On 10/28/2009 Tom Talbot - JCR said:

Gezelle -- Good question -- There are no hard and fast requirements on this one way or the other. I will say that it is important to balance the risk of MDRO spread with aspects of the individual patients therapy (e.g. PT in the hallway). I think that MDRO+ patients on isolation should be limited as to how often they come out of their rooms, and when they leave, would make sure hand hygiene is performed by the patient, that the patient dons a gown and gloves, and that the provider working with the patients does both as well. In the event of a unit outbreak of an MDRO, may consider more stringent precautions and limit MDRO pts to room unless necessary.

On 10/28/2009 Gezelle said:

Good day. I would like to know if it is allowed to bring patients with known MRSA or MDRO outside their room for wheelchair mobility or for ambulation around the unit/ward?

On 10/27/2009 Tom Talbot - JCR said:

Thank you everyone for participating today - we look forward to our next interactive blog on November 10th!

On 10/27/2009 Tom Talbot - JCR said:

Lisa -- Very good question. The issue of MRSA colonization in the pre-surgical patient is a good one. As you know, surgical site infections are most often due to the patient's own bacteria. Knowing which patients are colonized with MRSA could help guide specific interventions to reduce MRSA infections. Specifically, you could give MRSA-specific antibiotics as part of the prophylactic regimen. Decolonization is another issue -- there are so many questions as to which regimen is preferred, how often do you apply the agents, how much time do you have before surgery, etc. As for surgeon buy-in, I think the best way is with data and a plan that shows interventions to prevent MRSA will not impact dramatically their care of the patient -- I know, easier said than done . . .

On 10/27/2009 Tom Talbot - JCR said:

Cheryl -- Sorry -- Missed you too! I think you will know if your education is effective if you see canges in utilization, higher rates of de-escalation, more conversion over to oral options, etc. The key is have defined metrics to track to assess impact. Could also look at MDRO rates, but since other factors also impact those, may have a harder time seeing directly correlated assessments of education on stewardship.

On 10/27/2009 Tom Talbot - JCR said:

Kent -- Sorry, I missed your question! The question as to which senior leaders should review the clinical microbiology data is a good one. I think it is important to have content experts in infection control and hospital epidemiology be the points in examining the data at a granular level. Then, they need to identify and summarize concerning trends or issues (as well as acknowledge success stories) and present to key leaders (could include Quality Officer, Pt Safety leaders, CEOs, CNOs). The key is making sure leaders are not hit with tons of data without interpretation -- key is summarize and present the major issues.

On 10/27/2009 Tom Talbot - JCR said:

Bob -- Good question. There are several identified risk factors for acquisition and development of infection with C difficile. These include exposure to antibiotics in general, exposure to specific classes of antibiotics (quinolones and broader-spectrum antibiotics that target Gram negatives and anaerobes in particular), underlying comorbid illness, staying in a hospital room previously housing a C diff + patient (prob due to substandard environmental cleaning), etc. Also note that with the newly recognized strain of C diff that produces far more of the key toxins and has resulted in more fulminent disease, infection has occurred in persons without any antibiotic exposure.

On 10/27/2009 Lisa said:

I work at a surgery hospital. We have many patients coming in for elective procedures with a known hx of MRSA, many probably CA. Wouldn't decolonization be beneficial in this population who are about to have surgery? If so, how do you get the surgeons to buy it to this?

On 10/27/2009 Bob Rose said:

What, besides the amount of antibiotic received, increases the risk of CDAD for a patient?

On 10/27/2009 Tom Talbot - JCR said:

Dorie -- There are a growing number of studies that have shown that stewardship programs can reduce costs. This can occur in several ways -- 1) changing from more costly IV antibiotics to less expensive oral options if the patient can absord and take oral meds; 2) de-escalation from broad-spectrum antibiotics to more narrow-spectrum choices (which are often less expensive), and 3) not starting antibiotics inappropriately in the first place.

On 10/27/2009 Cheryl said:

How does the Antibiotic Stewardship program know their education to the medical staff is effective?

On 10/27/2009 Kent Willow said:

Which senior leaders should be reviewing the clinical microbiology data? - Which data should you show them that is both consolidated and effective?

On 10/27/2009 Dorie said:

How do we know that antibiotic stewardship programs actually save money?

On 10/27/2009 Tom Talbot - TJC said:

Louise -- Sorry -- nothing is wrong -- this is just a weblog live discussion. There's no formal program or audio content -- just a forum to ask any question you'd liek about MDRO.

On 10/27/2009 Louise said:

I am not able to hear anything on this Live Interactive Session today. What's wrong.

On 10/27/2009 Tom Talbot - TJC said:

Glen and Darcy -- Great minds think alike! An antimicrobial stewardship program is a program that focuses on antimicrobial use at a facility with the aim to reduce inappropriate and unnecessary utilization of antimicrobials. These programs come in various shapes, sizes and flavors -- some may choose to focus on specific type of antibiotics only (high cost, high toxic, limited supply), some may focus on scaling back broad antibiotics when a pathogen or its susceptibilities are identified, and others may focus on making sure a diverse array of antibiotics are used rather than the same two drugs for every infection (thus reducing selection pressure). The most successful programs are ones that are multi-disciplinary -- involving the key leaders and experts including pharmacy, infectious diseases, infection control, critical care, specialized populations, and pediatrics. Surprisingly, not every program includes an array of disciplines -- but they probably should to get buy-in and traction of efforts.

On 10/27/2009 Darcy said:

A stewardship program involves a multi-disciplinary approach - don't all organizations use a multi-disciplinary approach when it comes using antibiotic agents?

On 10/27/2009 Glen said:

IC Professionals at my organization speak a lot about Antibiotic Stewardship programs - what is an antibiotic stewardship program?

On 10/27/2009 Tom Talbot - JCR said:

Joan -- Thanks for joining the chat! As part of the National Patient Safety Goal for MDRO control, as you know, there is a requirement for education of patients with MDRO on aspects of infection prevention. In order to show compliance with that component of the NPSG, I think you do need to document that the education was provided (but we can also get the formal word from TJC if that helps). Thanks!

On 10/27/2009 Karen Iversen - JCR said:

Thank you for your question, Joan. Dr. Talbot will be on the blog shortly and will be happy to answer this.

On 10/27/2009 joan said:

does Multiple Drug resistant organism information given to patients need to be documented.