Stewardship / Resistance Scan for Aug 23, 2019

Better nursing home stewardship
New antimicrobial resistance coalition
Single-patient hospital rooms

Survey finds improved antibiotic stewardship programs in nursing homes

A national survey has found that antibiotic stewardship programs (ASPs) in US nursing homes have become more comprehensive since the Centers for Medicare and Medicaid (CMS) required the facilities to have them, researchers from Columbia University School of Nursing reported yesterday in the American Journal of Infection Control.

In the nationally representative survey, conducted in 2018, ASP comprehensiveness was defined by the number of policies, based on the Centers for Disease Control and Prevention's core stewardship elements, that nursing home staff reported having in place. Those reporting six or more policies were defined as "comprehensive," while those with four to five in place were defined as "moderately comprehensive," and those with three or fewer were labeled "not comprehensive."

The survey also asked about infection preventionist (IP) training and certification; on-site staffing of advanced practice registered nurses, physician assistants, and pharmacists; and involvement in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) initiatives.

Of 861 nursing homes that completed the survey, 33.2% had "comprehensive" ASP policies, 41.1% had "moderately comprehensive" ASP policies, and 25.6% had "not comprehensive" ASP policies. Overall, the rates of inclusion of specific policies ranged from 19.0% for restriction of specific antibiotics to 91.4% for data collection on antibiotic use, with 65.7% reporting use of antibiotic prescribing guidelines. Forty-six percent of nursing homes reported that their IP had no specific infection control training. Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy.

A 2013-2014 national survey found that only 51% of CMS-certified nursing homes collected antibiotic use data, and 46% had written guidelines for antibiotic initiation. In November 2017, CMS finalized a rule requiring nursing homes to have an ASP in order to receive Medicare and Medicaid payments.

"ASPs in NHs [nursing homes] are showing signs of increased comprehensiveness as indicated by the inclusion of more policies since the implementation of the CMS Final Rule," the authors of the study conclude. "Certain policies may be more easily adopted, whereas others may require more intensive efforts."
Aug 22 Am J Infect Control study


Biotech organization to lead new antimicrobial resistance coalition

The Biotechnology Innovation Organization (BIO) this week announced the launch of a new coalition to raise public awareness of antimicrobial resistance (AMR) and advocate for policies to stimulate new antibiotic development.

The "Working to Fight AMR" coalition will be led by BIO, a trade organization that represents biotechnology companies and related organizations, and will include scientists, public policy experts, and industry leaders. The group says that, in addition to educating the public, it will advocate for policies like the DISARM Act, which calls for higher Medicare reimbursement for new antibiotics that treat serious or life-threatening infections.

"Antimicrobial resistance already poses a grave threat to human health—and it is a looming public health emergency," Greg Frank, PhD, BIO's director of infectious disease policy, said in a press release. "Working to Fight AMR will advocate for policies to boost investment in this deeply neglected area."
Aug 21 Working to Fight AMR press release


Move to single-bed hospital rooms linked to less MRSA, VRA colonization

A Montreal hospital's move to single-patient rooms was associated with reduced colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), along with fewer VRE infections, Canadian researchers reported in JAMA Internal Medicine. But no change in MRSA infection or Clostridioides difficile infection (CDI) was found.

The time-series analysis compared institution-level rates of new multidrug-resistant organism colonization and healthcare-associated infections at Montreal's Royal Victoria Hospital before and after patients were moved to a newly constructed hospital on Apr 26, 2015. The original hospital, built in 1893, was a mix of three- and four-bed ward rooms and single rooms; the new building consisted entirely of single-bed rooms with individual toilets and showers and easy access to sinks for hand washing.

Compared with the 27 months before the hospital move, the analysis found during the 36 months after the move an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonization events; incidence rate ratio [IRR], 0.25; 95% confidence interval [CI], 0.19 to 0.34) and MRSA colonization (from 129 to 112 colonization events; IRR, 0.57; 95% CI, 0.33 to 0.96), as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12 to 0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51 to 1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34 to 2.29) did not decrease.

"The changes in VRE and MRSA colonization appeared to be temporally associated with the move with an immediate apparent difference and no subsequent return to historical levels," researchers from McGill University write. "This reduction occurred despite demographic changes that increased the high-risk tertiary care population, notably in hematology-oncology, complex surgery, and severe, end-stage respiratory diseases."

The researchers note that while their study could not account for other infection control and antimicrobial stewardship interventions that were going on simultaneously at the hospital, they believe the findings support the concept that moving to single-bed facilities could reduce the transmission of specific multidrug-resistant organisms.
Aug 19 JAMA Internal Med study

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