Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

A multimodal intervention program to control a long-term Acinetobacter baumannii endemic in a tertiary care hospital.

Background: Acinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs).The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact. Methods: Design: Quasi-experimental intervention study based on open cohorts.Setting: Public tertiary referral centre. Period: January 2009-August 2017.Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings.Analysis: joinpoint regression and interrupted time-series analysis. Results: The intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = - 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs. Conclusion: The multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.

Manual para la elaboración de documentos basados en la evidencia. Herramientas derivadas del conocimiento científico / Handbook for the preparation of evidence-based documents. Tools derived from scientific knowledge

Objetivo. El manual pretende ser una guía, accesible y fácil de consultar, que oriente a los profesionales en la elaboración o adaptación de documentos basados en la evidencia que ayuden a la estandarización de la práctica clínica y a la toma de decisiones velando siempre por la calidad de la misma de forma que siga unos referentes establecidos. Material y métodos. La Comisión de Atención Sanitaria Basada en la Evidencia (CASBE), perteneciente a la estructura de calidad del Hospital Universitario Virgen del Rocío, propuso elaborar un manual para la elaboración de documentos basados en la evidencia que incorpore la relación de productos, la descripción de sus características, atributos, utilidad, metodología de elaboración y ámbito de aplicación de cada uno de ellos. Resultados. El manual contiene 7 herramientas basadas en la evidencia, un capítulo sobre metodología de análisis crítico de la literatura científica, un capítulo con recursos en Internet y anexos con herramientas de evaluación. Conclusiones. Este manual ofrece grandes oportunidades para la mejora de la calidad a los clínicos como guía de estandarización de la práctica asistencial, a los gestores como estrategia para promover y fomentar la elaboración de documentos que ayuden a reducir la variabilidad de la práctica clínica y a los pacientes la oportunidad de participar en la planificación de sus cuidados(AU)

Objectives. This handbook is intended to be an accessible, easy-to-consult guide to help professionals produce or adapt Evidence-Based Documents. Such documents will help standardize both clinical practice and decision-making, the quality always being monitored in such a way that established references are complied with. Materials and methods. Evidence-Based Health Care Committee, a member of “Virgen del Rocío” University Hospital quality structure, proposed the preparation of a handbook to produce Evidence-Based Documents including: a description of products, characteristics, qualities, uses, methodology of production, and application scope of every one of them. Results. The handbook consists of seven Evidence-Based tools, one chapter on critical analysis methodology of scientific literature, one chapter with internet resources, and some appendices with different assessment tools. Conclusions. This Handbook provides general practitioners with a great opportunity to improve quality and as a guideline to standardize clinical healthcare, and managers with a strategy to promote and encourage the development of documents in an effort to reduce clinical practice variability, as well as giving patients the opportunity of taking part in planning their own care(AU)

[Handbook for the preparation of evidence-based documents. Tools derived from scientific knowledge]. / Manual para la elaboración de documentos basados en la evidencia. Herramientas derivadas del conocimiento científico.

OBJECTIVES: This handbook is intended to be an accessible, easy-to-consult guide to help professionals produce or adapt Evidence-Based Documents. Such documents will help standardize both clinical practice and decision-making, the quality always being monitored in such a way that established references are complied with. MATERIALS AND METHODS: Evidence-Based Health Care Committee, a member of "Virgen del Rocío" University Hospital quality structure, proposed the preparation of a handbook to produce Evidence-Based Documents including: a description of products, characteristics, qualities, uses, methodology of production, and application scope of every one of them. RESULTS: The handbook consists of seven Evidence-Based tools, one chapter on critical analysis methodology of scientific literature, one chapter with internet resources, and some appendices with different assessment tools. CONCLUSIONS: This Handbook provides general practitioners with a great opportunity to improve quality and as a guideline to standardize clinical healthcare, and managers with a strategy to promote and encourage the development of documents in an effort to reduce clinical practice variability, as well as giving patients the opportunity of taking part in planning their own care.