This study analyzed national ED visit data from 2006-2007 to determine the rate of antibiotic prescribing for cutaneous abscesses. The results showed that 80-82% of patients diagnosed with a cutaneous abscess received an antibiotic prescription upon discharge, despite evidence that incision and drainage alone is often sufficient treatment. Additionally, the rate of multiple antibiotic prescriptions increased from 9.4% to nearly 11% over this period. The overprescription of antibiotics contributes to growing antibiotic resistance. Further research is needed to understand provider behaviors and develop interventions to reduce unnecessary antibiotic use for abscesses.
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
Surgeons’ Perception to Needle Stick Injuries and Transmission of Blood Borne...CrimsonpublishersCJMI
Needle stick injuries (NSI) are commonly seen in health care workers and those into surgical practice are at a higher risk of sustaining such injuries. As per WHO Report of 2002, of the 35 million health-care workers, 2 million experience percutaneous exposure to infectious diseases every year
Avoidng disruption of timely surgical management of genitourinary cancers ...Valentina Corona
This article describes the experience of a large cancer center in Southern Italy in continuing timely surgical treatment of genitourinary cancers during the early phase of the COVID-19 pandemic. The center established a multidisciplinary team to prioritize urgent cancer cases and implemented screening, safety protocols, and transfer agreements to identify and manage any COVID-19 positive patients while maintaining surgical volume. Through regional healthcare reorganization designating the center as "COVID-free" and other measures, the hospital was able to safely perform a similar number and mix of cancer surgeries compared to the previous year without major disruption of care.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
St. Mary's Hospital tracks surgical site infections (SSIs) using several methods, but lacks complete data on post-discharge infections. Other hospitals are implementing innovative solutions like remote wound monitoring and strict post-op follow up protocols to better detect SSIs. Nationwide, SSIs contribute greatly to healthcare costs and readmissions. Improved post-discharge surveillance is critical for accurately assessing SSI rates and reducing avoidable readmissions.
EWMA 2013 - Ep534 - Prevention of pressure ulcers in cardiac surgery patientsEWMAConference
The document discusses prevention of pressure ulcers in cardiac surgery patients. It conducted a study using soft silicone dressings placed before surgery to preserve skin integrity in high-risk patients. Of the 26 patients monitored, 9 were high risk. For the high risk patients in the first post-operative period, 70% could not move and 100% had decreased hemoglobin, risk factors for pressure ulcers. Using the soft silicone dressings, the high risk patients did not develop any pressure ulcers and found the dressings comfortable. The study concludes the dressings were an effective prevention measure but more needs to be done to increase pressure ulcer prevention care.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
Surgeons’ Perception to Needle Stick Injuries and Transmission of Blood Borne...CrimsonpublishersCJMI
Needle stick injuries (NSI) are commonly seen in health care workers and those into surgical practice are at a higher risk of sustaining such injuries. As per WHO Report of 2002, of the 35 million health-care workers, 2 million experience percutaneous exposure to infectious diseases every year
Avoidng disruption of timely surgical management of genitourinary cancers ...Valentina Corona
This article describes the experience of a large cancer center in Southern Italy in continuing timely surgical treatment of genitourinary cancers during the early phase of the COVID-19 pandemic. The center established a multidisciplinary team to prioritize urgent cancer cases and implemented screening, safety protocols, and transfer agreements to identify and manage any COVID-19 positive patients while maintaining surgical volume. Through regional healthcare reorganization designating the center as "COVID-free" and other measures, the hospital was able to safely perform a similar number and mix of cancer surgeries compared to the previous year without major disruption of care.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
St. Mary's Hospital tracks surgical site infections (SSIs) using several methods, but lacks complete data on post-discharge infections. Other hospitals are implementing innovative solutions like remote wound monitoring and strict post-op follow up protocols to better detect SSIs. Nationwide, SSIs contribute greatly to healthcare costs and readmissions. Improved post-discharge surveillance is critical for accurately assessing SSI rates and reducing avoidable readmissions.
This study prospectively collected data on 10,745 patients from 357 centers in 58 countries who underwent emergency abdominal surgery. Overall mortality was 1.6% at 24 hours and 5.4% at 30 days. Mortality was highest in low HDI countries (3.4% at 24 hours and 8.6% at 30 days) and lowest in high HDI countries (1.1% at 24 hours and 4.5% at 30 days). After adjustment, 30-day mortality remained 2-3 times higher in middle- and low-income countries compared to high-income countries. Surgical safety checklist use was less frequent in low- and middle-income countries but associated with reduced mortality when used.
The COVID-19 pandemic led to a 55% decrease in urological consultations in emergency departments in Italy between March 2019 and March 2020. Hospitals in northern Italy, which was hit hardest by the pandemic, saw a 64% decrease, while southern Italy saw an 82% decrease. Patients in 2020 tended to be older and had conditions like gross hematuria and acute urinary retention that required urgent treatment. There was more aggressive early treatment for some conditions to reduce hospital visits and risk of infection. The study suggests emergency departments need to prepare for around half the usual urological caseload during the pandemic.
The document summarizes a study that evaluated the use of the antibiotic ceftriaxone at a referral hospital in Ethiopia. The study reviewed 127 patient medical records to assess ceftriaxone use based on World Health Organization criteria. It found that ceftriaxone was inappropriately prescribed in 70% of cases, most often due to short treatment durations. Inappropriate antibiotic use contributes to growing antimicrobial resistance, posing a major public health threat. The study concludes that improved antibiotic stewardship programs are needed to promote more prudent ceftriaxone prescribing and preserve its effectiveness.
The study evaluated the ability of an autofluorescence visualization device (VELscope) to detect oral pre-malignant lesions compared to conventional white light examination alone. 120 patients with suspicious oral lesions were randomly divided into two groups. One group received white light examination alone while the other received white light plus VELscope examination. Biopsies found the VELscope group had higher sensitivity (97.9% vs 75.9%) but lower specificity (41.7% vs 33.3%) compared to white light alone. The study suggests VELscope may help clinicians find pre-cancerous oral lesions but can also produce more false positives.
The document discusses a study evaluating the use of The Paris System (TPS) for reporting urinary cytology specimens. The study reevaluated 46 urinary cytology specimens according to TPS criteria and found fair agreement between TPS categorizations and biopsy results. However, the study identified limitations in TPS criteria for evaluating specimen adequacy and diagnostic categories of atypical urothelial cells and low-grade urothelial neoplasia. The study concludes that revising these TPS criteria could help establish its more widespread use and improve communication between pathologists and clinicians.
The document discusses the drug Avastin and challenges facing its manufacturer Roche/Genentech. It summarizes that while Avastin provides significant benefits to some cancer patients, recent clinical trials found only small average survival benefits or no survival benefits at all for some cancer types. As a result, government agencies and insurers are challenging Roche/Genentech to develop predictive biomarkers to identify the patients most likely to benefit from Avastin treatment. The manufacturer has tested over 150 potential biomarkers but has yet to find effective ones, which could impact patients and the drug's position in personalized cancer treatment.
