1,000 patient-days to 40.0 and 24.5, respectively, during 2004 to 2007. An increase in the use of these agents and resistance to these agents was witnessed during 2008–2010. Despite variability in antibiotic usage from the stewardship efforts, we were overall unable to show statistical relationships withP. aeruginosaresistance rate.Conclusion. Antibiotic resistance in the ICU setting is complex. Multimodal stewardship efforts attempt to prevent resistance, but such programs clearly have their limits.

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Acquisto, Nicole M., and Stephanie N. Baker. "Antimicrobial Stewardship in the Emergency Department." Journal of Pharmacy Practice 24, no. 2 (2011): 196–202. http://dx.doi.org/10.1177/0897190011400555.

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The practice of antimicrobial stewardship can be defined as optimizing clinical outcomes while minimizing the consequences of antimicrobial therapy such as resistance and superinfection. Antimicrobial stewardship can be difficult to transition to the emergency department (ED) since the traditional activities include the evaluation of broad-spectrum antimicrobial regimens at 72 and 96 hours and intravenous to oral medication conversion. The emergency medicine clinical pharmacist (EPh) has the knowledge and clinical assessment skills to manage an antimicrobial stewardship program focused on culture follow-up for patients discharged from the ED. This paper summarizes the experiences of developing an EPh-managed antimicrobial stewardship and culture follow-up program in the ED from 2 separate institutions. Specifically, the focus is on the steps for establishing an EPh-managed antimicrobial stewardship program, a description of the culture follow-up process, managing the culture data and cultures that require emergent notification and review, medical/legal concerns, and barriers to implementation. Outcomes data available from institutions with similar ED based antimicrobial stewardship programs are also discussed.

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Patidar, Anurag Bhai, Prabha Agnibhoj, and Sagar Khadanga. "Extended and expanded role of nurses in antimicrobial stewardship program: A review." Future Health 2 (September 26, 2024): 153–57. http://dx.doi.org/10.25259/fh_49_2024.

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Antimicrobial resistance is a significant healthcare concern in this century, marked by the emergence of multidrug-resistant microorganisms. An antimicrobial stewardship program, while an innovative approach to mitigating the global threat of antimicrobial resistance and its effects on public health, is also an absolute need of the hour. When implemented effectively, such a program, in conjunction with selecting the appropriate drug, determining the correct dosage and route of administration, and integrating with an infection control program, has proven to be an effective method for curbing the rapid emergence and transmission of antimicrobial-resistant pathogens. Partnerships with nurses to strengthen antimicrobial stewardship programs in healthcare have recently gained recognition, especially in the backdrop of increased antimicrobial resistance in developing countries. Traditionally, stewardship activities have involved only prescribers and pharmacists, but including nurses in these efforts has become increasingly important. Highlights of nurse-driven antimicrobial stewardship activities include effective assessment of allergies, meticulous sampling for blood and urine cultures, antibiotic de-escalation, and 24-hour monitoring of patient status. Antibiotic or general ward rounds provide unique opportunities for nurses to influence the indication and duration of antimicrobial treatment. Including nurses in antimicrobial stewardship programs will make the management of antimicrobial therapy robust and empower healthcare institutions to approach the prevention of AMR with truly multi-disciplinary strategies. Antimicrobial stewardship is often redundant and centered around doctors in tertiary care centers. However, active participation by nurses in both healthcare facilities and community settings is crucial for making Antimicrobial stewardship practice (AMSP) a reality. Scalable nursing involvement in antimicrobial stewardship is essential for developing and developed nations to combat AMR effectively.

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Johnson, Gary. "Tree Care Advisor: A Voluntary Stewardship Program." Arboriculture & Urban Forestry 21, no. 1 (1995): 25–32. http://dx.doi.org/10.48044/jauf.1995.005.

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Fifty-two urban forestry volunteers completed a specialized training program that included thirty classroon hours of training and a pledge of a minimum of fifty hours of service to urban forestry educational programs and projects in two Minnesota urban-centered areas. As part of a two year pilot program developed by the Minnesota Extension Service and the Minnesota Department of Natural Resources Division of Forestry, the volunteers contributed more than 2000 hours of service and program assistance to their communities over a period of fourteen months. The training program has developed into a continuing Minnesota Extension Service specialization training program for Master Gardeners and non- Master Gardeners, and will be expanded to more rural and small community areas of the state.

