Stewardship / Resistance Scan for Apr 03, 2019

Metrics for pediatric stewardship
Lack of water, sanitation in hospitals

Paper defines metrics for pediatric antimicrobial stewardship programs

A team of Canadian physicians and pharmacists has identified metrics that can be used to measure the impact of pediatric antimicrobial stewardship programs (ASPs), according to a new paper in Pediatrics.

Using a modified Delphi approach, the team developed two surveys that were sent to experts and stakeholders to establish consensus on metrics for evaluating the processes and outcomes of pediatric ASPs. The metrics were subdivided into four ASP domains: antimicrobial consumption, microbiologic outcomes, clinical outcomes, and process measures.

Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Consensus was defined as more than 75% of survey respondents agreeing that a metric had scientific merit, and selections were finalized with a face-to-face meeting and a third survey.

Overall, 38 participants from 15 pediatric hospitals across Canada completed all three rounds of the Delphi survey. In the domain of antimicrobial consumption, the two selected metrics were days of therapy per 1,000 patient-days and total antimicrobial days. The clinical and process outcomes chosen were 30-day readmission rate and adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers.

"Wide adoption of these pediatric ASP metrics among national and international programs will facilitate international comparative intervention studies," the authors of the paper conclude. "These metrics should be considered when planning the infrastructure necessary to monitor the effectiveness of pediatric ASPs."
Apr 1 Pediatrics article


Report highlights lack of water, sanitation in global healthcare facilities

One in four healthcare facilities around the world lacks consistent access to basic water services, and many lack other services that are crucial to preventing infections and reducing the spread of antimicrobial resistance, according to a report today from the World Health Organization (WHO) and UNICEF.

The report, the first from the WHO/UNICEF on access to water, sanitation, and hygiene (WASH) in healthcare facilities, found that 12% of healthcare facilities globally, used by an estimated 896 million people, had no water service. In addition, 14% had limited water service, meaning they had access to either an improved water source that was off site or did not have water at the time of the survey. A little more than half (55%) of healthcare facilities in least-developed countries (LDCs) had basic water services.

More than one in five healthcare facilities reported having no sanitation service, which translates to more than 1.5 billion people having either no toilets or unimproved toilets (such as pit latrines) at their healthcare facility.

The report also found that one out of six healthcare facilities globally (16%) had no hygiene service, including hand hygiene stations at points of care and soap and water at toilets, and only 27% of facilities in LDCs had basic healthcare waste management.

"Not only does the lack of WASH services in health care facilities compromise patient safety and dignity, it also has the potential to exacerbate the spread of antimicrobial-resistant infections and undermines efforts to improve child and maternal health," WHO Director-General Tedros Adhanom Ghebreyesus, PhD, and UNICEF Executive Director Henrietta Fore, MPA, write in the foreword to the report.

An accompanying "practical steps" report details eight actions governments can take to improve WASH services.
Apr 3 WHO press release
Apr 3 WHO full report
Apr 3 WHO practical steps report

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