Oral cancer is the most significant and growing concern worldwide. It ranks as 3rd in India and 8th
largest prevalent form of cancer in world. Oral cancer is often diagnosed, only after reached to an untreatable
stage. Early detection and prevention are the major objectives to control the oral cancer. Histopathology
analysis of biopsied lesion followed by visual examination is the current clinical procedure. This procedure is
invasive and requires a waiting period for the diagnostic results. Thus, there is a need to develop a non-invasive
screening device for oral cancer detection. Optical imaging has emerged as effective tool for detecting
malignant changes associated with oral cancer and also effective in assisting with the detection of oral mucosal
abnormalities. Hence, this paper focuses on development of non-invasive, real-time diagnostic tool based on
optical imaging technique in which involves - fluorescence emission and diffuse reflectance imaging modalities
for screening of oral cancer.
This document discusses infection control in surgical practice. It begins by outlining how surgical procedures expose patients to microorganisms and increase the risk of surgical site infections. Effective infection control requires an organized hospital-wide program to monitor infections, analyze data, implement corrective actions, and educate staff. Key aspects of infection control include proper hand hygiene, appropriate use of antibiotics, sterilization of surgical equipment, and classification of surgical wounds according to infection risk. Host factors like age, health status and operative factors like surgery duration influence infection risk. Strict adherence to infection control standards helps reduce surgical complications and healthcare costs.
This study compared the cost-effectiveness of single-dose versus multiple-dose prophylactic antibiotic regimens for preventing postoperative infections in patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH). The study found that a single dose of cefazoline was as effective at reducing infection rates as multiple doses, with a significantly lower incremental cost-effectiveness ratio. A single dose resulted in lower antibiotic costs without increasing infection rates or hospital stay compared to multiple doses. The results support using a single dose of cefazoline as the most cost-effective prophylactic antibiotic regimen for LAVH.
The document summarizes a study that assessed knowledge about robotics and minimally invasive robotic surgeries amongst otolaryngologists and head & neck onco-surgeons through a questionnaire. The study found that most surgeons viewed robotic surgery as the future of minimally invasive procedures due to advantages like improved visualization, precision, and reduced complications. However, many surgeons also noted that current robotics technology is not yet cost effective, requires specialized training, and more studies are needed to prove beneficial outcomes compared to traditional surgery.
jlme article final on NGS coverage n reimb issues w pat deverkaJennifer Dreyfus
The document discusses the challenges of obtaining coverage and reimbursement for clinical next generation sequencing (NGS) from both public and private health payers. It outlines the evidentiary standards payers use to evaluate new diagnostic tests, including requirements for analytic validity, clinical validity, and clinical utility. However, establishing these standards is difficult for NGS given limitations in analytical validation methods, lack of proficiency testing, and the technology's rapid advancement. Additionally, while regulatory approval for market entry requires less evidence than reimbursement decisions, demand for NGS often outpaces evidence development. The document argues more collaboration is needed between developers and payers to strengthen evidence standards and facilitate clinical integration of NGS.
Clinical research is essential to improving cancer treatment results. It offers patients access to state-of-the-art therapies through clinical trials when standard treatments may not be available or adequate. Latin America represents an important region for clinical research due to its large patient populations and qualified investigators. However, barriers like bureaucratic hurdles can stall development. Addressing discrepancies in cancer care globally through strategies like screening programs and vaccination could help reduce the growing cancer burden in developing areas.
Time To Onset in adverse drug reaction surveillanceGhazaleh Karimi
This thesis investigates the reported time to onset (TTO) of adverse drug reactions (ADRs) in the WHO global safety database VigiBase. It analyzes the median TTOs for 6 common ADRs - agranulocytosis, angioedema, hepatitis, serum sickness, Stevens-Johnson syndrome, and toxic epidermal necrolysis - by ADR, age, gender, and anatomical therapeutic chemical group. The study finds that the reported median TTOs generally correspond to literature but hepatitis had a shorter TTO. It observes only slight variations by gender and age but marked differences by ATC group, with long TTOs for certain drug-ADR pairs and short TTO
Infection Prevention Practices on the Healthcare Frontier: Emerging Models of...bden129
This document summarizes an educational session on infection prevention in emerging ambulatory care delivery models. It discusses trends driving the shift to outpatient care like declining inpatient volumes and growing outpatient encounters. Emerging models described include micro-hospitals, ambulatory surgery centers, and "hospital at home" programs. These models require new staffing approaches for infection prevention. The document outlines challenges for infection preventionists in these settings and resources available to assist them.
This article summarizes a study examining predictors of septic arthritis in adults. The study evaluated 458 knee aspirates from patients with suspected septic arthritis. Twenty-two patients (4.8%) were confirmed to have septic arthritis based on positive synovial fluid cultures. Key findings included:
- Erythrocyte sedimentation rate and serum white blood cell counts were not significantly different between septic arthritis and non-septic groups. Many septic arthritis patients had normal serum WBC counts and were afebrile.
- Mean synovial fluid WBC count was higher in the septic arthritis group (70,581 cells/μL) compared to the non-septic group (
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
Company x anti infective orthopedic implant drug device preliminary final rep...Brand Acumen
The document provides a market research report on the potential market for an anti-infective orthopaedic implant drug-device combination being developed by Company X. It summarizes interviews with 27 key opinion leaders in orthopaedics. The KOLs believe the market potential is high, particularly for procedures with high infection risks like open fractures and spinal/joint surgeries. However, efficacy must be proven through clinical trials demonstrating a significant reduction in infections. Regulatory approval and reimbursement will also depend on cost-effectiveness analyses. Concerns include antibiotic resistance, allergic reactions, and foreign body reactions.
This study aimed to develop an unbiased RNA profiling approach for the early detection of colorectal cancer (CRC) and advanced adenomas (AA) using blood samples. The researchers combined a literature review with microarray analysis of circulating RNA purified from plasma to identify RNA biomarker panels. They tested the panels on two cohorts, detecting CRC with 75% sensitivity and 93% specificity using an 8-gene panel, and detecting AA with 60% sensitivity and 87% specificity using a 2-gene panel. The study demonstrates the feasibility of unbiased molecular diagnosis of CRC and AA from blood and introduces circulating RNA profiling as a potential non-invasive screening approach.
The document discusses a study on reducing errors from multiple intravenous infusions in intensive care units. It notes that ICU environments involve numerous tubes and lines connecting critically ill patients to medical devices. The study found that ICU nurses face high workloads and tasks requiring speed and accuracy. Respondents suggested using color-coded labels and lines to help distinguish look-alike tubes and medications, especially for high-risk drugs. However, the study had concerns that color coding is not standardized and could lead to reliance on color over double checking labels and connections. The commenter argues color-tinted lines should still be considered as a visual aid to improve safety, even without standardization.
Preventing mediastinitis surgical site infections executive summary of the a...ricardovilla
This executive summary outlines guidelines for preventing mediastinitis surgical site infections after cardiac surgery procedures. It discusses risk factors for mediastinitis, recommendations for surveillance and data collection on infection rates, and components of an effective mediastinitis prevention program. The prevention program should involve monitoring compliance with best practices, mitigating risks from non-modifiable patient factors, and implementing evidence-based improvement initiatives to continuously reduce infection rates.
