When it comes to antibiotics, the Centers for Disease Control and Prevention is urging providers to take a less-is-more approach.
Less is more
CDC tracking system takes aim at antibiotic use
The CDC has launched two new antibiotics-related initiatives aimed at helping hospitals understand how they're using the drugs and how they can use them less.
First, the agency unveiled a new electronic monitoring system that will allow hospitals to track their antibiotic use in real time, compare data with other providers, and understand how they can curb inappropriate use. The module is part of the CDC's National Healthcare Safety Network, a secure, online system that uses data submitted by hospitals to monitor infections and guide prevention efforts.
The CDC also collaborated with the Cambridge, Mass.-based Institute for Healthcare Improvement to establish a pilot program intended to identify best practices for antibiotic use in hospitals.
The CDC estimates that more than half of antibiotics are prescribed unnecessarily, and misuse and overuse are fueling the growth of drug-resistant bacteria. And with few new antibiotics coming down the pipeline, the situation is becoming increasingly dire, said Dr. Arjun Srinivasan, head of the CDC's Get Smart About Healthcare program.
“The threat of untreatable infections is real,” Srinivasan said in a news release about the tracking system. “Although previously unthinkable, the day when antibiotics don't work in all situations is upon us.”
The agency says it is working with vendors of electronic medication administration records and bar coding systems to ensure they build NHSN compatibility into their products, Srinivasan said in an interview. Once those capabilities are in place, NHSN-participating hospitals—now numbering more than 4,800—will be able to use their electronic pharmacy systems to access the antibiotic tracking module.
“Many hospitals don't have those eMAR or bar coding systems yet, but it is the direction that the field is moving in,” Srinivasan said, adding that the tracking tool will become “more and more useful over time.”
The goal of the CDC's pilot project with IHI is to test theories about antimicrobial stewardship on a small scale and then use the results to carry out larger-scale pilot projects in the future, according to Diane Jacobsen, an IHI director. “Clinical theory and expertise is one piece, but that doesn't tell us how feasible and practical these steps are in the real world, and what we may be missing,” Jacobsen said.
Eight hospitals, representing a range of care settings, were chosen to participate in the eight-month pilot. Each hospital chose one or two target areas, such as timely antibiotic maintenance and de-escalation.
“The delivery and use of antibiotics in hospitals is very complex,” Srinivasan said. “The only way to make it easier is to break it down into discrete steps and show practical interventions for each one. That's what this project does.”
Community Hospital, Tallassee, Ala., was one of the hospitals selected for the pilot. Officials at the 69-bed hospital had worked with IHI in the past and jumped at the chance to take part, said Heather Johnson, clinical quality officer and infection preventionist at the hospital.
“We are a small, independent community hospital, so it really helps us to be able to partner with larger hospitals that have more resources,” Johnson said. “For us, it was a great opportunity.”
Other participating hospitals include 307-bed Rogue Valley Medical Center, Medford, Ore., and 456-bed Ronald Reagan UCLA Medical Center, Los Angeles.
Both initiatives were announced in conjunction with the CDC's fourth annual Get Smart About Antibiotics Week, which ran Nov. 14-20. While past campaigns have mainly targeted primary-care physicians and inpatient hospitals, this year the CDC also reached out to nursing homes and other long-term-care settings, Srinivasan said.
As many as 70% of long-term-care facility residents receive antibiotics at least once a year, according to CDC data, making them among the most prescribed type of drugs in those settings.
“A broader perspective is the key to preventing these infections from developing and moving from facility to facility,” said Russell Olmsted, an epidemiologist at St. Joseph Mercy Health System, Ann Arbor, Mich., and president of the Association for Professionals in Infection Control and Epidemiology, one of the CDC's partners in its Get Smart programs. “Antibiotic stewardship is everyone's responsibility, and we need to look at it from all of the points of care.”
Other organizations also used the occasion to generate publicity for research documenting the incidence and dangers of misusing and overusing antibiotics. The Washington-based Center for Disease Dynamics, Economics & Policy released research pointing to the Southeast as the region of the U.S. with the highest rates of outpatient antibiotic overuse. And online journal BMJ Open published a paper describing a drug-resistance indexing tool that can be used to monitor changes in antibiotic effectiveness over time.
Clustering announcements and events in a one-week span is a good way to build momentum and raise awareness, especially because providers have such a long list of quality and safety priorities, Srinivasan said. “Oftentimes taking a moment to emphasize the importance of an issue can really jump-start the process of making it part of overall care,” he said. “But ultimately, this is not something we want to be done just one week a year.”
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