Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum ß-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus.

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase (ESBL)-producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P<0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P=0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens.

Interrater reliability of hand-held dynamometry: effects of rater gender, body weight, and grip strength.

Clinicians and authors of previous publications have not reached agreement on the interrater reliability of dynametric strength testing. This study investigates the effects of gender, body weight, and grip strength on the reliability of hand-held dynametric strength measurements. Ten male and 10 female raters tested five muscle groups on the same two subjects (one male and one female) with a Chatillon Series D hand-held, spring-scale dynamometer. Both the raters and the test subjects were blinded to the dynametric output readings throughout the testing. Interrater reliability was good for all tests except for female raters when testing the male subjects' stronger muscle groups. Standard deviations were 61% and 50% greater for female vs. male raters for elbow flexors and knee extensors, respectively. Female raters' body weight had a significant correlation with torque when testing male subjects' wrist extensors, ankle dorsiflexors, and knee extensors (r > 0.64). Likewise, female raters' grip strength significantly correlated with torque when testing males' wrist extensors and elbow flexors (r >/= 0.71). The results indicate that gender, body weight, and grip strength affect a rater's ability to stabilize a hand-held dynamometer and could influence reliability when testing stronger muscle groups. J Orthop Sports Phys Ther 1992;16(2):74-81.