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Management of Infection > Lecture 24 - Antimicrobial Stewardship > Flashcards

Lecture 24 - Antimicrobial Stewardship Flashcards

1
Q

What is antimicrobial stewardship?

A

taking care of antibiotics

programme of activities to improve how we use antibiotics in hospitals and community settings

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2
Q

What is a priority in healthcare?

A

reducing HAI

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3
Q

What interventions are there to reduce HAI?

A

infection control, antimicrobial stewardship, maintenance of buildings, education of staff and the public

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4
Q

What is antimicrobial stewardship part of?

A

the healthcare associated infection agenda

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5
Q

What is a HAI?

A

infection starting after 48 hours in hospital and can affect any part of the body

infection resulting from medical care or treatment in hospital, care homes, patients own home

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6
Q

What patients are at risk of HAI?

A

elderly

prolonged admission

recent prolonged admission

ICU/HDU

invasive procedures

broad spectrum antibiotics

co-morbidity

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7
Q

What are the important HAIs?

A

MRSA/S aureus

multiresistant gram negative

C difficile

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8
Q

When does the onset of C difficile occur?

A

after antibiotic therapy

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9
Q

What are the drugs most implicated in C difficile infection?

A

clindamycin, cephalosporins, quinolones, co-amoxiclav

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10
Q

What patients are most at risk of C difficile infection?

A

patients over 65

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11
Q

Symptoms of C difficile infection?

A

mild watery to severe bloody diarrhoea

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12
Q

How is C difficile transmitted?

A

patient, environment, staff contaminated by spores

spores ingested and produce toxins in lower GI tract which cause colitis

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13
Q

What is the decrease in C difficile due to?

A

having different less virulent strains circulating

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14
Q

What to broad spectrum antibiotics cause?

A

disrupt natural bowel flora allowing pathogenic organisms such as C difficile to flourish

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15
Q

What are less likely to cause C difficile infection?

A

narrow spectrum antibiotics that cause little disruption to the bowel flora

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16
Q

What are some patients with C difficile infection reported?

A

not been exposed to any antibiotics

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17
Q

How to minimise C difficile infection when using antimicrobials?

A

restriction of antibiotics with a high risk of C difficile infection

local antibiotic policies may exclude them

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18
Q

What does there need to be a balance between?

A

effectively treating the current infection and not causing harm in the future to both patient and wider population

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19
Q

Prevention of C difficile infection?

A

standard infection control precautions

antimicrobial stewardship

20
Q

Management of C difficile infection?

A

isolation

medication review - antibiotics, PPIs

severity assessment

oral metronidazole or vanocymin

21
Q

Key elements of antimicrobial stewardship?

A

prescribing guidance

information about antibiotic use and antimicrobial resistance

audit of clinical practice

education of healthcare staff and patients/public

22
Q

What does a point prevalence survey provide?

A

a snapshot of antibiotic use at a given point in time

23
Q

Key information about antimicrobial use?

A

% of patients prescribed an antimicrobial

% IV vs oral

types of infections treated

which antimicrobials being used and in which wards

24
Q

What does a PPS involve?

A

staff collect data from patients medicines charts and notes

data collection tool - paper or online

analysis of data and comparison with previous PPS in same hospital or can compare between hospitals

identify areas for improvement e.g. use of policy antibiotics, use of IV route

25
Q

Compliance audits?

A

quality improvement methodology to review clinical practice in real time

26
Q

What do compliance audits involve?

A

collect and report data on a sample of patients every week or month and feed back data to staff involved in prescribing

27
Q

Key measures for compliance audit?

A

reason for antimicrobial therapy documented in notes

choice of antibiotic compliant with local policy

28
Q

Public education?

A

patients and public have poor knowledge about antibiotics and AMR

need to know about not using antibiotics for coughs, colds and how to manage themselves

also need to know how to take antibiotics when they are prescribed them

29
Q

What does SAGP do?

A

aim is to improve use of antibiotics throughout all health and care settings in scotland

30
Q

How will SAGP do this?

A

reduce unnecessary antibiotic use

ensure antibiotics are used correctly

educate healthcare staff, patients, public about antibiotic use

measure improvement in quantity and quality of antibiotic use and impact on clinical outcoes

reduce harm from antibiotics

31
Q

Specific infection SAGP guidance?

A

neutropenic sepsis

community acquired pneumonia

UTI

staph areus bacteraemia

32
Q

Where are antimicrobial management teams set up?

A

in each health board to oversee antimicrobial use

33
Q

People in antimicrobial management teams?

A

minimum of a doctor, a microbiologist and an antimicrobial pharmacist

34
Q

Where must antimicrobials be prescribed?

A

in hospitals documented on medicine chart or prescription form

in primary care on GP10 prescription

35
Q

Who can prescribe antimicrobials?

A

usually doctors but also nurses, pharmacists etc

36
Q

Who usually administers antimicrobials?

A

nursing staff

37
Q

Who administers antimicrobials in primary care?

A

patients and carers

38
Q

Obstacles to antimicrobial stewardship?

A

physician loss of autonomy

lack of resources

poor IT infrastructure

measure impact is difficult

lack of evidence for some aspects of stewardship

39
Q

How does physician loss of autonomy affect this?

A

resistance of being told what to do

fear of antagonising patients or more senior clinicians

40
Q

How can poor IT infrastructure affect this?

A

electronic prescribing
electronic data capture - audit
antibiotic usage data

41
Q

What does an antimicrobial pharmacist do?

A

develops, reviews and implements policies and guidance

evaluates antimicrobial use data

audits compliance with policy and use of antibiotics

provides education for medical, pharmacy and nursing staff

may have a clinical role

42
Q

Role of the pharmacist - hospital?

A

all medicine charts and prescriptions should be checked for compliance with antimicrobial policy for choice of antibiotic, route, frequency and duration

clinical pharmacists can promote use of policies at ward level and educate other staff

43
Q

How many patients in hospital are prescribed an antibiotic?

A

up to 1/3

44
Q

What is common in hospital pratice?

A

inappropriate use, wrong dosage regimens, penicillin use in allergic patients, prolonged courses, broad spectrum rather than narrow

45
Q

Role of pharmacist - primary care?

A

monitor prescribing of all medicines

identify problems with quantity and quality of antimicrobial prescribing

feedback of prescribing info to prescribers is best way to influence and promote compliance with policy

46
Q

Role of the pharmacist - community?

A

awareness of local antimicrobial prescribing policy

query use of non-policy antibiotics and inappropriate dosage or duration

patient education on self management of minor infections

pharmacy first initiative

provide advice to care homes on antibiotic use in high risk patients

Management of Infection (36 decks)

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