What Can ICPs do for stewardship
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1 What Can ICPs do for stewardship Harnessing, THE FORCE of ICPs Dr. Jennifer Grant March 4, 2016
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3 Black hole of resistance C. difficile
4
5 How Did We Get Here?
6 How Did We Get Here? S. pneumoniae, S. aureus Penicillin
7 How Did We Get Here? Penicillin Resistant S. pneumoniae, S. aureus Cephalosporins
8 How Did We Get Here? Cef R S. pneumoniae, MRSA Vancomycin
9 How Did We Get Here? Vanco R S. pneumoniae, VRSA Daptomycin, Linezolid
10 How Did We Get Here?
11 How Did We Get Here?
12 How Did We Get Here?
13 How Did We Get Here?
14 How Did We Get Here?
15 How Did We Get Here?
16 How Did We Get Here?
17 What Can We Do????
18 Stewardship vs. Infection Control Stewardship Making the wisest antibiotic choices for current and future patients Reducing the production of resistant organisms Preventing super infections and adverse events Improving the quality of patient care Infection Control Monitoring epidemiology of infections Preventing the spread of resistant organisms Reducing adverse events related to infection Improving the quality of patient care
19 Stewardship vs. Infection Control Stewardship Making the wisest antibiotic choices for current and future patients Reducing the production of resistant organisms Preventing super infections and adverse events Improving the quality of patient care Infection Control Monitoring epidemiology of infections Preventing the spread of resistant organisms Reducing adverse events related to infection Improving the quality of patient care
20 Our Common Goals Reducing production and spread of resistance Reducing adverse events for patients Reducing nosocomial infections Improving patient care Decreasing costs Improving patient flow
21 Our Different Approaches Personal Protective Equipment Hand Hygiene Surveillance Environmental Cleaning Education
22 Our Different Approaches Guidelines and Treatment pathways Antibiotic restrictions Audit and Feedback Multi-disciplinary teamwork Education
23 What does this look like?
24 Avoid Raw Pork
25 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
26 Decreased Use of Selecting Agents Antibacterial Products More toxic Select for resistance Affect environment Offer little benefit Are more expensive Are heavily advertised Falsely allay fears
27 Decreased Use of Selecting Agents Antibacterial Products More toxic Select for resistance Affect environment Offer little benefit Are more expensive Are heavily advertised Falsely allay fears
28 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
29 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
30 Decreased Use of Antibiotics Standards and monitoring
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32 Decreased use of antibiotics Point Stop or significantly decrease agricultural use Decrease courses, duration or spectrum of therapy Counter-point Decreased food supply, increasing cost Increased risk for patients Easier said than done Solution: Requires change in approach including better hygiene for animals, more oversight and better follow-up and support for prescribers
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34 Know The Latest Guidelines Prescribe the Narrowest Spectrum Drug for the Shortest period of time to treat infections Continuously re-evaluate prescriptions Make use of phone consultation and other support
35 Top 3 Conditions Not to Treat Asymptomatic Bactiuria Most commonly overtreated infection Requires symptoms and positive UA R/O everything before attributing ALC to UTI Viral Respiratory Tract Infections Includes COPD without purulence Chronic wounds No matter how icky if not cellulitis
36 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
37 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
38
39 Animal Husbandry
40 Farm Biosecurity
41 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
42 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
43 Responsible Drug Disposal
44 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
45 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
46 Vaccinate Eligible Patients Pneumococcus Meningococcus Influenza... Are all vaccines that can help prevent resistance
47 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
48 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
49 Hand Washing Nuff said
50 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
51 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
52 What Not to Do Scare patients Stigmatize patients Not address concerns Hospital grade cleaning PPE/precautions at home
53 What Not to Do There is no point in insisting on this: If your clients are doing this:
54 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
55 Where We Can Intervene Decreased Selection Decreased use of selecting agents antibacterials Decreased use of Antibiotics Food Production Courses of Therapy Duration of Therapy Spectrum of therapy Responsible Drug Disposal Decreased Transmission Decreased exposure Food withdrawl times Farm environmental control Vaccinations Hand Washing Normal Hygiene Practices at home Advanced Hygiene in Health care
56 Advanced Hygiene Guidelines for: Office Practice Long Term Care Clinics Home Health Care
57 What Else Can You Do?: Be Active Politically Antimicrobials on farms Local initiatives to reduce antimicrobial use Teach at local schools etc. when possible Make Changes in your Life Use regular soap at home Buy antibiotic free meat Dispose of phamaceuticals responsibly
58 And remember Always Always Always COOK YOUR CHICKEN
59 The End
60 Questions? Discussion
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