Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany
Background: In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a...
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doaj-985b05e8a0824775a6804ca88905d16b2020-12-05T04:19:52ZengElsevierJournal of Infection and Public Health1876-03412020-12-01131219461950Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in GermanyIrit Nachtigall0Sascha Tafelski1Edwin Heucke2Oliver Witzke3Annedore Staack4Sabine Recknagel-Friese5Christine Geffers6Marzia Bonsignore7Department for Hygiene, Helios Kliniken Ost and Bad Saarow, Pieskower Str. 33, 15526 Bad Saarow, Germany; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, GermanyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, GermanyHelios Cluster Saxony-Anhalt, Helios Bördeklinik, Kreiskrankenhaus 4, 39387 Oschersleben, GermanyUniversitätsmedizin Essen, Department of Infectious Diseases, West German Centre of Infectious Diseases, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, GermanyHelios Klinik Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, GermanyHelios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, GermanyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, 12203 Berlin, GermanyZentrum für Hygiene, Evangelische Kliniken Gelsenkirchen, Munckelstr. 27, 45879 Gelsenkirchen, Germany; Corresponding author.Background: In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a solution for an antimicrobial stewardship program (ASP) in small community hospitals in a rural area in Germany. Methods: Four hospitals of ca. 200 beds each, jointly hired an antimicrobial stewardship expert to start a common ASP. This expert did rounds on every ward once a week, mostly as chard reviews with the physician in charge. Outside the rounds, he could be consulted by mail. Working time and number of visited patients were documented. Anti-infectives consumption, incidence of Clostridioides difficile infections (CDI) and mortality rates were retrieved from routinely collected data. The intervention period (01/2018–12/2018) was compared to the preintervention period (01/2017–12/2017). Results: 3321 patients were visited in the intervention period. In average, 20 patients were seen per day and 20 min were needed per patient/ chard. About 65% of the expert’s working time was needed for rounds, 15% for driving between the hospitals. The anti-infectives consumption of the 4 hospitals in the preintervention period amounted to 50 defined daily doses per 100 occupied bed days. The total consumption was reduced by 10% and of quinolones by 36%. The incidence of hospital-acquired CDI receded from 0.14 to 0.07 cases per 100 patient days (−50%, p = 0.001). The overall in-hospital mortality did not change. Conclusions: A single expert was able to implement a successfull ASP in 4 hospitals. While multidisciplinary antimicrobial stewardship teams are ideal for tertiary care hospitals, small hospitals need a more practical solution. This survey shows that one expert can be sufficient for several small hospitals even with the distances in a rural setting.http://www.sciencedirect.com/science/article/pii/S187603412030678XAntibiotic stewardshipAntimicrobial stewardship programmClostridioides difficile |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Irit Nachtigall Sascha Tafelski Edwin Heucke Oliver Witzke Annedore Staack Sabine Recknagel-Friese Christine Geffers Marzia Bonsignore |
spellingShingle |
Irit Nachtigall Sascha Tafelski Edwin Heucke Oliver Witzke Annedore Staack Sabine Recknagel-Friese Christine Geffers Marzia Bonsignore Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany Journal of Infection and Public Health Antibiotic stewardship Antimicrobial stewardship programm Clostridioides difficile |
author_facet |
Irit Nachtigall Sascha Tafelski Edwin Heucke Oliver Witzke Annedore Staack Sabine Recknagel-Friese Christine Geffers Marzia Bonsignore |
author_sort |
Irit Nachtigall |
title |
Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany |
title_short |
Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany |
title_full |
Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany |
title_fullStr |
Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany |
title_full_unstemmed |
Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany |
title_sort |
time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in germany |
publisher |
Elsevier |
series |
Journal of Infection and Public Health |
issn |
1876-0341 |
publishDate |
2020-12-01 |
description |
Background: In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a solution for an antimicrobial stewardship program (ASP) in small community hospitals in a rural area in Germany. Methods: Four hospitals of ca. 200 beds each, jointly hired an antimicrobial stewardship expert to start a common ASP. This expert did rounds on every ward once a week, mostly as chard reviews with the physician in charge. Outside the rounds, he could be consulted by mail. Working time and number of visited patients were documented. Anti-infectives consumption, incidence of Clostridioides difficile infections (CDI) and mortality rates were retrieved from routinely collected data. The intervention period (01/2018–12/2018) was compared to the preintervention period (01/2017–12/2017). Results: 3321 patients were visited in the intervention period. In average, 20 patients were seen per day and 20 min were needed per patient/ chard. About 65% of the expert’s working time was needed for rounds, 15% for driving between the hospitals. The anti-infectives consumption of the 4 hospitals in the preintervention period amounted to 50 defined daily doses per 100 occupied bed days. The total consumption was reduced by 10% and of quinolones by 36%. The incidence of hospital-acquired CDI receded from 0.14 to 0.07 cases per 100 patient days (−50%, p = 0.001). The overall in-hospital mortality did not change. Conclusions: A single expert was able to implement a successfull ASP in 4 hospitals. While multidisciplinary antimicrobial stewardship teams are ideal for tertiary care hospitals, small hospitals need a more practical solution. This survey shows that one expert can be sufficient for several small hospitals even with the distances in a rural setting. |
topic |
Antibiotic stewardship Antimicrobial stewardship programm Clostridioides difficile |
url |
http://www.sciencedirect.com/science/article/pii/S187603412030678X |
work_keys_str_mv |
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