Improving Antimicrobial Prescribing Practices in the Neonatal Intensive Care Unit

改善新生儿重症监护病房的抗菌药物处方实践

• 批准号: 8257542
• 负责人: LISA SAIMAN
• 金额: $ 91.71万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-24 至 2013-10-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8257542
• 关键词: Acute; Address; Adult; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Antimicrobial Resistance; Beds; Belief; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Childhood; Clinical; Clinical Trials; Computers; Data; Education; Educational Intervention; Effectiveness of Interventions; Electronic Health Record; Enabling Factors; Feedback; Goals; Government; Hand; Health; Health behavior change; Hospitalized Child; Hospitals; Infant; Infection; Intervention; Knowledge; Length of Stay; Link; Measures; Medical; Modeling; Monitor; Morbidity - disease rate; Multi-Drug Resistance; Neonatal Intensive Care Units; Organism; Outcome; Patients; Pattern; Population; Population Intervention; Predisposing Factor; Provider; Randomized; Reinforcing Factor; Research Design; Resistance; Resources; Risk; Sepsis; Testing; United States; antimicrobial; base; computerized; cost; cost effective; cost effectiveness; density; disorder prevention; improved; innovation; mortality; pathogen; prevent; programs; prospective; success; treatment as usual

The increased emergence of antibiotic resistance has been linked to the overuse of antibiotics, particularly in hospitals. Antimicrobial stewardship programs are widely acknowledged as essential to improve appropriate antibiotic use, decrease antimicrobial resistance, and reduce cost. However, few data exist describing the efficacy of such programs in pediatric populations, particularly in the neonatal intensive care unit (NICU). The long-term objectives of this study are to reduce antimicrobial resistance by implementing innovative interdisciplinary interventions aimed to improve antibiotic prescribing practices in the NICU and thereby define the optimal interventions for this population. The Specific Aims are to: 1) measure the impact of three interdisciplinary intervention bundles on inappropriate antimicrobial use as categorized by the CDC 12 Step Campaign Program to Prevent Antimicrobial Resistance; 2) determine the impact of these . intervention bundles on resistance density, i.e., changes in the rate of infant infections and colonization with multidrug-resistant organisms (MDROs) and changes in the proportion of MDROs carried on NICU staff hands; and 3) determine the cost effectiveness of the intervention bundles in preventing bloodstream infections caused by MDROs. The Study Design is a quasi-experimental prospective clinical trial whereby 4 study NICUs in the United States (total beds - 214, annual discharges - 3649) will berandomized to successive bundles of interventions versus usual care to determine which combinations of interventions have the greatestjmpact on appropriate antibiotic use, antimicrobial resistance, and cost. The interventions have beendeveloped using the PRECEDE-PROCEEDhealth promotion planning model which suggests that programsto change health behavior should include predisposing, enabling, and reinforcing factors. Thus, the Education intervention in this study addresses the predisposing knowledge and beliefs of staff regarding antimicrobial resistance and helps set goals for improving prescribing practices. The Clinical Decision Support- Computerized Provider Order Entry intervention provides computer prompts in the electronic health record to enable better decisions about stopping, changing, or continuing antibiotic treatment. The Audit and Prescriber Feedback intervention reinforces desired prescribing practices as providers can monitor the success of their prescribing decisions on health outcomes and receive praise and encouragement from the study team.

抗生素耐药性的增加尤其与抗生素的过度使用有关

项目成果

Development of an antimicrobial stewardship intervention using a model of actionable feedback.

• DOI: 10.1155/2012/150367
• 发表时间: 2012-01-01
• 期刊: Interdisciplinary perspectives on infectious diseases
• 作者: Patel, Sameer J;Saiman, Lisa;Larson, Elaine
• 通讯作者: Larson, Elaine

Sociotechnical analysis of a neonatal ICU.

新生儿 ICU 的社会技术分析。

• 发表时间: 2009
• 期刊: Studies in health technology and informatics
• 作者: Currie,Leanne;Sheehan,Barbara;Graham3rd,PhillipL;Stetson,Peter;Cato,Kenrick;Wilcox,Adam
• 通讯作者: Wilcox,Adam

Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship.

• DOI: 10.1016/j.clp.2010.06.004
• 发表时间: 2010-09
• 期刊: Clinics in perinatology
• 影响因子: 2.1
• 作者: Patel SJ;Saiman L
• 通讯作者: Saiman L