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![Integration of the ESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting
3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015
Indicators for hospital antimicrobial
stewardship programmes
Seventeen “core” indicators
essential to fully characterise all
aspects of ASP programmes
Sixteen “supplemental” indicators
CORE Indicators for hospital antimicrobial stewardship programs
Infrastructure
1. Does your facility have a formal antimicrobial stewardship programme accountable for ensuring
appropriate antimicrobial use?
2. Does your facility have a formal organizational structure responsible for antimicrobial stewardship (e.g., a
multidisciplinary committee focused on appropriate antimicrobial use, pharmacy committee, patient
safety committee or other relevant structure)?
3. Is an antimicrobial stewardship team available at your facility (e.g., greater than one staff member
supporting clinical decisions to ensure appropriate antimicrobial use)?
4. Is there a physician identified as a leader for antimicrobial stewardship activities at your facility?
5. Is there a pharmacist responsible for ensuring appropriate antimicrobial use at your facility?
6. Does your facility provide any salary support for dedicated time for antimicrobial stewardship activities
(e.g., percentage of full-time equivalent (FTE) for ensuring appropriate antimicrobial use)?
7. Does your facility have the IT capability to support the needs of the antimicrobial stewardship activities?
PolicyandPractice
8. Does your facility have facility-specific treatment recommendations based on local antimicrobial
susceptibility to assist with antimicrobial selection for common clinical conditions?
9. Does your facility have a written policy that requires prescribers to document an indication in the medical
record or during order entry for all antimicrobial prescriptions?
10. Is it routine practice for specified antimicrobial agents to be approved by a physician or pharmacist in
your facility (e.g., pre-authorization)?
11. Is there a formal procedure for a physician, pharmacist, or other staff member to review the
appropriateness of an antimicrobial at or after 48 hours from the initial order (post-prescription review)?
MonitoringandFeedback
12. Has your facility produced a cumulative antimicrobial susceptibility report in the past year?
13. Does your facility monitor if the indication is captured in the medical record for all antimicrobial
prescriptions?
14. Does your facility audit or review surgical antimicrobial prophylaxis choice and duration?
15. Are results of antimicrobial audits or reviews communicated directly with prescribers?
16. Does your facility monitor antimicrobial use by grams [Defined Daily Dose (DDD)] or counts [Days of
Therapy (DOT)] of antimicrobial(s) by patients per days?
17. Has an annual report focused on antimicrobial stewardship (summary antimicrobial use and/or practices
improvement initiatives) been produced for your facility in the past year?
Domains
• Infrastructure
• Policy and practice
• Monitoring and feedback](https://image.slidesharecdn.com/diamantisplouchourasantiobiotcstewardshipindicators-150302062843-conversion-gate02/85/Antibiotic-stewardship-indicators-Diamantis-Plachouras-ECDC-30-320.jpg)
![Integration of the ESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting
3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015
Core indicators - Monitoring and feedback
12. Has your facility produced a cumulative antimicrobial susceptibility report in the past year?
13. Does your facility monitor if the indication is captured in the medical record for all antimicrobial
prescriptions?
14. Does your facility audit or review surgical antimicrobial prophylaxis choice and duration?
15. Are results of antimicrobial audits or reviews communicated directly with prescribers?
16. Does your facility monitor antimicrobial use by grams [Defined Daily Dose (DDD)] or counts [Days
of Therapy (DOT)] of antimicrobial(s) by patients per days?
17. Has an annual report focused on antimicrobial stewardship (summary antimicrobial use and/or
practices improvement initiatives) been produced for your facility in the past year?](https://image.slidesharecdn.com/diamantisplouchourasantiobiotcstewardshipindicators-150302062843-conversion-gate02/85/Antibiotic-stewardship-indicators-Diamantis-Plachouras-ECDC-33-320.jpg)
![Integration of the ESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting
3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015
Core indicators using strict criteria
1. Does your facility have a formally defined antimicrobial stewardship
programme for assuring appropriate antimicrobial use? (78.9%)