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Weston, Adam, Lauren Epstein, Lisa E. Davidson, Alfred DeMaria, and Shira Doron. "The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals." Infection Control & Hospital Epidemiology 34, no. 4 (2013): 437–39. http://dx.doi.org/10.1086/669861.

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Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

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Atif, Moazzam Ali, and Sana Tufail. "Knowledge and perception of doctors regarding antibiotic stewardship in a tertiary care hospital of Southern Punjab." International Journal of Endorsing Health Science Research (IJEHSR) 10, no. 2 (2022): 179–87. http://dx.doi.org/10.29052/ijehsr.v10.i2.2022.179-187.

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Background: Pakistan has been working on Antimicrobial Resistance (AMR) for a decade; unfortunately, there is a lack of concept of antibiotic stewardship in most health setups, especially in the public sector. This study aims to analyze the knowledge and perception of junior physicians towards antibiotic stewardship programs. The need for this knowledge and impact of antimicrobial resistance on antibiotic stewardship ascertain barriers to stewardship acceptance. Methodology: A cross-sectional study was conducted at different clinical departments of Sheikh Zayed Hospital, Rahim Yar Khan, including 50 junior physicians recruited via convenience sampling technique. The data was collected using a structured questionnaire comprising physician's hospital associated data and questions regarding the knowledge, perspectives, and practices concerning antibiotic stewardship programs (ASP) to reduce AMR. Statistical analysis was done using SPSS version 22.0, and data were presented using frequencies and percentages. Results: Most of the enrolled physicians knew AMR and agreed that it is a serious global health issue. However, all the medical officers were completely unaware of the antibiotic stewardship program, while 42.9% of house officers and only 25.7% of PGs knew about the program. Conclusion: Our study shows support from doctors for expanded stewardship implementation and provides an important understanding of the current attitudes of doctors regarding stewardship execution. A better understanding of perceptions and attitudes is dire for healthcare stakeholders to expand stewardship activities into healthcare settings.

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McGee, Edoabasi U., Arrington D. Mason-Callaway, and Brent L. Rollins. "Are We Meeting the Demand for Pharmacist-Led Antimicrobial Stewardship Programs during Postgraduate Training-Year 1 (PGY1)?" Pharmacy 8, no. 2 (2020): 91. http://dx.doi.org/10.3390/pharmacy8020091.

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In the United States of America, pharmacists play a pivotal role in antimicrobial stewardship; training from postgraduate residency may hone knowledge and skills gained from didactic pharmacy education. Specifically, the first year of postgraduate training, the learner may become an “everyday steward in training” and may go on to complete a second year in infectious diseases. However, there are a limited number of second year infectious diseases programs. The current demand for pharmacist to participate in and or lead stewardship is disproportionate to available specialized training. The first year of post-graduate training has to be setup to ensure appropriate preparation, so newly trained pharmacist may help meet the demand. Currently, no clear standards exist for training in the first year. The purpose of this study is to survey the nature of stewardship training performed by first year residents from the perspective of residency program directors and preceptors. A 13-question online survey was distributed to examine resident exposure to antimicrobial stewardship activities. Survey data from targeted residency directors and preceptors were analyzed. A third of the programs required it as a mandatory rotation. Resident’s stewardship activities ranged from program to program; there was not consensus of the training activities.

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Wong, Jacqueline, Kathryn Timberlake, Sabrina Boodhan, et al. "Canadian Pediatric Antimicrobial Stewardship Programs: Current Resources and Implementation Characteristics." Infection Control & Hospital Epidemiology 39, no. 3 (2018): 350–54. http://dx.doi.org/10.1017/ice.2017.292.

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Antimicrobial stewardship programs (ASPs) became an accreditation requirement for Canadian hospitals in 2013. Pediatric programs are in various stages of program development and implementation, with 93% of surveyed Canadian academic pediatric hospitals having established ASPs. The programs varied in their team composition, implementation of stewardship strategies, and measured metrics.Infect Control Hosp Epidemiol 2018;39:350–354

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Drekonja, Dimitri M., Gregory A. Filice, Nancy Greer, et al. "Antimicrobial Stewardship in Outpatient Settings: A Systematic Review." Infection Control & Hospital Epidemiology 36, no. 2 (2014): 142–52. http://dx.doi.org/10.1017/ice.2014.41.