This document summarizes 5 research studies related to preventing post-surgical MRSA infections in acute care hospitals. The studies examined: (1) risk factors for vascular surgical site infections and preventative measures, (2) guidelines for controlling and preventing MRSA in healthcare facilities, (3) non-pharmacological interventions for preventing hospital-acquired infections, (4) the relationship between infection rates, procedures, antimicrobial use and bacterial resistance in an ICU, and (5) the impact of active MRSA screening and decolonization protocols on surgical site infections. The studies found that hand hygiene, screening protocols, limiting unnecessary procedures and antimicrobial use, and bundled infection control strategies can effectively reduce the rate of post-
This study prospectively collected data on 10,745 patients from 357 centers in 58 countries who underwent emergency abdominal surgery. Overall mortality was 1.6% at 24 hours and 5.4% at 30 days. Mortality was highest in low HDI countries (3.4% at 24 hours and 8.6% at 30 days) and lowest in high HDI countries (1.1% at 24 hours and 4.5% at 30 days). After adjustment, 30-day mortality remained 2-3 times higher in middle- and low-income countries compared to high-income countries. Surgical safety checklist use was less frequent in low- and middle-income countries but associated with reduced mortality when used.
The COVID-19 pandemic led to a 55% decrease in urological consultations in emergency departments in Italy between March 2019 and March 2020. Hospitals in northern Italy, which was hit hardest by the pandemic, saw a 64% decrease, while southern Italy saw an 82% decrease. Patients in 2020 tended to be older and had conditions like gross hematuria and acute urinary retention that required urgent treatment. There was more aggressive early treatment for some conditions to reduce hospital visits and risk of infection. The study suggests emergency departments need to prepare for around half the usual urological caseload during the pandemic.
The document summarizes a study that evaluated the use of the antibiotic ceftriaxone at a referral hospital in Ethiopia. The study reviewed 127 patient medical records to assess ceftriaxone use based on World Health Organization criteria. It found that ceftriaxone was inappropriately prescribed in 70% of cases, most often due to short treatment durations. Inappropriate antibiotic use contributes to growing antimicrobial resistance, posing a major public health threat. The study concludes that improved antibiotic stewardship programs are needed to promote more prudent ceftriaxone prescribing and preserve its effectiveness.
The study evaluated the ability of an autofluorescence visualization device (VELscope) to detect oral pre-malignant lesions compared to conventional white light examination alone. 120 patients with suspicious oral lesions were randomly divided into two groups. One group received white light examination alone while the other received white light plus VELscope examination. Biopsies found the VELscope group had higher sensitivity (97.9% vs 75.9%) but lower specificity (41.7% vs 33.3%) compared to white light alone. The study suggests VELscope may help clinicians find pre-cancerous oral lesions but can also produce more false positives.
The document discusses a study evaluating the use of The Paris System (TPS) for reporting urinary cytology specimens. The study reevaluated 46 urinary cytology specimens according to TPS criteria and found fair agreement between TPS categorizations and biopsy results. However, the study identified limitations in TPS criteria for evaluating specimen adequacy and diagnostic categories of atypical urothelial cells and low-grade urothelial neoplasia. The study concludes that revising these TPS criteria could help establish its more widespread use and improve communication between pathologists and clinicians.
The document discusses the drug Avastin and challenges facing its manufacturer Roche/Genentech. It summarizes that while Avastin provides significant benefits to some cancer patients, recent clinical trials found only small average survival benefits or no survival benefits at all for some cancer types. As a result, government agencies and insurers are challenging Roche/Genentech to develop predictive biomarkers to identify the patients most likely to benefit from Avastin treatment. The manufacturer has tested over 150 potential biomarkers but has yet to find effective ones, which could impact patients and the drug's position in personalized cancer treatment.
Oral cancer is the most significant and growing concern worldwide. It ranks as 3rd in India and 8th
largest prevalent form of cancer in world. Oral cancer is often diagnosed, only after reached to an untreatable
stage. Early detection and prevention are the major objectives to control the oral cancer. Histopathology
analysis of biopsied lesion followed by visual examination is the current clinical procedure. This procedure is
invasive and requires a waiting period for the diagnostic results. Thus, there is a need to develop a non-invasive
screening device for oral cancer detection. Optical imaging has emerged as effective tool for detecting
malignant changes associated with oral cancer and also effective in assisting with the detection of oral mucosal
abnormalities. Hence, this paper focuses on development of non-invasive, real-time diagnostic tool based on
optical imaging technique in which involves - fluorescence emission and diffuse reflectance imaging modalities
for screening of oral cancer.
This document discusses infection control in surgical practice. It begins by outlining how surgical procedures expose patients to microorganisms and increase the risk of surgical site infections. Effective infection control requires an organized hospital-wide program to monitor infections, analyze data, implement corrective actions, and educate staff. Key aspects of infection control include proper hand hygiene, appropriate use of antibiotics, sterilization of surgical equipment, and classification of surgical wounds according to infection risk. Host factors like age, health status and operative factors like surgery duration influence infection risk. Strict adherence to infection control standards helps reduce surgical complications and healthcare costs.
This study compared the cost-effectiveness of single-dose versus multiple-dose prophylactic antibiotic regimens for preventing postoperative infections in patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH). The study found that a single dose of cefazoline was as effective at reducing infection rates as multiple doses, with a significantly lower incremental cost-effectiveness ratio. A single dose resulted in lower antibiotic costs without increasing infection rates or hospital stay compared to multiple doses. The results support using a single dose of cefazoline as the most cost-effective prophylactic antibiotic regimen for LAVH.
The document summarizes a study that assessed knowledge about robotics and minimally invasive robotic surgeries amongst otolaryngologists and head & neck onco-surgeons through a questionnaire. The study found that most surgeons viewed robotic surgery as the future of minimally invasive procedures due to advantages like improved visualization, precision, and reduced complications. However, many surgeons also noted that current robotics technology is not yet cost effective, requires specialized training, and more studies are needed to prove beneficial outcomes compared to traditional surgery.
jlme article final on NGS coverage n reimb issues w pat deverkaJennifer Dreyfus
The document discusses the challenges of obtaining coverage and reimbursement for clinical next generation sequencing (NGS) from both public and private health payers. It outlines the evidentiary standards payers use to evaluate new diagnostic tests, including requirements for analytic validity, clinical validity, and clinical utility. However, establishing these standards is difficult for NGS given limitations in analytical validation methods, lack of proficiency testing, and the technology's rapid advancement. Additionally, while regulatory approval for market entry requires less evidence than reimbursement decisions, demand for NGS often outpaces evidence development. The document argues more collaboration is needed between developers and payers to strengthen evidence standards and facilitate clinical integration of NGS.
Clinical research is essential to improving cancer treatment results. It offers patients access to state-of-the-art therapies through clinical trials when standard treatments may not be available or adequate. Latin America represents an important region for clinical research due to its large patient populations and qualified investigators. However, barriers like bureaucratic hurdles can stall development. Addressing discrepancies in cancer care globally through strategies like screening programs and vaccination could help reduce the growing cancer burden in developing areas.
Time To Onset in adverse drug reaction surveillanceGhazaleh Karimi
This thesis investigates the reported time to onset (TTO) of adverse drug reactions (ADRs) in the WHO global safety database VigiBase. It analyzes the median TTOs for 6 common ADRs - agranulocytosis, angioedema, hepatitis, serum sickness, Stevens-Johnson syndrome, and toxic epidermal necrolysis - by ADR, age, gender, and anatomical therapeutic chemical group. The study finds that the reported median TTOs generally correspond to literature but hepatitis had a shorter TTO. It observes only slight variations by gender and age but marked differences by ATC group, with long TTOs for certain drug-ADR pairs and short TTO
Infection Prevention Practices on the Healthcare Frontier: Emerging Models of...bden129
This document summarizes an educational session on infection prevention in emerging ambulatory care delivery models. It discusses trends driving the shift to outpatient care like declining inpatient volumes and growing outpatient encounters. Emerging models described include micro-hospitals, ambulatory surgery centers, and "hospital at home" programs. These models require new staffing approaches for infection prevention. The document outlines challenges for infection preventionists in these settings and resources available to assist them.