2. Is an antimicrobial stewardship team available at your facility?
(83.3%)
3. Is there a physician identified as a leader for stewardship activities
at your facility (88.9%)
4. Is there a pharmacist responsible for working to improve
antimicrobial use at your facility? (76.5%)
5. Does your facility produce a cumulative antimicrobial
susceptibility report at least annually? (73.7%)
6. Is there a formal procedure for a physician, pharmacist, or other staff
member to review the appropriateness of an antimicrobial after 48
hours from the initial order (post-prescription review)? (72.2%)
7. Does your facility monitor antimicrobial use by grams [Defined
Daily Dose (DDD)] or counts [Days of Therapy (DOT)] of
antimicrobial(s) by patients per day? (89.5%)](https://image.slidesharecdn.com/diamantisplouchourasantiobiotcstewardshipindicators-150302062843-conversion-gate02/85/Antibiotic-stewardship-indicators-Diamantis-Plachouras-ECDC-41-320.jpg)
Antibiotic stewardship indicators. Diamantis Plachouras (ECDC)
The document discusses the integration of the ESAC-net data collection protocol at the ARHAI networks level, focusing on the need for monitoring antimicrobial resistance and infections across Europe. It emphasizes the development of indicators to evaluate the effectiveness of national action plans and hospital antimicrobial stewardship programs. The document outlines various types of indicators, their relevance in assessing healthcare quality, and the importance of collaboration between EU and U.S. efforts to improve antimicrobial use and control measures.
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Antibiotic stewardship indicators. Diamantis Plachouras (ECDC)
- 1. Integration of theESAC-Net data collection / protocol at the ARHAI networks level Diamantis Plachouras Surveillance and response support unit - ECDC 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015
- 2. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Source: ECDC PPS, 2011-2012 Antimicrobial consumption of Antibacterials For Systemic Use in Europe, 2013 Source: ESAC-Net
- 3. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Outline • Need for indicators • Overview of indicators in HAI-Net • HAI-Net Point Prevalence Survey • HAI-Net ICU • HAI-Net SSI • The TATFAR indicators of hospital antimicrobial stewardship programmes
- 4. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Need for monitoring and evaluation Second report from the commission on the implementation of the council recommendation (2002/77/ec) on the prudent use of antimicrobial agents in human medicine. • Develop and use indicators to monitor the implementation of the Council Recommendation and assess the impact of national action plans and the efficiency of measures. • Develop mechanisms and indicators to assess the impact of national guidelines Communication from the commission to the European parliament and the council: Action plan against the rising threats from Antimicrobial Resistance, 2011 • Better assessment and monitoring at national level of the implementation and efficiency of the national strategies and control measures.
- 5. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Quality indicators • Assessment of quality of care is increasingly important element of the healthcare systems • This is especially true for infections associated with healthcare and caused by pathogens resistant to antimicrobials • Indicators allow the assessment of the quality of care Mainz J. International Journal for Quality in Health Care 2003.15;6:523–530 Indicators are measures to assess a particular structure, process or outcome
- 6. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Types of indicators • Structure • Attributes of care settings – Material resources – Human resources – Organisational structure • e.g. presence of antimicrobial stewardship team • Process • Actual activity during care provision • e.g. proportion of perioperative prophylaxis prescriptions reviewed • Outcome • Accomplishment of desired outcomes • e.g. number of antibiotic prescriptions or incidence of infections by resistant pathogens
- 7. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 The ideal indicator should be • Clearly defined • Evidence-based • Specific and sensitive • Accurate and reproducible • Valid • Feasible • Allow discrimination and comparison • Action-focused
- 8. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Common indicators for ARHAI surveillance networks EARS-Net HAI-Net Lab001 Lab002 ESAC-Net Hospital-based antimicrobial consumption PPS ICU SSI CDI Specific indicators Hosp12 Hosp34 Hosp56 Hosp78 Standardised hospital codes Hospital indicators and denominator data
- 9.
- 10. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Objectives Increase awareness for HAI/AMR prevention Add local value to surveillance by inter-hospital comparison and follow-up of key preventive measures Inter-country comparison and follow-up of implementation of key preventive measures in EU/EEA countries Follow-up of implementation of ECDC guidance and Council Recommendation 2009/C 151/01 At the longer term: linking evolution of prevention indicators with outcome indicators trends
- 11. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 ECDC PPS in acute care hospitals, 2011-2012: structure and process indicators IPC indicators: single bed rooms, alcohol hand rub consumption, IPC staffing Mapping leads to action: e.g. improve AHR data availability; establishment National HAI Reference Centre, new IPC guidance Percentage of beds in single roomsAlcohol hand rub consumption Source: ECDC PPS, 2011-2012. Report available from http://www.ecdc.europa.eu/en/publications/Publications/healthcare- associated-infections-antimicrobial-use-PPS.pdf
- 12. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Hospital-wide indicators for second ECDC PPS: based on SIGHT project Source: W. Zingg et al. Lancet Infectious Diseases, Published online Nov 11 2014. Systematic review & expert opinion => 10 Key Components and proposed indicators
- 13. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Key components and indicators identified by systematic review, 1-5 Source: W. Zingg et al. Lancet Infectious Diseases, Published online Nov 11 2014.