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ObjectiveEvaluate the effect of outpatient antimicrobial stewardship programs on prescribing, patient, microbial outcomes, and costs.DesignSystematic reviewMethodsSearch of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (eg, infectious conditions, prescription services) evaluating stewardship programs in outpatient settings and reporting outcomes of interest. Data regarding study characteristics and outcomes were extracted and organized by intervention type.ResultsWe identified 50 studies eligible for inclusion, with most (29 of 50; 58%) reporting on respiratory tract infections, followed by multiple/unspecified infections (17 of 50; 34%). We found medium-strength evidence that stewardship programs incorporating communication skills training and laboratory testing are associated with reductions in antimicrobial use, and low-strength evidence that other stewardship interventions are associated with improved prescribing. Patient-centered outcomes, which were infrequently reported, were not adversely affected. Medication costs were generally lower with stewardship interventions, but overall program costs were rarely reported. No studies reported microbial outcomes, and data regarding outpatient settings other than primary care clinics are limited.ConclusionsLow- to moderate-strength evidence suggests that antimicrobial stewardship programs in outpatient settings improve antimicrobial prescribing without adversely effecting patient outcomes. Effectiveness depends on program type. Most studies were not designed to measure patient or resistance outcomes. Data regarding sustainability and scalability of interventions are limited.Infect Control Hosp Epidemiol 2014;00(0):1–11

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M’ikanatha, Nkuchia M., Sameh W. Boktor, Arlene Seid, Allen R. Kunselman, and Jennifer H. Han. "Implementation of antimicrobial stewardship and infection prevention and control practices in long-term care facilities—Pennsylvania, 2017." Infection Control & Hospital Epidemiology 40, no. 6 (2019): 713–16. http://dx.doi.org/10.1017/ice.2019.80.

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AbstractIn 2017, we surveyed long-term care facilities in Pennsylvania regarding antimicrobial stewardship and infection prevention and control (IPC) practices. Among 244 responding facilities, 93% had IPC programs and 47% had antimicrobial stewardship programs. There was significant variation in practices across facilities, and a number of program implementation challenges were identified.

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Sick, Anna C., Christoph U. Lehmann, Pranita D. Tamma, Carlton K. K. Lee, and Allison L. Agwu. "Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program." Infection Control & Hospital Epidemiology 34, no. 6 (2013): 573–80. http://dx.doi.org/10.1086/670625.

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Objective.To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.Design.Retrospective cohort study and cost analysis.Methods.Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.Results.Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.Conclusions.A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

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Cosgrove, Sara E., Elizabeth D. Hermsen, Michael J. Rybak, Thomas M. File, Sarah K. Parker, and Tamar F. Barlam. "Guidance for the Knowledge and Skills Required for Antimicrobial Stewardship Leaders." Infection Control & Hospital Epidemiology 35, no. 12 (2014): 1444–51. http://dx.doi.org/10.1086/678592.

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Antimicrobial stewardship programs are increasingly recognized as critical in optimizing the use of antimicrobials. Consequently, more physicians, pharmacists, and other healthcare providers are developing and implementing such programs in a variety of healthcare settings. The purpose of this guidance document is to outline the knowledge and skills that are needed to lead an antimicrobial stewardship program. It was developed by antimicrobial stewardship experts from organizations that are engaged in advancing the field of antimicrobial stewardship.Infect Control Hosp Epidemiol 2014;35(12):1444–1451

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Ahmed, Abdullah Akhtar. "Call to Start Antimicrobial Stewardship Program." KYAMC Journal 12, no. 1 (2021): 1–2. http://dx.doi.org/10.3329/kyamcj.v12i1.53358.

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Traynor, Kate. "Antiretroviral stewardship program reduces drug errors." American Journal of Health-System Pharmacy 70, no. 22 (2013): 1964–65. http://dx.doi.org/10.2146/news130075.

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Probst, Varvara, Florinda Islamovic, and Ayesha Mirza. "Antimicrobial stewardship program in pediatric medicine." Pediatric Investigation 5, no. 3 (2021): 229–38. http://dx.doi.org/10.1002/ped4.12292.

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García-Rodríguez, José Francisco, Belén Bardán-García, Pedro Miguel Juiz-González, Laura Vilariño-Maneiro, Hortensia Álvarez-Díaz, and Ana Mariño-Callejo. "Long-Term Carbapenems Antimicrobial Stewardship Program." Antibiotics 10, no. 1 (2020): 15. http://dx.doi.org/10.3390/antibiotics10010015.

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Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.