This article summarizes a study examining predictors of septic arthritis in adults. The study evaluated 458 knee aspirates from patients with suspected septic arthritis. Twenty-two patients (4.8%) were confirmed to have septic arthritis based on positive synovial fluid cultures. Key findings included:
- Erythrocyte sedimentation rate and serum white blood cell counts were not significantly different between septic arthritis and non-septic groups. Many septic arthritis patients had normal serum WBC counts and were afebrile.
- Mean synovial fluid WBC count was higher in the septic arthritis group (70,581 cells/μL) compared to the non-septic group (
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
Company x anti infective orthopedic implant drug device preliminary final rep...Brand Acumen
The document provides a market research report on the potential market for an anti-infective orthopaedic implant drug-device combination being developed by Company X. It summarizes interviews with 27 key opinion leaders in orthopaedics. The KOLs believe the market potential is high, particularly for procedures with high infection risks like open fractures and spinal/joint surgeries. However, efficacy must be proven through clinical trials demonstrating a significant reduction in infections. Regulatory approval and reimbursement will also depend on cost-effectiveness analyses. Concerns include antibiotic resistance, allergic reactions, and foreign body reactions.
This study aimed to develop an unbiased RNA profiling approach for the early detection of colorectal cancer (CRC) and advanced adenomas (AA) using blood samples. The researchers combined a literature review with microarray analysis of circulating RNA purified from plasma to identify RNA biomarker panels. They tested the panels on two cohorts, detecting CRC with 75% sensitivity and 93% specificity using an 8-gene panel, and detecting AA with 60% sensitivity and 87% specificity using a 2-gene panel. The study demonstrates the feasibility of unbiased molecular diagnosis of CRC and AA from blood and introduces circulating RNA profiling as a potential non-invasive screening approach.
The document discusses a study on reducing errors from multiple intravenous infusions in intensive care units. It notes that ICU environments involve numerous tubes and lines connecting critically ill patients to medical devices. The study found that ICU nurses face high workloads and tasks requiring speed and accuracy. Respondents suggested using color-coded labels and lines to help distinguish look-alike tubes and medications, especially for high-risk drugs. However, the study had concerns that color coding is not standardized and could lead to reliance on color over double checking labels and connections. The commenter argues color-tinted lines should still be considered as a visual aid to improve safety, even without standardization.
Preventing mediastinitis surgical site infections executive summary of the a...ricardovilla
This executive summary outlines guidelines for preventing mediastinitis surgical site infections after cardiac surgery procedures. It discusses risk factors for mediastinitis, recommendations for surveillance and data collection on infection rates, and components of an effective mediastinitis prevention program. The prevention program should involve monitoring compliance with best practices, mitigating risks from non-modifiable patient factors, and implementing evidence-based improvement initiatives to continuously reduce infection rates.
This document summarizes 5 research studies related to preventing post-surgical MRSA infections in acute care hospitals. The studies examined: (1) risk factors for vascular surgical site infections and preventative measures, (2) guidelines for controlling and preventing MRSA in healthcare facilities, (3) non-pharmacological interventions for preventing hospital-acquired infections, (4) the relationship between infection rates, procedures, antimicrobial use and bacterial resistance in an ICU, and (5) the impact of active MRSA screening and decolonization protocols on surgical site infections. The studies found that hand hygiene, screening protocols, limiting unnecessary procedures and antimicrobial use, and bundled infection control strategies can effectively reduce the rate of post-
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Knolisandrai1k
SYSTEMS-LEVEL QUALITY IMPROVEMENT
From Cues to Nudge: A Knowledge-Based Framework
for Surveillance of Healthcare-Associated Infections
Arash Shaban-Nejad1,2 & Hiroshi Mamiya2 & Alexandre Riazanov3 & Alan J. Forster4 &
Christopher J. O. Baker2,5 & Robyn Tamblyn2 & David L. Buckeridge2
Received: 3 June 2015 /Accepted: 30 September 2015 /Published online: 4 November 2015
# Springer Science+Business Media New York 2015
Abstract We propose an integrated semantic web framework
consisting of formal ontologies, web services, a reasoner and a
rule engine that together recommend appropriate level of
patient-care based on the defined semantic rules and guide-
lines. The classification of healthcare-associated infections
within the HAIKU (Hospital Acquired Infections – Knowl-
edge in Use) framework enables hospitals to consistently fol-
low the standards along with their routine clinical practice and
diagnosis coding to improve quality of care and patient safety.
The HAI ontology (HAIO) groups over thousands of codes
into a consistent hierarchy of concepts, along with relation-
ships and axioms to capture knowledge on hospital-associated
infections and complications with focus on the big four types,
surgical site infections (SSIs), catheter-associated urinary tract
infection (CAUTI); hospital-acquired pneumonia, and blood
stream infection. By employing statistical inferencing in our
study we use a set of heuristics to define the rule axioms to
improve the SSI case detection. We also demonstrate how the
occurrence of an SSI is identified using semantic e-triggers.
The e-triggers will be used to improve our risk assessment of
post-operative surgical site infections (SSIs) for patients un-
dergoing certain type of surgeries (e.g., coronary artery bypass
graft surgery (CABG)).
Keywords Ontologies . Knowledge modeling .
Healthcare-associated infections . Surveillance . Semantic
framework . Surgical site infections
Introduction
Healthcare-associated Infections (HAIs) affect millions of
patients around the world, killing hundreds of thousands
and imposing, directly or indirectly, a significant socio-
economic burden on healthcare systems [1]. According
to the Centers for Disease Control (CDC) [2], hospital-
acquired infections in the U.S., where the point preva-
lence of HAIs among hospitalized patients is 4 %, result
in an estimated 1.7 million infections, which lead to as
many as 99,000 deaths and cost up to $45 billion annually
[3, 4]. Similar or higher rates of HAI occur in other coun-
tries as well with an estimated 10.5 % of patients in Ca-
nadian hospitals having an HAI [5]. Clinical assessment
and laboratory testing are generally used to detect and
confirm an infection, identify its origin, and determine
appropriate infection control methods to stop the infection
from spreading within a healthcare institution. Failure to
monitor, and detect HAI in timely manner can delay di-
agnosis, leading to complications (e.g., sepsis), and
allowing an epid ...
SYSTEMS-LEVEL QUALITY IMPROVEMENTFrom Cues to Nudge A Kno.docxdeanmtaylor1545
The document proposes a knowledge-based framework called HAIKU that uses ontologies, web services, and rules to improve surveillance of healthcare-associated infections. The framework focuses on consistently classifying infections like surgical site infections according to standards and guidelines. It uses the HAI ontology to group thousands of codes into a hierarchy of infection concepts and relationships. Statistical analysis and heuristics are used to define rules to improve detection of surgical site infection cases. The framework aims to use "e-triggers" identified through the ontology to better assess risk of postoperative infections for certain surgeries.