- 14. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Key components and indicators identified by systematic review, 6-10 Source: W. Zingg et al. Lancet Infectious Diseases, Published online Nov 11 2014.
- 15. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Examples of selected indicators for second PPS Microbiological support: • Number of blood culture sets in previous year • Number of stool samples tested for C. difficile Annual IPC report FTE IPC nurses and doctors and % of single room beds Ward occupancy at midnight Availability and consumption of alcohol-based hand rub at point of care Observed hand hygiene opportunities in the previous year In addition to IPC indicators: indicators of antimicrobial stewardship, e.g. dedicated FTE for antimicrobial stewardship
- 16. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 0 5 10 15 20 25 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 Austria Belgium Estonia France Italy Lithuania Luxembourg Portugal Slovakia Spain NofIAP/1000intubationdays Intubation-associated pneumonia, HAI-Net ICU 2008-2012
- 17. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 HAI-Net ICU surveillance perspectives: HAI prevention indicators 1-2 weeks data collection & aggregated reporting per year/surveillance period, Unit based (aggregated), at least 30 opportunities per indicator Current proposal: – Hand hygiene: alcohol handrub consumption (L/1000 pt days) in ICU – ICU staffing: registered nurses and nurse aides – IAP prevention: cuff pressure control and/or oral decontamination – CR-BSI prevention: CVC maintenance – dressing observation and/or clinical surveillance of insertion site (chart review) – Antimicrobial stewardship: systematic review of AM after 24-72 hrs
- 18. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Indicators for perioperative antibiotic prophylaxis • to identify the effectiveness of key modalities of perioperative antibiotic prophylaxis from a systematic review • to develop five key PAP modalities and process indicators for monitoring their implementation on the basis of scientific evidence and expert opinion. ECDC, 2013
- 19. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Five key modalities and indicators for perioperative antibiotic prophylaxis 1. Multidisciplinary AM team •Presence of a multidisciplinary AM team 2. Responsibility for appropriate timing •Measurement of the presence of an anaesthesiologist 3. Timing of perioperative antibiotic prophylaxis •Rate of compliance with the administration of PAP within 60 min 4. Dosing •Rate of compliance with indication, selection and dosage 5. Duration and termination •Rate of compliance with discontinuation of PAP within 24 hours
- 20. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 http://www.ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf
- 21. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Proposed indicators in HAI-Net SSI surveillance Peri-operative prophylaxis (PAP): two indicators from ECDC guidance: –% compliance with the administration of PAP within 60 minutes –% compliance with discontinuation of PAP within 24 hours after initiation of surgery SSI prevention, other: –Pre-operative skin preparation: % no hair removal or clipping –Peri-operative normothermia (pilot) –OR discipline ? (door opening based on Dutch PREZIES experience, inclusion in pilot) –Possibly others in pilot, e.g. alcohol-based skin antisepsis
- 22. Modified Delphi Processfor common structure and process indicators for hospital antimicrobial stewardship programmes Transatlantic Taskforce on Antimicrobial Resistance (TATFAR)
- 23. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 TATFAR was created in 2009 with the goal of improving cooperation between the U.S. and the EU in three key areas 1. appropriate therapeutic use of antimicrobial drugs in medical and veterinary communities 2. prevention of healthcare and community-associated drug- resistant infections and 3. strategies for improving the pipeline of new antimicrobial drugs
- 24. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Objective TATFAR Recommendation #1: Develop a set of structure and process indicators for hospital antimicrobial stewardship programs • Key elements of successful stewardship programmes and interventions • Common strategy for the use, monitoring, and interpretation • Meaningful comparisons between the US and EU Member States, as well as among institutions and regions.
