ANTIBIOTIC Stewardship ProgramESSENTIAL LEARNING FOR MEDICAL GRADUATES

1. ANTIBIOTIC Stewardship Program
ESSENTIAL LEARNING FOR MEDICAL GRADUATES
Dr.T.V.Rao MD
7/5/2017 Dr.T.V.Rao MD @gmail.com 1

2. WHY WE NEED ANTIBIOTIC STEWARDSHIP
• Antimicrobial resistance is
increasing; however,
antimicrobial drug development
is slowing. Now more than ever
before, antimicrobial
stewardship is of the utmost
importance as a way to optimize
the use of antimicrobials to
prevent the development of
resistance and improve patient
outcomes.
7/5/2017 Dr.T.V.Rao MD @gmail.com 2

3. Antibiotic Resistance is a emerging challenges in human care –
Making the matters understand need a coordinated approach
THE COMPONETNS INCLUDE ATTENTION
•Antimicrobial Stewardship (AS)
•The components of a high functioning AS program
•Why infection prevention is essential to efforts to
improve AS
•Ways in which Infection Perfectionists (IPs) can
collaborate with key stakeholders to improve AS
efforts despite the degree of implementation of the
program
7/5/2017 Dr.T.V.Rao MD @gmail.com 3

4. ➔ Misuse and over-use
of antibiotics
• The last 50 years have witnessed
the golden age of antibiotic
discovery and their widespread
use in hospital and community
settings. Regarded as very
effective, safe and relatively
inexpensive, antibiotics have
saved millions of lives. However,
this has led to their misuse
through huse without a
prescription and overuse for self-
limiting infections
7/5/2017 Dr.T.V.Rao MD @gmail.com 4

5. Combating antimicrobial resistance
• To overcome the threat of antimicrobial resistance, a
three-pillar
• approach has been advocated:
• 1 Optimise the use of existing antimicrobial agents
• 2 Prevent the transmission of drug-resistant
organisms through
• infection control
• 3 Improve environmental decontamination
7/5/2017 Dr.T.V.Rao MD @gmail.com 5

6. “Need for Antimicrobial stewardship:
• is an inter-professional effort, across
• the continuum of care
• ➤ involves timely and optimal selection, dose and
• duration of an antimicrobial
• ➤ for the best clinical outcome for the treatment or
• prevention of infection
• ➤ with minimal toxicity to the patient
• ➤ and minimal impact on resistance and other
• ecological adverse events such as C. difficile”
7/5/2017 Dr.T.V.Rao MD @gmail.com 6

7. The greater Initiation to
stop the misuse of
Antibiotics
• Hospitals today straggle the
demands of increasing
regulation, changing
technology requirements,
more stringent reporting
requirements and a rising
number of quality initiatives
in an already challenging
economic environment.
7/5/2017 Dr.T.V.Rao MD @gmail.com 7

8. Need for Antibiotic
Steward ship
• With competition for
time, attention and
financial resources, why
does your hospital need
an antimicrobial
stewardship program
(ASP)?7/5/2017 Dr.T.V.Rao MD @gmail.com 8

9. Overprescribing of
antibiotics wastes
money:
• Worldwide monitoring
shows an alarming
increase in antibiotics
prescriptions, often for
conditions that do not
warrant them. In U.S.
hospitals, studies indicate
that up to 50% of
antibiotic prescriptions
are inappropriate.
7/5/2017 Dr.T.V.Rao MD @gmail.com 9

10. Inappropriate
Treatments costs
life and economy
• Not only are those
inappropriate
prescriptions
dangerous, they drive
up costs for hospitals,
payers and patients. In
fact, overuse and
inappropriate use of
antibiotics costs the
healthcare system
7/5/2017 Dr.T.V.Rao MD @gmail.com 10

11. Inappropriate use of
antibiotics increases
resistance in infectious
organisms:
• The improper use of
antibiotics directly
contributes to the rising
number of strains of
multidrug resistant
organisms (MDROs) in
communities across the
country, posing a
significant risk to patient
health.
7/5/2017 Dr.T.V.Rao MD @gmail.com 11

12. Poor prescribing
practices endanger
patients
• Receiving a broad-
spectrum antibiotic
triples a patient’s
subsequent risk of
infection with a more
resistant organism,
according to the
Centers for Disease
Control and
Prevention (CDC).
7/5/2017 Dr.T.V.Rao MD @gmail.com 12

13. 7/5/2017 Dr.T.V.Rao MD @gmail.com 13

14. 7/5/2017 Dr.T.V.Rao MD @gmail.com 14

15. MDROs increase morbidity and mortality
• Infections lead to more
than eight million
additional hospital days
and are responsible for
23,000 deaths each year.
According to the CDC,
improved antibiotic
prescription reduces rates
of MDROs in hospitals and
improves clinical outcomes
for patients.
7/5/2017 Dr.T.V.Rao MD @gmail.com 15