This document discusses perioperative infection control and the role of anesthesiologists. It begins with the epidemiology of healthcare-associated infections and surgical site infections, noting their impact and common causative pathogens. The pathophysiology of the inflammatory response to surgical tissue damage is described. Risk factors for surgical site infections are outlined. The document then reviews the microbiology of surgical site infections and the role of anesthesiologists in controlling various infection prevention measures like hand hygiene, environmental disinfection, and aseptic techniques for procedures. Guidelines for optimizing infection control in the operating room anesthesia work area are also summarized.
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...Anil Haripriya
The study revealed good knowledge of infection control procedures but there were problems in practices of
sterilization. Most of them did not separate the needle from the syringe prior to disposal therefore needle
prick injuries were common. So more intensive and regular training programs to surgeons must be included
in the plans of quality control in all hospital and regular inspection from the ministry of health guarantees
good infection control practices
A Quality Improvement Approach To Reduce Unplanned Extubation In The NICU Whi...Emily Smith
This document provides operational definitions for measuring adverse drug events, multidrug-resistant organisms and Clostridium difficile infections, and antibiotic use. It defines adverse drug events as patient harm from medication errors. It defines multidrug-resistant organisms and C. difficile infections according to National Healthcare Safety Network standards and outlines inclusion/exclusion criteria. Antibiotic use is measured by days of antibiotic therapy per 1000 patient days. The document also describes the seven core elements of antibiotic stewardship programs.
Skin infections as targets for antibiotic stewardship 2007 2010Jaime dehais
This study analyzed national emergency department data from 2007-2010 to evaluate antibiotic prescribing practices for skin infections. The key findings were:
1) The percentage of ED visits for skin infections remained stable around 3%, while incision and drainage procedures for abscesses increased slightly.
2) The use of antibiotics targeting community-associated MRSA (CA-MRSA) increased significantly from 61% to 74% of antibiotic regimens for skin infections.
3) Potential quality measures identified were high rates of antibiotic prescribing for discharged abscess patients (87%, indicating overuse) and low rates of CA-MRSA antibiotic inclusion for abscess patients given antibiotics (84%, indicating underuse).
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
This document summarizes presentations and discussions from a working group meeting between the EU and US to propose standards for measuring antimicrobial use in hospitals. It was noted that while surveillance of hospital antimicrobial consumption is becoming more widespread, challenges remain in harmonizing measurement methods between regions. Key challenges include determining the best data sources, units of measurement, and ways to account for differences in patient case mix between hospitals. The group discussed various approaches used in the US and EU and potential standardized indicators, but recognized further work is still needed to develop truly comparable data across multiple healthcare settings and jurisdictions.
NGS for Infectious Disease Diagnostics: An Opportunity for Growth Alira Health
Infectious diseases are a major public health concern causing over 3.5 million deaths worldwide. Diagnosing patients as quickly and effectively as possible is crucial for managing disease outbreaks. Next-generation sequencing (NGS) provides unique capabilities to understand the genetic profile of infectious disease patients that no other technology can match.
Whole-genome metagenomics allows clinicians to take a deeper dive into pathogens by generating big-data about their characteristics. This data can be rapidly analyzed using complex bioinformatics software algorithms to achieve clinical-grade diagnostic accuracy. In a healthcare system shifting towards personalized medicine, NGS can provide clinicians the tools that they need to prescribe individualized treatments to save patients who were previously untreatable. The result is improved quality of care, better treatment regimes, and cost-saving healthcare.
EFFECTS OF MRSA SCREENING ON THE HEALTH.docxwrite5
This document discusses screening patients for methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a bacterium that is difficult to treat and often spreads in healthcare settings. The document notes that current evidence on MRSA screening is limited and does not adequately address outcomes like morbidity, mortality, and resource use. It proposes a new research study on MRSA screening that would incorporate controls for trends and confounding factors, and assess various infection control interventions and their impact on outcomes. The goal would be to develop a more effective strategy for preventing MRSA infections.
knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdfDr. Gawad Alwabr
This study assessed the knowledge and practices of nurses in Sana'a, Yemen regarding needlestick injury prevention measures. A survey of 259 nurses found that 44% had poor knowledge of prevention measures and 76.5% had poor practices. The level of knowledge was significantly associated with gender and hospital, while practices did not significantly vary by demographics. Needlestick injuries were commonly reported, with 37.5% of nurses experiencing one in the last 6 months, but most injuries went unreported. The results indicate that knowledge and prevention practices among nurses need to be improved through education programs.
This document summarizes a study conducted by the World Health Organization to standardize antibiotic sensitivity testing techniques. The study involved 16 laboratories testing the minimum inhibitory concentrations and inhibition zone sizes of 16 bacterial organisms using broth and agar dilution and agar diffusion methods. The results showed that the agar diffusion technique was the most reproducible. The working party then recommended standard reference techniques for performing the three types of tests based on their findings. They also proposed a 4-grade system for clinically reporting bacterial sensitivity results related to minimum inhibitory concentrations and attainable antibiotic levels in vivo.
Central Line-associated Bloodstream Infections.Walden UniversiMaximaSheffield592
Central Line-associated Bloodstream Infections.
Walden University
Dr. Linda Johanson
Francis Mercado
1
Identification and description of the clinical issue.
The clinical issue or problem identified for my study is the central line bloodstream infections (CLABSI)
Central line bloodstream infections(CLABSI) is a health condition that affects many people.
It occurs when pathogens such as bacteria and other germs invade the patients central line after which they get into the bloodstream.
CLABSI related infections are often serious but they can be successfully managed through appropriate treatment approaches.
Femoral central venous catheters and internal jugular along with subclavian central lines have high risk of getting infected.
As per the survey conducted in 2019 about the central line bloodstream infections, it was found that the infection ratio for the said infections was 0.8 per 1000 central line days. This means that over 250000 people across the world bloodstream infections occur yearly and most of them are associated with the presence of intravascular devices.
2
Identification and description of the clinical issue.
Cont.………
Risk factors for Central Line-associated Bloodstream Infections (CLABSI)
presence of gastrostomy tube.
ICU placement of central venous catheter.
Immunosuppression.
Antibiotic therapy(Steffens et al., 2019,).
Poor nutrition;
Multiple invasive procedures.
nonoperative cardiovascular disease.
Central line bloodstream infection is associated with numerous predisposing risk factors. From healthcare stats, it can be said that central line catheters are the common causes of health callings linked to CLABSI. However there are many other risk factors that predispose patients to contracting or developing central line bloodstream infections. Contamination may occur within the central line and this may cause central line related illness. Such contamination include; non interact dressing, contaminated infusion, central venous access devices as well as patient's skin flora.
3
How to develop PICOT question for CLABSI
By analyzing the major components of PICOT, that is P-population, patients, or problem at hand, I-interventions required to solve the issue, C- control or alternative interventions to be compared, O-outcome or the objective to be achieved and T-time framework required to achieve desired outcome(Steffens et al., 2019).
This will help formulate questions such as;
Who and what is the issues that need to be addressed?
What is the proposed intervention and actions to remedy the issue?
What is desired outcome?
How much time is required to realized anticipated results?
To come up with PICOT statement of question on the clinical issues that I had chosen I had to analyze all the components of PICOT to identify their meanings so as to develop a questions that meets PICOT guidelines. The analysis of the PICOT components will help develop questions about the what are kind of population or patients affec ...