- 25. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Antimicrobial stewardship programme a coordinated programme that implements interventions to ensure appropriate antimicrobial prescribing in order to • improve clinical efficacy of antimicrobial treatment • limit antimicrobial resistance • prevent Clostridium difficile infections
- 26. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Development of initial list of indicators
- 27. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Indicator scope and rating Domains • Structures – Governance and management – Human resources – Laboratory – Information technology – Education • Processes – Policies for appropriate use – Guidelines – Protocols – Activities and interventions • Monitoring appropriate use Criteria • Feasibility (F) • Clinical importance (CI) • Relevance to minimizing resistance (RMR)
- 28. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Level of evidence Code Quality of Evidence Definition A High Further research is very unlikely to change our confidence in the estimate of effect. Several high-quality studies with consistent results In special cases: one large, high- quality multi-centre trial B Moderate Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. One high-quality study Several studies with some limitations C Low Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. One or more studies with severe limitations D Very Low Any estimate of effect is very uncertain. Expert opinion No direct research evidence One or more studies with very severe limitations Grading of Recommendations Assessment, Development and Evaluation (GRADE)
- 29. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Delphi process • Panel of 20 experts based on involvement in antimicrobial stewardship • Three round Delphi with e-mail, one group call after round 2 and a final face-to-face meeting • RAND/UCLA appropriateness method • Rating on 1-9 likert scale – 1-3: disagree; 4-6: neutral; 7-9: agree • Criteria • Feasibility (F) • Clinical importance (CI) • Relevance to minimizing resistance (RMR) • Assessment of disagreement – Inter-percentile range 10-90 adjusted for symmetry (IPRAS-IPR) RAND/UCLA appropriateness method user’s manual http://www.rand.org/pubs/monograph_reports/MR1269.html Disagreement Agreement 1 1 1 6 1 6 2 6 3 6 3 7 6 7 8 7 8 7 9 8 9 8 9 8 IPRAS-IPR -3.1 3.6
- 30. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Indicators for hospital antimicrobial stewardship programmes Seventeen “core” indicators essential to fully characterise all aspects of ASP programmes Sixteen “supplemental” indicators CORE Indicators for hospital antimicrobial stewardship programs Infrastructure 1. Does your facility have a formal antimicrobial stewardship programme accountable for ensuring appropriate antimicrobial use? 2. Does your facility have a formal organizational structure responsible for antimicrobial stewardship (e.g., a multidisciplinary committee focused on appropriate antimicrobial use, pharmacy committee, patient safety committee or other relevant structure)? 3. Is an antimicrobial stewardship team available at your facility (e.g., greater than one staff member supporting clinical decisions to ensure appropriate antimicrobial use)? 4. Is there a physician identified as a leader for antimicrobial stewardship activities at your facility? 5. Is there a pharmacist responsible for ensuring appropriate antimicrobial use at your facility? 6. Does your facility provide any salary support for dedicated time for antimicrobial stewardship activities (e.g., percentage of full-time equivalent (FTE) for ensuring appropriate antimicrobial use)? 7. Does your facility have the IT capability to support the needs of the antimicrobial stewardship activities? PolicyandPractice 8. Does your facility have facility-specific treatment recommendations based on local antimicrobial susceptibility to assist with antimicrobial selection for common clinical conditions? 9. Does your facility have a written policy that requires prescribers to document an indication in the medical record or during order entry for all antimicrobial prescriptions? 10. Is it routine practice for specified antimicrobial agents to be approved by a physician or pharmacist in your facility (e.g., pre-authorization)? 11. Is there a formal procedure for a physician, pharmacist, or other staff member to review the appropriateness of an antimicrobial at or after 48 hours from the initial order (post-prescription review)? MonitoringandFeedback 12. Has your facility produced a cumulative antimicrobial susceptibility report in the past year? 13. Does your facility monitor if the indication is captured in the medical record for all antimicrobial prescriptions? 14. Does your facility audit or review surgical antimicrobial prophylaxis choice and duration? 15. Are results of antimicrobial audits or reviews communicated directly with prescribers? 16. Does your facility monitor antimicrobial use by grams [Defined Daily Dose (DDD)] or counts [Days of Therapy (DOT)] of antimicrobial(s) by patients per days? 17. Has an annual report focused on antimicrobial stewardship (summary antimicrobial use and/or practices improvement initiatives) been produced for your facility in the past year? Domains • Infrastructure • Policy and practice • Monitoring and feedback
- 31. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Core indicators - Infrastructure 1. Does your facility have a formal antimicrobial stewardship programme accountable for ensuring appropriate antimicrobial use? 2. Does your facility have a formal organizational structure responsible for antimicrobial stewardship (e.g., a multidisciplinary committee focused on appropriate antimicrobial use, pharmacy committee, patient safety committee or other relevant structure)? 3. Is an antimicrobial stewardship team available at your facility (e.g., greater than one staff member supporting clinical decisions to ensure appropriate antimicrobial use)? 4. Is there a physician identified as a leader for antimicrobial stewardship activities at your facility? 5. Is there a pharmacist responsible for ensuring appropriate antimicrobial use at your facility? 6. Does your facility provide any salary support for dedicated time for antimicrobial stewardship activities (e.g., percentage of full-time equivalent (FTE) for ensuring appropriate antimicrobial use)? 7. Does your facility have the IT capability to support the needs of the antimicrobial stewardship activities?