16. MDROs increase
hospital costs:
• Approximately 70% of healthcare
associated infections (HAIs) involve
organisms resistant to at least one drug. As
Medicare and other payers do not
reimburse for HAIs, every hospital has a
significant interest in reducing the number
of MDROs present in the facility and in the
broader community
7/5/2017 Dr.T.V.Rao MD @gmail.com 16

17. Few new antibiotics
are in development:
• In the last 20 years, the number of
antibiotics in development has
dropped sharply. Since 2008,
pharmaceutical companies have
introduced four new antibiotics,
compared to 16 approved from 1983 to
1987—and no new classes of
antibiotics to treat gram-negative
bacilli have been released in more than
40 years.
7/5/2017 Dr.T.V.Rao MD @gmail.com 17

18. How stewardship program helps
• Consequently, hospitals must do
everything possible to maintain
the efficacy and extend the useful
life of the antibiotics currently
available. An antimicrobial
stewardship program helps ensure
that the narrowest spectrum
antimicrobial known to be
effective is used for each infection,
reducing the development of
resistant strains.
7/5/2017 Dr.T.V.Rao MD @gmail.com 18

19. Point-of-care interventions can include:
• appropriate use of guidance,
• ➤ indication for antibiotic,
• ➤ choice of agent,
• ➤ route [IV vs. oral] of administration of treatment,
• ➤ timeliness of treatment,
• ➤ likelihood of on-going infection or not,
• ➤ use of investigation,
• ➤ interpretation of microbiology with a view tode-escalation or stopping
therapy,
• ➤ duration of therapy.
7/5/2017 Dr.T.V.Rao MD @gmail.com 19

20. Data collection for quality
improvement
• Antimicrobial stewardship is part of many patient safety
programs. To measure the performance of these programs, data is
primarily used for 3 purposes [Solberg et al., 1997]:
• l Accountability (e.g. targets)
• l Improvement
• l Research.
• A range of such measures for antimicrobial stewardship programs
have been proposed. They can be summarized as four types
structural, process, outcomes and balancing (are the changes
causing new problems?)
7/5/2017 Dr.T.V.Rao MD @gmail.com 20

21. . Who should receive education
in hospitals?
• Prescribers and other healthcare staff with modules
adapted to their background including:
• l Undergraduate curriculum
• l Internship
• l Professional training for new staff
• l Continuing professional development for all
prescribers
• l Postgraduate education
7/5/2017 Dr.T.V.Rao MD @gmail.com 21

22. The content of education should be adapted to each
profession
and include
• Basic knowledge of infection management,
• l Basic microbiology
• l Importance of prudent prescribing in tackling
antimicrobial resistance.
• l Best practices for prescribing to support safe and effective
prescribing, administration and monitoring of antimicrobial
therapy.
• The training is usually delivered by the antimicrobial
management team and may include competency
assessment
7/5/2017 Dr.T.V.Rao MD @gmail.com 22

23. THE KEYS TO
SUCCESS
• A number of interventions
are key to the success of a
hospital-based Antimicrobial
Stewardship Program.
• ➤ Establish a clear
aim/vision that is shared by
all the stakeholders and that
conveys a sense of urgency.
• Stewardship should be a
patient safety priority.
7/5/2017 Dr.T.V.Rao MD @gmail.com 23

24. THE KEYS TO
SUCCESS
• Seek management
support, accountability
and secure funding.
• ➤ Assemble a strong
coalition including a
multi-professional
antimicrobial
stewardship team with a
strong influential clinical
leader.
7/5/2017 Dr.T.V.Rao MD @gmail.com 24

25. THE KEYS TO
SUCCESS
• Establish effective
communication structures
within your hospital.
• ➤ Start with core evidence-
based stewardship
interventions depending on
local needs, geography and
resources and plan
measurement to demonstrate
their impact.
7/5/2017 Dr.T.V.Rao MD @gmail.com 25

26. THE KEYS TO SUCCESS
• Ensure all healthcare
staff are aware of the
importance of
stewardship. Empower
them to act and support
with education using a
range of effective
strategies.
• ➤ Ensure early or short
term wins and then
consolidate
success/gains while
progressing with more
change or innovation.
7/5/2017 Dr.T.V.Rao MD @gmail.com 26

27. 7/5/2017 Dr.T.V.Rao MD @gmail.com 27

28. References
• Why Your Hospital Needs an Antimicrobial Stewardship Program
Pharmacy OneSource Blog
• Practical Guide TO ANTIMICROBIAL STEWARDSHIP IN HOSPITALS
BioMérieux
7/5/2017 Dr.T.V.Rao MD @gmail.com 28

29. •Program Created by Dr.T.V.Rao MD for benefit of
Medical and Paramedical Professionals on Universal
education on Antibiotic Stewardship
• Email.com
• doctortvrao@gmail.com
7/5/2017 Dr.T.V.Rao MD @gmail.com 29