This document discusses support vector machines (SVM), a machine learning technique used for classification and regression analysis. SVM works by finding optimal hyperplanes in a multidimensional space that maximize the margin between examples of different classes. It can handle both continuous and categorical variables. The algorithm finds this optimal hyperplane by minimizing an error function during training. Depending on the type of error function used, there are four main types of SVM models: C-SVM classification, nu-SVM classification, epsilon-SVM regression, and nu-SVM regression.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
The document discusses key concepts in developing a Management Information System (MIS) for a hospital. It outlines the components and modules of an MIS, including collecting data on patient registration, admissions/discharges, operating theaters, laboratories, and finances. The summary describes how an MIS helps monitor performance indicators like mortality/morbidity rates, bed occupancy rates, infection rates, and average length of stay to analyze the efficiency and quality of health services. Developing relevant indices and comparing them to norms allows hospitals to identify issues and make improvements.
Guideline for the Prevention of Surgical Site Infection, 2017RubenMariscal3
This guideline provides evidence-based recommendations for preventing surgical site infections (SSIs). Key recommendations include administering preoperative antimicrobial prophylaxis timed with surgery, maintaining normothermia and glycemic control in patients, and avoiding additional antimicrobial doses after surgery. The guideline is intended to improve patient safety by reducing preventable SSIs and incorporating strategies into surgical quality improvement programs. It is based on a systematic review of the literature evaluating various prevention practices and aims to advance the field by assessing areas deemed important by clinical experts.
Similar to What is the Rate of Antibiotic Prescribing by Emergency Department Providers for Cutaneous Abscess? (20)
Guideline for the Prevention of Surgical Site Infection, 2017
What is the Rate of Antibiotic Prescribing by Emergency Department Providers for Cutaneous Abscess?
1. What is the Rate of
Antibiotic Prescribing by
Emergency Department
Providers for Cutaneous
Abscess?
Medical-Mentorship
Abstract
Objective: Cutaneous abscesses aremajor sourceof ED visits.Previous research and
guidelines suggests antibioticsareunnecessary for mostcutaneous abscess,with incision
and drainagealonebeing sufficient. We examine the most recent two years of the
National Hospital Ambulatory Medical CareSurvey (NHAMCS) to determine trends for
antibiotic prescribingfor abscess by ED providers to determine if ED providers are
respondingwith decreasingprescription rates.
Methods: Study Design: retrospective analysis of NHAMCS databases for 2006 and 2007
availablefromthe National Center for Health Statistics.Subjects:all patients fromED with
a firstdiagnosisof Cutaneous Abscess based on the International Classification of
Diseases, Ninth Revision, Clinical Modification, diagnoses codes were selected for analysis.
Measures: estimated total numbers and percentages of patients by year. Analysis:Total
patients with a diagnosisof cutaneous abscess,percentreceivingantibiotics,percent
discharged and received a prescription for an antibiotic,and total number of prescriptions
were calculated independently. Independent sampleT tests were used to compare
differences between years.
Results: Our study demonstrates a disproportionately high rateof antibiotic prescriptions
given at dischargefor cutaneous abscess at80%. Our study shows a trend towards
increasingrates of prescribingantibioticsfor management of abscess,risingfrom80% in
2006 to more than 82% in 2007. Multipleantibiotic prescriptions given atdischargefor
abscess areshown to be increasing, from9.4% of discharges receivingtwo prescriptionsin
2006 to almost11%in 2007.
Conclusions: Emergency Department visits for abscesscontinueto rise,and prescriptions
of antibiotics,especially multipleprescriptions,appear to be risingdespiteevidence that
suggests many abscesses may be treated with incision and drainagealone. Further
research is necessary to determine why this rate remains elevated and whether provider
behavior can be altered to reduce prescribingof antibiotics.
RVGS
Charlie Harless
Roanoke ValleyGovernor’sSchool
1/30/2010
2. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
Objective
Cutaneousabscessesare majorsource of ED visits.Previousresearchandguidelinessuggests
antibioticsare unnecessaryformostcutaneousabscess,withincisionanddrainage alone being
sufficient. We examinethe mostrecenttwoyearsof National Hospital AmbulatoryMedical Care Survey
(NHAMCS) todetermine trendsforantibioticprescribingforabscessbyEDproviderstodetermine if ED
providersare respondingwithdecreasingprescriptionrates.
Introduction
Abscessandsofttissue infectionshave becomeamajorhealthcare concernbothfor the public
and healthcare providers.CA MRSA is a majorcause of skinand softtissue infections.Anabscessisan
enclosedcollectionof liquefiedtissue,knownaspus,somewhere inthe body.Itisthe resultof the
body'sdefensive reactiontoforeignmaterial. (see appendix1-1)
There are twotypesof abscesses,septicandsterile.Mostabscessesare septic,whichmeans
that theyare the resultof an infection.Septicabscessescanoccur anywhere inthe body.Onlyagerm
and the body'simmune response are required.Inresponsetothe invadinggerm, whitebloodcells
gatherat the infectedsite andbeginproducingchemicalscalledenzymesthatattackthe germ by
digestingit.These enzymesactlike acid,killingthe germsandbreakingthemdownintosmall pieces
that can be pickedupby the circulationandeliminatedfromthe body.Unfortunately,these chemicals
alsodigestbodytissues.Inmostcases,the germproducessimilarchemicals.The resultis thick,yellow
liquid— pus—containingdigestedgerms,digestedtissue,whitebloodcells,andenzymes.
Staphor MRSA are oftenthe bacteriathat cause cutaneousabscesses.Staphbacteriaare
resistanttoantibiotics.MRSA isa type of staph that isresistanttoantibioticscalledbeta-lactams.Beta-
lactam antibioticsinclude methicillin.While25% to 30% of the populationiscolonizedwithstaph,
approximately1%iscolonizedwithMRSA. MRSA infectionsthatare acquiredbypersonswhohave not
beenrecently(withinthe pastyear) hospitalizedorhada medical procedure (suchasdialysis,surgery,
3. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
catheters) are knownasCA-MRSA infections.StaphorMRSA infectionsinthe communityare usually
manifestedasskininfections,suchaspimplesandboils,andoccurinotherwise healthypeople.
National datasuggeststhatover3 millionvisitstoUSEmergencyDepartmentswere for
infectionsof the skin,the 7thleadingcause of visitstoEmergencyDepartments.Over2.5millionvisits
were forabscess(1). MethicillinResistant StaphylococcusAureus(MRSA) isthe mostcommoncause of
cutaneousabscessandthe rate of infectioncontinuestorise.(2,3, 4)
PreviousworkbyTaira,using2005 NHAMCS data,suggeststhatup to 50% of ED visitsforsoft
tissue infectionsandabscesseswere treatedwiththe additionof antibiotics(5). Chambers,etal found
ratesof 77-86% inyears upto 2005 usingdifferentmethodologywiththe same NHAMCSdata.(4)
Remote andrecentliterature overthe past30 years,aswell asmore recentguidelines from2006,
includingthose fromthe InfectiousDiseasesSociety of America and theCentersfor Disease Controland
Prevention supportthe opinionthatabscessescanbe effectivelytreatedwithincisionanddrainage (see
appendix1-2) alone;andactuallyresolve (see appendix1-3) atthe same rate as those dischargedwith
an addedantibioticprescription.(6-10)
It isunclearif providerbehaviorsare changingtowardsthe managementof antibiotic
prescribingforcutaneousabscessbasedonthisevidence.If ratesof prescribingare notdropping,
interventionstochange practice patternsare needed. Overprescriptionof antibioticsisamajor cause
of antibioticresistance.(11)
Thisstudycomparestwo recentyearsof national data(2006 and 2007) to learn ratesof
prescribingpatternsof antibioticsforpatientswithcutaneousabscessseenandtreatedinU.S.EDs.
