Study: Widespread Antibiotic Overprescribing by Outpatient Clinics

A new study reveals that outpatient clinics are prescribing antibiotics at an unwarranted rate, according to a news release from the Infectious Diseases Society of America. 

The research, which was presented at IDWeek 2018 and funded by the Agency for Healthcare Research and Quality, examined more than half a million prescriptions given to nearly 280,000 patients by more than 500 outpatient clinics from November 2015 through October 2017.

Key takeaways from the study are as follows:

  • 46% of antibiotics were prescribed without an infection-related diagnosis.

  • 20% of prescriptions were provided without an in-person visit.

  • For those antibiotics prescribed outside of an in-person visit, most were by phone, with others completed through electronic health record system.

  • 29% of prescriptions noted something other than an infection diagnosis (e.g., high blood pressure, annual visit).

  • 17% percent of prescriptions were written without a diagnosis indicated.

  • For those prescriptions without a diagnosis, researchers speculated that while some may be tied to poor diagnosis coding, much of it likely reflects prescribing for vague or inappropriate reasons (e.g., infections caused by viruses).

In the release, Jeffrey Linder, MD, MPH, lead author of the study, said, "We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom. We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all. When you consider about 80% of antibiotics are prescribed on an outpatient basis, that's a concern."

The results of this study echo those of many others pointing to antibiotic misuse as a significant issue. Prescribing the correct dose of the correct antibiotic at the appropriate time and for the correct duration can help fight antibiotic resistance, protect patients from unnecessary side effects and help ensure antibiotics will work when they are needed. 

If your organization requires expert assistance with developing and maintaining an antimicrobial stewardship program, contact Infection Control Consulting Services (ICCS). ICCS is a national consulting firm providing services to healthcare facilities including outpatient clinics, ambulatory surgery centers, hospitals and nursing homes. 

CDC Publishes New Healthcare-Associated Infection Progress Report

CDC Publishes New Healthcare-Associated Infection Progress Report

The Centers for Disease Control and Prevention (CDC) has published its 2016 Healthcare-Associated Infection Progress Report. The report provides year-to-year progress on the prevention of key healthcare-associated infections (HAIs) in acute care hospitals, long-term acute care hospitals and inpatient rehabilitation facilities.

The HAI Progress Report consists of national and state-by-state summaries of HAIs across the settings. The 2016 HAI Progress Report is the first report to measure year-to-year HAI prevention progress using the 2015 baseline (reference point). 

While progress was seen in some areas, improvements are greatly needed in others. Here are some national highlights from the 2016 HAI Progress Report:

Acute Care Hospitals

  • About 11% decrease in central line-associated bloodstream infections (CLABSIs) 

  • About 7% decrease in catheter-associated urinary tract infections (CAUTIs) 

  • About 13% decrease in abdominal hysterectomy surgical site infections (SSIs) 

  • About 7% decrease in colon surgery SSIs 

  • About 7% decrease in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia 

  • About 8% decrease in Clostridium difficile (C. difficile) infections

Long-Term Acute Care Hospitals

  • About 4% decrease in CLABSIs

  • About 15% decrease in C. difficile infections

  • About 5% increase in ventilator-associated events (VAEs) 

Inpatient Rehabilitation Facilities

  • About 7% increase in CAUTIs

  • About 17% increase in MRSA bacteremia

  • About 4% decrease in C. difficile infections

Working toward the elimination of HAIs is a CDC priority, and should be a priority of all healthcare organizations. Data indicates that on any given day, about 1 in 25 hospital patients has at least one HAI. They lead to the loss of tens of thousands of lives and cost the U.S. health care system billions of dollars annually.

If your organization needs assistance with developing, implementing and maintaining evidence-based infection prevention and control programs, contact Infection Control Consulting Services (ICCS), a nationally renowned consulting firm offering expert services to healthcare facilities and organizations.

Patient Infection Risks Prominent on ECRI Annual List of Health Tech Hazards

ECRI Institute has included three potential sources of patient infections on its "2019 Top 10 Health Technology Hazards" list.

They are as follows:

  • #2: Mattresses Remaining Contaminated After Cleaning. ECRI notes, "Blood and other body fluids that remain on, or within, mattresses or mattress covers after cleaning can contact subsequent patients, posing an infection risk."

  • #3: Retained Surgical Sponges. ECRI notes, "Surgical sponges that are unintentionally left inside the patient after the surgical site is closed can lead to infection and other serious complications, including the need for secondary operations."

  • #5: Recontamination of Endoscopes After Disinfection. ECRI notes, "Failure to precisely follow a robust reprocessing protocol can lead to debilitating or even fatal infections. Less well known is that improper handling and storage practices can recontaminate previously disinfected scopes, heightening the risk of patient infections."

Rounding out the top 5 were "Hackers Exploiting Remote Access Vulnerabilities" (#1) and "Improperly Set Ventilator Alarms" (#5).

To select topics for its 2019 list, ECRI stated it accepted nominations from ECRI engineers, scientists, clinicians and other patient safety analysts and also considered health-technology-related problem reports received through its Problem Reporting Network and through data that participating facilities share with its patient safety organization. ECRI hopes its lists can serve as a "starting point for discussions, helping healthcare organizations plan and prioritize their patient safety efforts," according to news release.

Infection risks also took top spots in ECRI's 2018 health technology hazards list, with endoscope reprocessing at #2, mattress and mattress cover contamination at #3 and improper cleaning and device failures at #5.

In a recent column for Becker's Clinical Leadership & Infection Control, Infection Control Consulting Services (ICCS) Founder and President Phenelle Segal, RN, CIC, FAPIC, shared common infection prevention and control deficiency findings in healthcare facilities. It's not surprising to see how deficiencies identified in this article can contribute to patient infection risks highlighted in ECRI's report.

The 2019 Top 10 Health Technology Hazards executive brief is available for complimentary download at www.ecri.org/2019hazards.

September 2018 Issue of Infection Prevention & Control Newsletter Published

The September 2018 issue of the ICCS Infection Prevention & Control Newsletter has published.

The issue identifies some of the most pertinent infection prevention and control news from September. Topics covered in this issue include common deficiencies, challenging Joint Commission standards, surgical site infections, high-touch surfaces, sepsis, privacy curtains, jet air dryers and antibiotic resistance.

Access the issue by clicking here.

Receive the free ICCS Newsletter by signing up here.

Phenelle Segal Writes Column on Infection Prevention and Control Deficiencies

Phenelle Segal, RN, CIC, FAPIC, Founder and President of Infection Control Consulting Services (ICCS), has contributed a column to Becker's Clinical Leadership & Infection Control discussing infection prevention and infection control deficiencies.

The story focuses on 10 of the most common deficiencies cited by Medicare and/or accreditation surveys across the continuum of care as observed by ICCS consultants from January 2018 through August 2018.

Access the column on deficiency findings.