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Gaffin, Neil. "Reflections From an Antimicrobial Stewardship Program." Clinical Infectious Diseases 60, no. 10 (2015): 1588–89. http://dx.doi.org/10.1093/cid/civ073.

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EVANS, JEFF. "Stewardship Program Explores Antimicrobial Use, Resistance." Skin & Allergy News 39, no. 9 (2008): 49. http://dx.doi.org/10.1016/s0037-6337(08)70688-0.

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Huang, Hsin-Ying, Hsiao-Ching Lin, and Agnes L. F. Chan. "Pharmacists in an antimicrobial stewardship program." Journal of Microbiology, Immunology and Infection 48, no. 2 (2015): S63—S64. http://dx.doi.org/10.1016/j.jmii.2015.02.223.

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Lin, Wen-Liang, Wen-Chien Ko, Pheng-Ying Yeh, Hui-Jen Chang, and Ching-Chuan Liu. "Antifungal consumption under antibiotic stewardship program." Journal of Microbiology, Immunology and Infection 48, no. 2 (2015): S124. http://dx.doi.org/10.1016/j.jmii.2015.02.437.

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Nichols, Kristen, Sylvia Stoffella, Rachel Meyers, and Jennifer Girotto. "Pediatric Antimicrobial Stewardship Programs." Journal of Pediatric Pharmacology and Therapeutics 22, no. 1 (2017): 77–80. http://dx.doi.org/10.5863/1551-6776-22.1.77.

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The frequent use of antimicrobials in pediatric patients has led to a significant increase in multidrug-resistant bacterial infections among children. Antimicrobial stewardship programs have been created in many hospitals in an effort to curtail and optimize the use of antibiotics. Pediatric-focused programs are necessary because of the differences in antimicrobial need and use among this patient population, unique considerations and dosing, vulnerability for resistance due to a lifetime of antibiotic exposure, and the increased risk of adverse events. This paper serves as a position statement of the Pediatric Pharmacy Advocacy Group (PPAG) who supports the implementation of antimicrobial stewardship programs for all pediatric patients. PPAG also believes that a pediatric pharmacy specialist should be included as part of that program and that services be covered by managed care organizations and government insurance entities. PPAG also recommends that states create legislation similar to that in existence in California and Missouri and that a federal Task Force for Combating Antibiotic-Resistant Bacteria be permanently established. PPAG also supports post-doctoral pharmacy training programs in antibiotic stewardship.

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D’Agata, Erika M. C., Curt C. Lindberg, Claire M. Lindberg, et al. "The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities." Infection Control & Hospital Epidemiology 39, no. 12 (2018): 1400–1405. http://dx.doi.org/10.1017/ice.2018.237.

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AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

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Gupta, YK, Shakti Kumar Gupta, Madhav Madhusudan Singh, DK Sharma, and Aarti Kapil. "To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center." International Journal of Research Foundation of Hospital and Healthcare Administration 3, no. 1 (2015): 13–24. http://dx.doi.org/10.5005/jp-journals-10035-1031.

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ABSTRACT Introduction As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects. Aim To study the antimicrobial stewardship program in a large tertiary care teaching center. Objectives • To study the antibiotic prescribing practices in a tertiary care government hospital • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital • To make recommendation if any for rational use of antibiotics. Materials and methods • Review of literature • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients. • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients. • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription. • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program. Results The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices. Conclusion Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used. How to cite this article Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

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Reddy Kasarla, Rajeshwar, Sidhy Choudhary, Aishwarya Verma, Ritesh Sharma, and Laxmi Pathak. "Get Smart in Healthcare to Preserve the Power of Antimicrobials: Antimicrobial Stewardship." Medical Journal of Eastern Nepal 3, no. 01 (2024): 41–49. http://dx.doi.org/10.3126/mjen.v3i01.67449.

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Antimicrobial resistance is one of the alarming health hazard to mankind. Unnecessary antibiotic usage leads to drug resistance, predisposes to opportunistic infections in immunodeficient and unnecessary economical loss to patient. This manuscript compiles & describes how crucial is Antimicrobial stewardship programs recommendations, strategies and implementation. Awareness and execution of institutional stewardship programs leads to better patient management, halt development of drug resistance and spread of resistant strains. This review is undertaken with an aim to discuss the development of an effective antimicrobial stewardship program and the key components and operating principles, and execution of these programs at healthcare facilities.

