This document discusses several patient cases that raise issues around infection control and antimicrobial stewardship in hospitals. It addresses challenges like limited isolation room availability, proper use and charging of personal protective equipment, prompt notification of multidrug-resistant organism results, pre-operative antimicrobial timing, HIV screening consent and confidentiality, opportunistic infection precautions, and establishing effective communication between nurses, doctors and pharmacists regarding antibiotic duration. The document uses these case examples to illustrate common problems encountered in infection prevention and antibiotic stewardship in hospital settings.

1. Panel Case Discussion

3. Victoria D. Villanueva, RN

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▰ 50 M
▰ Admitted in ward type MS-ICU
▰ Tertiary government hospital
▰ Acute Respiratory Failure
▰ After 7 days, patient developed Ventilator
Associated Pneumonia (VAP)

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▰ ETA C/S
▰ A. baumanii MDR
▰ Antibiotics shifted
▰ Contact Precautions instituted by area

6. ▰ Appropriate PPEs
▰ Availability of PPEs
▰ To whom the PPEs should be charged?
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7. ▰ Infrastructure is limited to a ward
▰ Difficulty of getting a private room/single patient
room
▰ Unavailability of the room
▰ Financial incapacity of the patient
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8. ▰ Availability of appropriate
disinfectants to be used
▰ Concerned healthcare workers
and/or housekeepers
▰ Difficulty in monitoring proper
disinfection of the environment.
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9. ▰ Difficulty in instituting prompt notification
of MDROs (initial culture results)
▰ Who will notify the area?
▰ Prompt management and proper
isolation precaution are implemented
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10. ▰ 35 F
▰ Chronically admitted and receiving dialysis
▰ Private secondary hospital
▰ Scheduled for exploratory laparotomy
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11. ▰ 2 days prior to scheduled OR
▰ Patient developed CLABSI
▰ Methicillin-resistant Staphylococcus aureus
▰ 1 hour pre-operative antimicrobial prophylaxis
for surgery
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12. ▰ Who will give the antibiotic?
▰ Ward nurse who prepared the antibiotic
and performed skin test
▰ OR circulating nurse
▰ Anesthesiologist
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13. ▰ When the surgeon comes in late
▰ Antibiotic was already given
▰ Which antibiotic will need redosing?
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14. ▰ When to stop antimicrobial therapy
post-operatively?
▰ Duration of administration?
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15. ▰ Proper endorsement of patient
▰ Including infectious status and
communicability
▰ Prioritization of cases
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16. ▰ 17 M
▰ Admitted at MS-ICU
▰ Private tertiary hospital
▰ Under HMO
▰ Central Nervous System Infection
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17. ▰ Intubated
▰ GCS 3
▰ Fever and vesicular rashes in the perianal area
▰ Referred to IDS
▰ Rapid HIV screening positive
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18. ▰ Rapid and prick test may not need
written consent
▰ Confirmatory test need proper consent
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19. ▰ Charges of the HIV screening and whole
confinement since disease related to underlying
condition of HIV infection/ AIDS might not be
within the HMO policy of the patient
▰ Issues on coverage of HMO on the whole
hospitalization and patient’s final diagnosis
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20. ▰ HIV status of the patient is not revealed in the chart
due to hospital policy
▰ Proper identification and endorsement within the
healthcare team with strict confidentiality of the
patient’s status should be observed
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21. ▰ Should patient with HIV infection/ AIDS
(regardless of co-infection) be mixed with
non-HIV case?
▰ Which opportunistic co-infection warrants
additional precautions?
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22. ▰ 62 F
▰ Secondary government hospital
▰ Urinary Tract Infection
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23. ▰ The hospital has policy regarding implementation
of Antimicrobial Stewardship Program
▰ Antibiotic is given until 7th day
▰ Nurse-in-charge notified attending physician that
the antibiotic will be stopped after the 7th day
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24. ▰ The attending physician is also the hospital
administrator who opted to continue the
antibiotic treatment.
▰ Difficulty in establishing proper communication
between the nurse-in-charge, attending
physician and the pharmacist.
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