Stewardship / Resistance Scan for Nov 17, 2017

Primary care stewardship
No-touch superbug disinfection
Surgical antimicrobial prescribing

Hong Kong launches antibiotic stewardship efforts

Hong Kong's Centre for Health Protection (CHP) this week launched an Antibiotic Stewardship Program (ASP) in Primary Care and hospital guidelines on multidisciplinary prescribing as two key steps in rolling out the Hong Kong Strategy and Action Plan on Antimicrobial Resistance (AMR).

In a seminar on ASP in primary care and hospital settings to commemorate World Antibiotic Awareness Week, Dr Wong Ka-hing, CHP controller, said, "Optimising the use of antimicrobials is one key in controlling the emergence of AMR," according to a CHP press release. He added that primary care providers "play a pivotal role in tackling the AMR problem, not only by practising rational antibiotics prescription, but also educating and empowering patients on the safe use of antibiotics during clinical encounters." Ka-hing said the launch of the ASP and prescribing guidelines "provides comprehensive and updated clinical guidelines of infections for healthcare professionals in both the community and hospitals."

For the primary care ASP, an advisory group of experts has produced evidence-based guidance for acute pharyngitis (throat inflammation), acute uncomplicated cystitis (bladder inflammation) in women, and simple skin and other soft-tissue infections, with a goal of reducing unnecessary prescriptions. The advisors plan to formulate additional guidelines for other common infections.

The CHP has provided guidance notes on antibiotic use, educational materials for physicians, and other material on its ASP in Primary Care website.

The CHP, in collaboration with hospitals, two universities, and the Hong Kong Medical Association, has updated its hospital prescribing guidelines to make them more useful in reinforcing appropriate antimicrobial use and has added a new section on tuberculosis. The guidelines, interactive medical calculators, and easy-to-read antibiograms are available on a separate website.
Nov 13 Hong Kong CHP news release


Studies show positive effect of no-touch disinfection on C difficile

No-touch disinfection methods may be effective against Clostridium difficile and other AMR bacteria, according to two studies yesterday in Infection Control & Hospital Epidemiology.

In the first paper, Iowa researchers conducted a meta-analysis involving 20 studies that involved either ultraviolet light (UVL; 13 studies) or aerosolized hydrogen peroxide (AHP; 7 studies) to decontaminate hospital rooms.

Their pooled analysis of the UVL studies showed statistically significant reductions in C difficile and vancomycin-resistant enterococci infections but not for methicillin-resistant Staphylococcus aureus (MRSA) or gram-negative multidrug-resistant pathogens. Analysis of AHP data revealed only a statistically nonsignificant drop in C difficile infections.
Nov 16 Infect Control Hosp Epidemiol meta-analysis

In the second study, investigators at University College London Hospitals compared the effects of manual disinfection and of AHP on C difficile contamination at various hospital locations.

Over the course of a year, the team sampled 2,529 sites in 146 rooms and 44 bays. They found C difficile on 131 of 572 surfaces (22.9%) before cleaning, on 105 of 959 surfaces (10.6%) after manual cleaning, and on 43 of 967 surfaces (4.4%) after AHP disinfection. The bacterium persisted most frequently on floor corners (97 of 334; 29.0%) after disinfection.

The researchers also noted that feedback of results did not lead to lower C difficile rates after manual cleaning.
Nov 16 Infect Control Hosp Epidemiol study


Australia survey cites frequent poor surgical antimicrobial prescribing

In another report during World Antibiotic Awareness Week, the Australian Commission on Safety and Quality in Health Care (ACSQHS) released updated data on surgical use of antimicrobials that highlighted up to a 60% rate of inappropriate prescribing, depending on the situation.

Citing 2016 data, the ACSQHS said 50.5% of antimicrobials administered preventively before or during surgery (prophylactic use) were deemed appropriate, while 43.4% had at least one inappropriate prescribing element. When procedural antimicrobials were prescribed, 46.1% were compliant with national guidelines, 8.3% were compliant with local guidelines, and 38.3% were not compliant with any guidelines. The most common reason for inappropriate procedural antimicrobial prescribing (45.7% of the instances) was incorrect timing.

Post-operative antimicrobials, in contrast, were prescribed appropriately 38.7% of the time, whereas 59.9% had at least one inappropriate prescribing element.

The report cites four areas of potential improvement:

  • Documentation of incision time and administration time for antimicrobials
  • Compliance with guidelines for surgical antimicrobial prophylaxis
  • Timing of procedural antimicrobial administration
  • Duration of therapy for post-procedural antimicrobials, when required

The authors of the report conclude, "As the use of antimicrobials for surgical prophylaxis has been demonstrated to be suboptimal, and antimicrobials are used for longer than necessary in this setting, the Commission will continue to work with the Royal Australasian College of Surgeons to develop guidance in this area."
Nov 16 ACSQHS report

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