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Pollack, Lori A., Diamantis Plachouras, Ronda Sinkowitz-Cochran, Heidi Gruhler, Dominique L. Monnet, and J. Todd Weber. "A Concise Set of Structure and Process Indicators to Assess and Compare Antimicrobial Stewardship Programs Among EU and US Hospitals: Results From a Multinational Expert Panel." Infection Control & Hospital Epidemiology 37, no. 10 (2016): 1201–11. http://dx.doi.org/10.1017/ice.2016.115.

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OBJECTIVESTo develop common indicators, relevant to both EU member states and the United States, that characterize and allow for meaningful comparison of antimicrobial stewardship programs among different countries and healthcare systems.DESIGNModified Delphi process.PARTICIPANTSA multinational panel of 20 experts in antimicrobial stewardship.METHODSPotential indicators were rated on the perceived feasibility to implement and measure each indicator and clinical importance for optimizing appropriate antimicrobial prescribing.RESULTSThe outcome was a set of 33 indicators developed to characterize the infrastructure and activities of hospital antimicrobial stewardship programs. Among them 17 indicators were considered essential to characterize an antimicrobial stewardship program and therefore were included in a core set of indicators. The remaining 16 indicators were considered optional indicators and included in a supplemental set.CONCLUSIONSThe integration of these indicators in public health surveillance and special studies will lead to a better understanding of best practices in antimicrobial stewardship. Additionally, future studies can explore the association of hospital antimicrobial stewardship programs to antimicrobial use and resistance.Infect Control Hosp Epidemiol 2016:1–11

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Chiotos, Kathleen, Clare Rock, Marin L. Schweizer, et al. "Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN)." Infection Control & Hospital Epidemiology 40, no. 9 (2019): 1046–49. http://dx.doi.org/10.1017/ice.2019.172.

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AbstractWe used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.

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Padron, Maria, and Marta A. Miyares. "Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution." Journal of Pharmacy Practice 28, no. 1 (2013): 93–98. http://dx.doi.org/10.1177/0897190013514091.

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Pharmacist-directed anticoagulation management services (AMSs) have been shown to significantly lower anticoagulation-related mortality, length of hospital stay, bleeding complications, blood transfusion requirements, and cost of therapy. AMSs are only 1 component of an anticoagulation stewardship program. Frequently, stewardship programs are limited to inpatient populations. Incorporating components that facilitate transition to outpatient status will ideally encompass complete care. The purpose of this program was to expand anticoagulation services and standardize care by implementing a full-service stewardship program including a transition of care service. The first component of the study involved medication surveillance for inpatients on anticoagulation therapy. The second component involved transitioning patients on anticoagulation, primarily with venous thromboembolism (VTE) to outpatient management. Finally, the pharmacist identified areas for optimization. Optimization involved developing or updating protocols to reflect updates in the literature as well as updating institution-specific information resources. Interventions made through medication surveillance and utilization of the VTE transition of care services translated into a total cost savings of approximately US$270 320. A postgraduate, first-year pharmacy resident contributed to improving patient outcomes while reducing utilization of hospital services and obtaining substantial cost savings through participation in anticoagulation stewardship services.

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Wilson, Brigid M., Richard E. Banks, Christopher J. Crnich, et al. "Changes in antibiotic use following implementation of a telehealth stewardship pilot program." Infection Control & Hospital Epidemiology 40, no. 7 (2019): 810–14. http://dx.doi.org/10.1017/ice.2019.128.

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AbstractStarting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

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Upitis, Rena, Scott Hughes, and Anna Peterson. "Promoting Environmental Stewardship through gardens: A case study of children’s views of an urban school garden." Journal of the Canadian Association for Curriculum Studies 11, no. 1 (2013): 92–135. http://dx.doi.org/10.25071/1916-4467.36544.

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Fostering children’s relationships with nature to develop their sense of environmental stewardship is an important means for redressing damage to the planet caused by human consumption and our collective failure to connect with the natural world. School garden programs provide a potentially meaningful way to promote children’s sense of connection to nature. This paper describes findings from an 8-month qualitative study investigating how a school garden program at one public elementary school in southeastern Ontario promoted the students’ sense of environmental stewardship. Data collected from eight students through observations, semi-structured interviews, and students’ photographs identified five broad themes associated with enhancing environmental stewardship for children (including connecting with nature, caretaking, and harvesting) as well as three broad themes that help explain the long-term success of the venture (including parental involvement and community connections). The discussion highlights some of the benefits of the school garden program, as well as some of the difficulties associated with the program and limitations of the study.