Methods
NHAMCS encompassesanational probabilitysampleof visitstoUS hospital emergencyand
outpatientdepartmentsbythe Divisionof HealthCare Statisticsof the National CenterforHealth
4. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
Statistics,CentersforDisease ControlandPrevention andincludesEDandOutpatientdatasets(ED and
OPD).For the purposesof ourstudy,we usedonlythe ED data.
We identifiedacutaneousabscessbythe InternationalClassification of Diseases,Ninth Revision,
Clinical Modification (ICD9),diagnosescodesinthe primarydiagnosisfield.ICD9broadcodes680
(carbuncle andfuruncle);681(cellulitisandabscessof fingerandtoe);682 (othercellulitisand
abscesses);and685 (pilonidal cystswithabscess)were usedtonarrow the systemsdata.
The Multum(CernerMultum,inc) classificationof therapeuticclasseswasusedtoidentify
antibioticsgiven.Antibioticswere identifiedasbeinggiveninthe EDor as a prescriptionforall
dischargedpatientsanddischarge prescriptionswere categorizedasnone,one,or2 or more
prescriptionsforantibioticsatdischarge.We excludedall topical antibioticsexceptbactroban. Total
patientswithadiagnosisof cutaneousabscess,percentreceivingantibiotics,percentof patients
receivingadiagnosisof abscesswhowere dischargedandreceivedaprescriptionforanantibioticand
total numberof prescriptionswere calculatedindependently.Independentsample T testswere usedto
compare differencesbetweenyears.
2007 NHAMCS survey alsoincludedanew surveyitemthatdocumentedwhetherincisionand
drainage wasperformedinthe ED. The occurrence of a procedure forIncisionanddrainage inthe
NHAMCS data setlikelyrepresents "true"abscesses andthus,discharge antibioticprescriptionsare
likelyasaccurate,or more so,than standardreliance onICD9 coding to identifyabscess. We calculated
the percentage of patients receivingantibioticswhounderwentIncisionanddrainage andused
dependentTtestfor comparisonwithsignificance atthe 95% confidence interval (p<0.05).
Percentof dischargedpatientswithadiagnosisof abscesswere computedbyusingweights
providedbyNHAMCSdocumentation.Confidence intervalswerecalculatedforpercentagesusing
standarderrors (SE’s),whichwere estimatedusingmethodsdescribedbyNHAMCSsurvey
documentation. AllanalysiswasperformedusingSTATA 10.1 forWindowsXP(StataCorpLP, College
5. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
Station,TX) (see appendix3-1).Comparisonof yearswasperformedusingatwo tailedT- testat the
95% confidence interval(p<0.05). Data Processingandcodingwere performedbyDamonKuehl,MD,
CarilionClinic,VTCSchool of Medicine,Departmentof EmergencyMedicine.
Results
In 2006 there wasa total of 119.2millionED visitsand116.8millionED visitsin2007. Of these
patients,3.45millionEDvisitswere forabscess(2.9%) in2006 and 3.56 millionvisitsforabscess(3.0%) in
2007.
Excludingall admittedpatients withdiagnosisof abscess,there were3.02 millionpatients
dischargedwithadiagnosisof abscessin2006 and3.03 millionin2007.
Of the 3.02millionpatientsfrom2006, 80.2% receivedaprescriptionforanantibioticupon
discharge.In2007, the total was 82.3%, representingastatisticallysignificantincrease inthe numberof
patientsdiagnosedwithabscesswhowere dischargedwithaprescriptionforanantibiotic the
3.03millionpatients (p<0.05) (see appendix2-1)
In 2007 the NHAMCS surveyincludedanew surveyitemthatdocumentedwhetherincisionand
drainage wasperformedinthe ED. There were 1.17 millionincisionanddrainage proceduresperformed
inthe ED and 80% of patientswhoreceivedincisionanddrainage foracutaneousabscessinthe ED
where givenatleastone antibioticprescriptionupondischarge.
Ourdata includednoraw cellsof lessthan30 observationsandnogrouphad standarderrors
greaterthan 10%-all lessthanthe 30% reportedasbeingaccurate by NHAMCSsurveydocumentation.
Discussions
Our studydemonstratesadisproportionatelyhighrate of antibioticprescriptionsforcutaneous
abscess.Ourrate of 80% is significantlyhigherthancomparable studiesusingdataas recentas 2005 (5)
but correlateswithChambers.More importantly,ourstudyshowsatrendtowardsincreasingratesof
prescribingantibioticsformanagementof abscess,risingfrom80% in2006 to more than 82% in2007.
6. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
Anotherconcerningbehavior identifiedinourstudyismultiple antibioticprescriptions givenat
discharge forabscess,withanincrease from9.4% of dischargesreceivingtwoprescriptionsin2006 to
almost11% in2007.
Analyzingthe groupundergoingprocedure forincisionanddrainage alone asanidentifierof
patients beingtreatedwith antibioticsforabscesscorrelateswell with ourICD9codingmethodfor
determine antibioticratesof prescribing. We feel thatthispercentage of antibioticprescribingis
particularlytelling,as mentionof the procedure "Incisionanddrainage"inthe NHAMCSdatasetlikely
represents "true"abscesses andthus,discharge antibioticprescriptionsare likelyasaccurate,or more
so,than standardreliance onICD9 coding to identifyabscess.
Evidence thatincisionanddrainage of cutaneousabscesses inthe CAMRSA eraissufficient
alone hasbeenwell documentedinmultiple studiesandclinicalguidelines. Whilenumerousstudies
have shownantibiotictreatmentisprobablyunnecessaryformostsimpleskinabscesses(6-10),
adoptionof suchrecommendationsmayprove tobe difficult. (11,12) High ratesof prescribing
antibioticsforabscessesare likelymulti-factorial innature.(12) CAMRSA has garneredmuchpressand
concernby providersandpatientsalike.Fearof pooroutcomesandconcernfor risk avoidance by
providersdrive unnecessaryuse of antibiotics(11-13). We alsobelieveasignificantcause amongED
providersisthe facttheyoftensee abscessesattheirinitial states,orat theirworst,withlarge amounts
of erythemaassociatedwithan un-drainedabscesscavity. EDproviderslikelyhave significantconcern
for patientfollowupandappearto be erringon givingantibioticswithaperceptionof safety. Itisalso
well understoodthatpatientandsocietal expectationsof receivinganantibioticforanykindof infection
are powerful driversof antibioticoveruseandprovideradoptionof guidelinesandchangingprescribing
practiceshave alsoshownto be slowanddifficult(11,12-14) There are barriersto convincingproviders
and patients thatantibioticsare notalwaysnecessaryinthe treatmentof skinabscesses,despitethe
7. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
widespreadknowledgeregardingthe excessiveandunnecessaryuse of antibioticscontributionto
antibioticresistance.
