Value of hospital antimicrobial stewardship programs [ASPs]:a systematic review

Abstract Background Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range:$2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention

Antibiotics and infusion phlebitis. Clinical and experimental studies.

Intravenous administration of antibiotics is often followed by infusion phlebitis. In this condition are vessel irritation, inflammation and sometimes superficial thrombosis included. In this thesis, the risk for infusion phlebitis for various antibiotics has been evaluated in a clinical study in 550 patients. Various effects of four antibiotics on cultured endothelial cells have also been examined. The aim was to find a simple cytotoxic assay for assessment of the phlebitogenic properties of i.v. antibiotics. In the clinical studies, it was found that patients on treatment with i.v. antibiotics had a doubled risk for infusion phlebitis (odds ratio 2.34). Dicloxacillin, erythromycin, cloxacillin, benzylpenicillin and cefuroxime, in that order, were the antibiotics associated with a higher risk for infusion phlebitis. In pair-wise comparison, dicloxacillin was found to confer a higher risk than cloxacillin. Other significant risk factors were the insertion site of the peripheral venous catheter and patients being 51-60 years. In the experimental studies, dicloxacillin and erythromycin, but not benzylpenicillin or cefuroxime, were found to inhibit DNA-synthesis in endothelial cells. The inhibition was dose dependent and time-related. Antibiotic concentrations and incubation times in the experiments were close to those used in the clinic. Dicloxacillin and erythromycin increased the expression of ICAM-1 in human umbilical vein endothelial cells, a finding with possible implications of the pathogenesis of infusion phlebitis. In conclusion, the concordance of the clinical and experimental studies in this thesis indicates that testing of i.v. antibiotics on endothelial cells is a valid test model for phlebitis predictio

Design for the post-antibiotic era: experiences from a new building for infectious diseases in Malmö, Sweden.

To describe the experience of planning and designing a new facility for infectious diseases in Sweden and to discuss underlying theories relating to infection prevention and evidence-based design

Antibiotics differ in their tendency to cause infusion phlebitis: a prospective observational study.

Intravenous administration of antibiotics is a known risk factor for infusion phlebitis. We have previously demonstrated differences in cell toxicity for 4 antibiotics. Clinical experience indicates that antibiotics differ in their tendency to cause phlebitis. The present study was done prospectively on 550 patients with 1386 peripheral venous catheters. The incidence of phlebitis was 18.5% with antibiotics and 8.8% without (odds ratio 2.34). Dicloxacillin (odds ratio 5.74) and erythromycin (odds ratio 5.33) had the greatest tendency to cause phlebitis in univariate, multivariate and Cox regression analyses. Benzylpenicillin, cefuroxime and cloxacillin were also associated with a greater risk of phlebitis, whereas ampicillin, imipenem/cilastatin, clindamycin, netilmicin and vancomycin were not. Other risk factors were the site of insertion and age 51-60 y. Medication with warfarin was found to be protective, but not with aspirin. Treatment with low molecular weight heparin reduced the risk of phlebitis, but the difference was not significant. With regard to when antibiotics were given, the day-specific risk increased between Days 1 and 2, but no further on subsequent days. The hypothesis that antibiotics differ in their tendency to cause phlebitis was confirmed

A Head-to-Head Comparison of Hydrogen Peroxide Vapor and Aerosol Room Decontamination Systems.

Objective. New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide-based area decontamination technologies on the market, but no head-to-head studies have been performed. Design. We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HPV) system (Bioquell) and an aerosolized hydrogen peroxide (aHP) system (Sterinis). Setting. The tests were conducted in a purpose-built 136-m(3) test room. Methods. One HPV generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched Geobacillus stearothermophilus biological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system. Results. All BIs were inactivated for the 3 HPV tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HPV and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HPV tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage. Conclusion. One HPV generator was more effective than 2 aHP machines for the inactivation of G. stearothermophilus BIs, and cycle times were faster for the HPV system

Understanding effects of design – mapping healthcare processes in spatial configurations

The paper reports and reflects on an evaluation project at Malmö Nya Sjukhus, NSM, Sweden, where the relationship between healthcare performance objectives and indicators in the built environment have been studied. The starting point of the study was the outcomes in performance set by the hospital and a retrospective analysis of how these could be related to evaluation of the design of the new hospital. The paper discusses evaluation against a backdrop of existing studies on evaluations and with an argument that that there is a need for tools and methods to strengthen design work in general. The main argument is that it is valuable to evaluate the work processes in healthcare against spatial configurations in addition to studying effects of specific design features. Connecting healthcare process indicators to spatial design also envision several challenges and possibilities that are addressed in the paper. The study presented is mainly qualitative with and explorative approach

Perception of risk factors for infusion phlebitis among Swedish nurses: a questionnaire study

This questionnaire study was set up to assess the perceptions of risk factors for infusion phlebitis among Swedish nurses, as their concepts of these factors may influence the incidence. A majority of the nurses believed that insertion of a peripheral venous catheter in the forearm and catheter rotation within 48 hours was protective. These measures are not supported in recent studies and guidelines. Surveillance of the educational level of staff, who insert peripheral venous catheters, is an important tool for reducing the incidence of infusion phlebitis