- 32. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Core indicators - Policy and practice 8. Does your facility have facility-specific treatment recommendations based on local antimicrobial susceptibility to assist with antimicrobial selection for common clinical conditions? 9. Does your facility have a written policy that requires prescribers to document an indication in the medical record or during order entry for all antimicrobial prescriptions? 10. Is it routine practice for specified antimicrobial agents to be approved by a physician or pharmacist in your facility (e.g., pre-authorization)? 11. Is there a formal procedure for a physician, pharmacist, or other staff member to review the appropriateness of an antimicrobial at or after 48 hours from the initial order (post-prescription review)?
- 33. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Core indicators - Monitoring and feedback 12. Has your facility produced a cumulative antimicrobial susceptibility report in the past year? 13. Does your facility monitor if the indication is captured in the medical record for all antimicrobial prescriptions? 14. Does your facility audit or review surgical antimicrobial prophylaxis choice and duration? 15. Are results of antimicrobial audits or reviews communicated directly with prescribers? 16. Does your facility monitor antimicrobial use by grams [Defined Daily Dose (DDD)] or counts [Days of Therapy (DOT)] of antimicrobial(s) by patients per days? 17. Has an annual report focused on antimicrobial stewardship (summary antimicrobial use and/or practices improvement initiatives) been produced for your facility in the past year?
- 34. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Potential for comparison • 15 questions based on the indicators are currently being asked to nearly 4000 US facilities reporting to NHSN • acute care, • long-term acute care, • inpatient rehabilitation facilities National Healthcare Safety Network (NHSN) annual hospital survey. Courtesy of L. Pollack, CDC
- 35. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Outcome measures • Antimicrobial consumption measures • Antimicrobial resistance measures • Incidence of infections by antimicrobial resistant organisms • Patient outcome measures • Mortality associated with antimicrobial resistant organisms • Incidence of infection by C. difficile • Length of hospitalisation Morris AM et al. Infect Control Hosp Epidemiol. 2012 Apr;33(4):374-80 • Challenges • Specificity of association • Interpretation of quantitative information • Variability of systems
- 36. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 ECDC antimicrobial stewardship indicators overview TATFAR PAP guidelines HAI-Net AMS programme Multidisciplinary committee AMS team Multidisciplinary AMS team Physician leader Participating pharmacist Salary support Dedicated FTE for antimicrobial stewardship IT support Treatment recommendations Documentation of indication Pre-authorisation Post-prescription review Systematic review after 24-72 h Annual susceptibility report Monitoring of indication Review surgical prophylaxis Rate of timely administration Rate of compliance with indication, selection, dosage and duration Rate of timely administration Rate of compliance with indication, selection, dosage and duration Results communicated with prescribers Monitor antimicrobial use Annual report on AMS
- 37. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Conclusions and future steps Harmonised indicators • Enable • Monitoring of activities related to antimicrobial use • Inter-hospital comparisons • Inter-country comparisons • Global comparisons • Set common targets for quality improvement • Support the optimal use of antimicrobials
- 38. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Acknowledgements • Centers for Disease Prevention and Control: Heidi Gruhler, Ronda Sinkowitz-Cochran, J. Todd Weber • ECDC ARHAI Disease Programme: Klaus Weist, Carl Suetens, Anna- Pelagia Magiorakos, Marc Struelens, Dominique Monnet • TATFAR Indicators for Hospital Antimicrobial Stewardship Programmes Expert Group: Anastasia Antoniadou, Bojana Beovic, Franky Buyle, Sara Cosgrove, Peter Davey, Elizabeth S. Dodds Ashley, Catherine Dumartin, Alison Holmes, Winfried Kern, Maria Luisa Moro, Dilip Nathwani, Jeanne Negley, Melinda Neuhauser, Christopher A. Ohl, Jeroen Schouten, Ed Septimus, Agnes Wechsler- Fördös
- 39. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Website: http://antibiotic.ecdc.europa.eu Facebook: EAAD.EU Twitter: @EAAD_EU (#EAAD) 18 November
- 40. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015