Limitations
Our studyhas several limitations includingthose commontosecondaryanalysisof alarge
probabilityweighteddataset. While the NHAMCSdatahas beenshowntobe an accurate
representationof EDvisitsitreliesonretrospective dataandcodingforvariousdiseasescanonly
approximate the true diagnosisatdischarge ortreatment. Inaddition,inusingICD9 codingour
methodologycapturesadiagnosisof abscessbutdoesnotconclusivelyprovethatthe antibioticwas
prescribedforthatpurpose. We feel we have addressedsome of these concernsbyaddingthe 2007
incisionanddrainage ratesof prescribing,whichcorrelateverycloselywiththe ratesof prescribingfor
ICD9 codeddiagnosisof abscess.
Conclusions
EmergencyDepartmentvisitsforabscesscontinue torise,andprescription of antibiotics
appearsto be rising,or at minimumbeingmaintainedata veryhighlevel despiteevidence thatsuggests
manyabscessesmaybe treatedwithincisionanddrainage alone. Ourresearchsuggesturgentresearch
isnecessaryto both understandthe reasonsforthe continuedhighrate of antibioticprescribingand
methodsforchangingbehaviorsamongproviderstoreduce antibioticprescribingforcutaneous
abscess.
Future Studies
Our studysuggestsa needforstudiesorinterventionstoreduce antibioticprescribingbyED
providersforthe managementof cutaneousabscesses.Additionalworkisneededtoreduce what
appearsto be a growingtrendof prescribingantibioticsformostcutaneousabscessestopreventwhat
will be aninevitablegrowingproblemof resistance tocurrentlyeffective antibioticsthattreatcommon
pathogensassociatedwiththisdisease. CarilionClinicEDresearcherswill be usingthisdatatopursue
8. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
fundingfora large clinical trial thatwill use apreviouslyprovenmethodforreducingprescribingratesof
antibioticsinchildrenwithearinfections(the"WaitandSee"process),inanattempttoreduce
prescriptionof antibioticsbyprovidersforabscess.
9. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
References
1. Nawar EW, NiskaRW, XuJ. National Hospital AmbulatoryMedical Care Survey:2005 emergency
departmentsummary.Advanceddatafromvital andhealthstatistics;no.386 Hyattsville MD:National
CenterforhealthCare Statistics;2007.
2. GorwitzRJ, JerniganDB,PowersJH,et al,and the Participantsinthe CDC-ConvenedExperts’Meeting
on Managementof MRSA inthe Community.Summaryof anexperts’meetingconvenedbythe Centers
for Disease Control andPrevention.2006. at:http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html
3. Moran G.J., KrishnadasanA., GorwitzR.J., etal: Methicillin-resistantS.aureusinfectionsamong
patientsinthe emergencydepartment. N Engl J Med. 355. 666-674.2006;
4. ChambersHF, HershAL, Maselli JH,GonzalesR.National TrendsinAmbulatoryVisitsandAntibiotic
PrescribingforSkinandSoft-TissueInfections. Arch Intern Med. 2008;168(14):1585-1591.
5. Taira BR, SingerAJ,Thode HC, Lee CC. National Epidemiology of CutaneousAbscesses:1996 to 2005.
AJEM(2009);27:289 292.
6. HankinA, EverettWW, Are antibioticsnecessaryafterincisionanddrainage of acutaneous
abscess?Ann Emerg Med - 01-JUL-2007; 50(1): 49-51
7. StevensD.L., BisnoA.L., ChambersH.F., etal: Practice guidelinesforthe diagnosisandmanagement
of skinandsoft-tissue infections. Clin InfectDis. 41. 1373-1406.2005;
8. Macfie J., HarveyJ.: The treatmentof acute superficial abscesses:aprospective clinical trial. BrJ
Surg. 64. 264-266.1977;
9. Llera J.L., LevyR.C.: Treatmentof cutaneousabscess:adouble-blindclinical study. Ann Emerg
Med. 14. 15-19.1985;
10. RajendranP.M., YoungD., Maurer T., et al: Treatmentof abscessesinthe eraof methicillinresistant
Staphylococcusaureus:are antibioticsnecessary[abstract]. JAmColl Surg. 203. (suppl 1):S62.2006;
11. http://www.cdc.gov/drugresistance/ accessed1/25/2010
12. NyquistCA,GonzalesR,SteinerJF,Sande MA.Antibioticprescribingforchildrenwithcolds,upper
respiratorytract infections,andbronchitis. JAMA. 1998;279:875-877.
13. BenjaminSchwartz,MD;Arch G. Mainous III,PhD;S. Michael Marcy, MD. Why Do Physicians
Prescribe AntibioticsforChildrenWithUpperRespiratoryTractInfections?
JAMA.1998;279:881-882.
14. HrisosS, EcclesM, JohnstonM,Francis J,KanerEF, SteenN,Grimshaw J. Anintervention modeling
experimenttochange GPs'intentionstoimplementevidence-basedpractice:usingtheory-based
interventionstopromote GPmanagementof upperrespiratorytractinfectionwithoutprescribing
antibiotics#2. BMC HealthServRes2008;8:10.
10. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
Appendix:
1-1
Picture 1-1 showsa patientwith a cutaneous abscessontheirouter-thighthathasnot yetbeentreated.
In thispicture twomainareas of the abscesscan be clearlyidentified:the fluctuant(fluidfilledpocket)
area inthe centerwhichis a pusfilledcavitarylesion, andthe surrounding areaof arythematious (red
coloration) induration (firm)of inflammatorychanges.Spontaneously(withoutbeingincised) draining
serosanguinous(blood) purulent(pus)discharge canbe seenaswell.Thissoft-tissue infection needsto
incisedanddrained.
11. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
1-2
Picture 1-2 showsa cutaneousabscessfoundonthe mid-dorsumof the foot.Thisabscesshasalready
beenincisedandpackedwithiodo-formgauze toenable the abscesstodrainwithoutscabbingupand
closingoff.
12. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
1-3
Picture 1-3 showsa cutaneousabscessthathas beensuccessfullybeentreatedwithincisionand
drainage.Notice the openhealthygranulationtissue base (sunkencratershaped).Thisabscessappears
to be healingappropriately
.
13. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
2-1
2-1 Graphs the ratesof patientswhoreceivedantibioticsuponbeingdischargedwithadifferential of
cutaneousabscessforthe years2006 and 2007 as determinedfromNHAMCSdatasets withconfidence
intervals. The total numberof patientsdischargedwithaprescriptionof anantibioticfora cutaneous
abscessis showninred,alongwithpercentof patientsgivenanantibiotic.The lowerbar(blue)
representsthose dischargedwithnoantibiotic prescription. The discrepancyinthe numberof patients
receivingprescriptionsupondischarge andthose withnoprescriptionnotaddingupto100% is
explainedbythe slimnumberof patientswhowereadmittedintothe hospital because of theirabscess.
17.7% 19.8%
80.2%
(2.42 million)
82.3%
(2.86 million)
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
2006 2007
Patientdischargesforabscess(Millions)
Percent of ED Visits for Abscess Receiving
Discharge Prescription for an Antibiotic (2006-07)
Given an Antibiotic Prescription
at Discharge
No Prescription
14. What is the Rate ofAntibioticPrescribingby Emergency Department
Providersfor CutaneousAbscess? Charlie Harless
3-1
3-1 isa screenshot takenwhile conductingstatisticalanalysisonthe NHAMCSdata inthe program
STATA. Seenhere inthe middle of the screenisanoutputgraph showingcalculatedvalues.InSTATA,0’s
and 1’s are usedtosymbolize “yes”or“no” inansweringsimplequestionssuchas,“Didthe patient
receive aprescriptionupondischarge?”