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Kuper, Kristi M., Jerod L. Nagel, Jarrod W. Kile, Larissa S. May, and Francesca M. Lee. "The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs." Infection Control & Hospital Epidemiology 40, no. 05 (2019): 501–11. http://dx.doi.org/10.1017/ice.2019.51.

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AbstractIncreasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

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Drew, Richard H. "Antimicrobial Stewardship Programs: How to Start and Steer a Successful Program." Journal of Managed Care Pharmacy 15, no. 2 Supp A (2009): 18–23. http://dx.doi.org/10.18553/jmcp.2009.15.s2.18.

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Bleasdale, Susan C., Marsha Barnden, and Sue Barnes. "The Impact of Antibiotic Stewardship Program Resources on Infection Prevention Programs." Clinical Infectious Diseases 69, no. 3 (2018): 552–53. http://dx.doi.org/10.1093/cid/ciy986.

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AbstractDoernberg and colleagues describe the role and resourcing of the infectious disease (ID) physician for an effective hospital-based antibiotic stewardship program (ASP). There are similar resource requirements for the ID physician leader in an effective infection prevention (IP) program. This ID physician partnership is supported by professional organizations and predates the imperative of ID physician leadership in ASP. There are regulatory requirements for established IP programs, but they do not specify leadership structure to the same degree as ASP regulations. The Centers for Medicare and Medicaid and The Joint Commission have specified the inclusion of an ID-trained physician leader in ASP, and this has led to the development of curriculum to train more ASP physicians. More robust advocacy may ensure a similar regulatory mandate supporting the participation of ID-trained physicians in IP programs. This may encourage the development of a curriculum to meet the workforce.

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Ghafoor, Virginia L., Pamela Phelps, and John Pastor. "Implementation of a pain medication stewardship program." American Journal of Health-System Pharmacy 70, no. 23 (2013): 2070–75. http://dx.doi.org/10.2146/ajhp120751.

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Nagao, Miki. "3) Infection Prevention and Antimicrobial Stewardship Program." Nihon Naika Gakkai Zasshi 108, Suppl (2019): 135b. http://dx.doi.org/10.2169/naika.108.135b.

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Nagao, Miki. "3) Infection Prevention and Antimicrobial Stewardship Program." Nihon Naika Gakkai Zasshi 108, no. 9 (2019): 1815–19. http://dx.doi.org/10.2169/naika.108.1815.

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Barreveld, Antje M., Robert J. McCarthy, Nabil Elkassabany, et al. "Opioid Stewardship Program and Postoperative Adverse Events." Anesthesiology 132, no. 6 (2020): 1558–68. http://dx.doi.org/10.1097/aln.0000000000003238.

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Abstract Background A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals. Methods Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals. Results Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals. Conclusions A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Bio, Laura L., Jenna F. Kruger, Betty P. Lee, Matthew S. Wood, and Hayden T. Schwenk. "Predictors of Antimicrobial Stewardship Program Recommendation Disagreement." Infection Control & Hospital Epidemiology 39, no. 07 (2018): 806–13. http://dx.doi.org/10.1017/ice.2018.85.

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OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children’s hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.RESULTSIn total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99–15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08–18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92–19.77), or had been admitted for 31–90 days at the time of the audit (OR, 2.08; 95% CI, 1.36–3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01–1.04).CONCLUSIONSEvaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.Infect Control Hosp Epidemiol 2018;806–813

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Chang, Shan-Chwen. "Antimicrobial stewardship program in hospitals: Taiwan experience." Journal of Microbiology, Immunology and Infection 48, no. 2 (2015): S6. http://dx.doi.org/10.1016/j.jmii.2015.02.013.

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Lustig, A., S. Kerekesh, R. Leibowitz, et al. "Process Measures of an Antimicrobial Stewardship Program." Clinical Therapeutics 37, no. 8 (2015): e34. http://dx.doi.org/10.1016/j.clinthera.2015.05.106.

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Al-Khatib, Naser, Brenda Cholin, and John Moraros. "ANTIBIOTIC STEWARDSHIP PROGRAM; CONTEXTUAL ENVIRONMENT AND FRAMEWORK." Journal of Epidemiology and Community Health 67, no. 10 (2013): e2.16-e2. http://dx.doi.org/10.1136/jech-2013-203098.5.

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