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6 results

  • Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry
  • Eva M. Amenta, Robin L.P. Jump, Barbara W. Trautner
  • Journal: Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue 1 / 2023
  • Published online by Cambridge University Press: 09 January 2023, e4
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  • View abstract

    The evidence base for refraining from screening for or treating asymptomatic bacteriuria (ASB) in older adults is strong, but both practices remain prevalent. Clinical confusion over how to respond to a change from baseline, when to order a urinalysis and urine culture, and what to do with a positive urine culture fuels unnecessary antibiotic use for ASB. If the provider can take a mindful pause to apply evidenced-based assessment tools, the resulting increased clarity in how to manage the situation can reduce overtreatment of ASB.

  • A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers
  • Lauren D. Stevenson, Richard E. Banks, Krysttel C. Stryczek, Christopher J. Crnich, Emma M. Ide, Brigid M. Wilson, Roberto A. Viau, Sherry L. Ball, Robin L.P. Jump
  • Journal: Infection Control & Hospital Epidemiology / Volume 39 / Issue 10 / October 2018
  • Published online by Cambridge University Press: 06 September 2018, pp. 1163-1169
  • Print publication: October 2018
  • View abstract
    Objective

    To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.

    Design

    A prospective quasi-experimental pilot study.

    Setting

    Two rural VAMCs with acute-care and long-term care units.

    Intervention

    At each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.

    Methods

    Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.

    Results

    Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.

    Conclusions

    This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.