- 41. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Core indicators using strict criteria 1. Does your facility have a formally defined antimicrobial stewardship programme for assuring appropriate antimicrobial use? (78.9%) 2. Is an antimicrobial stewardship team available at your facility? (83.3%) 3. Is there a physician identified as a leader for stewardship activities at your facility (88.9%) 4. Is there a pharmacist responsible for working to improve antimicrobial use at your facility? (76.5%) 5. Does your facility produce a cumulative antimicrobial susceptibility report at least annually? (73.7%) 6. Is there a formal procedure for a physician, pharmacist, or other staff member to review the appropriateness of an antimicrobial after 48 hours from the initial order (post-prescription review)? (72.2%) 7. Does your facility monitor antimicrobial use by grams [Defined Daily Dose (DDD)] or counts [Days of Therapy (DOT)] of antimicrobial(s) by patients per day? (89.5%)
- 42. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Features of ideal TATFAR indicators Characterize and differentiate among programmes Capture current and expansion activities Able to integrate with other assessment tools Comparable Manageable number of indicators
- 43. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Challenges Differences in public health and health care systems • CDC is a health agency for one country, with no national healthcare system • ECDC is a health agency for many countries, some with national healthcare systems Link to outcomes • What are the best outcomes? • Do they impact resistance?
- 44. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Why Delphi? • Structured communication technique based on panel of experts for: • synthesising information • building of expert consensus • avoiding domination of the process by one or few experts Boulkedid R et al. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6(6):e20476.
- 45. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Supplemental - Infrastructure S1. Does your facility have a named senior executive officer with accountability for antimicrobial leadership? (Core 3) Is an antimicrobial stewardship team available at your facility (e.g., greater than one staff member supporting clinical decisions to ensure appropriate antimicrobial use)? S2. If YES, Is an infection preventionist or hospital epidemiologist involved in stewardship activities? S3. If YES, Is a microbiologist (laboratory staff) involved in stewardship activities? S4. Is clinical infectious disease (ID) consultation available at your facility? (Core 4) Is there a physician identified as a leader for antimicrobial stewardship activities at your facility? S5. If YES, are stewardship duties included in the job description and/or annual review? S6. If YES, has this physician had specialized training in infectious diseases, clinical microbiology and/or antimicrobial stewardship? (Core 5) Is there a pharmacist responsible for ensuring antimicrobial use at your facility? S7. If YES, has this pharmacist had specialized training in infectious disease management or stewardship?
- 46. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Supplemental – Policy and practice (Core 9) Does your facility have facility-specific treatment recommendations based on local antimicrobial susceptibility to assist with antimicrobial selection for common clinical conditions: S8. If YES, for surgical prophylaxis? S9. If YES, for community acquired pneumonia? S10. If YES, for urinary tract infection? S11. If YES to any of the clinical conditions above, are these treatment recommendations easily accessible to prescribers on all wards (printed ‘pocket guide’ or electronic summaries at workstations)? (Core 11,12) Are any of the following actions implemented in your facility to improve antibiotic prescribing? S12. Standardized criteria for changing from intravenous to oral antimicrobial therapy in appropriate situations? S13. Dose optimization (pharmacokinetics/pharmacodynamics) to optimize the treatment of organisms with reduced susceptibility? S14. Discontinuation of specified antimicrobial prescriptions after a pre-defined duration?
- 47. Integration of theESAC-Net data collection / protocol at the ARHAI networks level - ESAC-Net Meeting 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks – Stockholm, 11-13 February 2015 Supplemental - monitoring S15. Does your facility measure the percentage of antimicrobial prescriptions that are consistent with the local treatment recommendations for either UTI or CAP? (Core 15) Does your facility audit or review surgical antimicrobial prophylaxis choice and duration? S16. If YES, are antimicrobial prescriptions for surgical prophylaxis compliant with facility- specific guidelines in >80% of sampled cases in your facility?