993. A Modified Audit and Feedback Approach Increases Antimicrobial Stewardship Program Visibility in a Resource-limited Setting
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

While audit and feedback (A&F) has improved antimicrobial utilization and reduced Clostridium difficileinfection (CDI) rates, a resource-limited antimicrobial stewardship program (ASP) may not be able to implement A&F on a hospital-wide basis. In an effort to expand its reach and increase interest with limited personnel, a community ASP employed an educational strategy in addition to a modified A&F approach on wards with a rise in CDI.


North York General Hospital (NYGH) is a 400-bed acute care center with an ASP staffed by 0.3 FTE physician and 0.6 FTE pharmacist. At NYGH, when Infection Prevention and Control identifies a rise in CDI on a ward, the ASP initiates a CDI dispatchwhich includes: 1) an audit of antibiotic (ABX) use in the 30 days prior 2) identification of suboptimal ABX prescribing patterns and 3) feedback to the relevant staff, focusing on guidelines and current standard of care.


From Dec 2011 – Dec 2012, three CDI dispatcheswere initiated. On an orthopaedic surgery ward, 15 % of ABX were eligible for optimization; 71 % of these pertained to therapy for urinary tract infection (UTI). UTI diagnosis and management was discussed with the ward hospitalist and as a result, the ASP was invited to perform weekly A&F on the ward. On a general surgery ward, 22 % of ABX were suboptimal; 83 % of these included therapy for intra-abdominal infections (IAI). Despite the issuance of city-wide IAI guidelines, fluoroquinolones and broad-spectrum cephalosporins were being prescribed for mild, community-onset IAI. After reviewing local and national IAI guidelines with a representative surgeon, the ASP was invited to surgery rounds for further discussion and subsequently developed an institutional IAI guideline and computerized order set.  Finally, on a second surgical ward, 32 % of ABX were suboptimal; 48 % of these ABX were used for prolonged post-op prophylaxis in urologic cases. The ASP approached a representative urologist for discussion and has engaged several others in a dialogue regarding post-op and pre-op prophylaxis as well as in the treatment of multidrug resistant UTI.


In a resource-limited setting, an educational strategy utilized alongside a modified A&F approach allowed for greater ASP visibility, advancement of ASP initiatives, and development of a rapport with prescribers.

Pavani Reddy, MD1,2, Peter Stotland, MD MSc, FRCSC3,4, Irv Feferman, MD5, Neelesh Jain, MD3 and Sumit Raybardhan, BSc Phm, MPH6, (1)Division of Infectious Diseases, North York General Hospital, Toronto, ON, Canada, (2)Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada, (3)Department of General Surgery, North York General Hospital, Toronto, ON, Canada, (4)Division of General Surgery, University of Toronto, Toronto, ON, Canada, (5)Department of Internal Medicine, North York General Hospital, Toronto, ON, Canada, (6)Department of Pharmacy Services, North York General Hospital, Toronto, ON, Canada


P. Reddy, None

P. Stotland, None

I. Feferman, None

N. Jain, None

S. Raybardhan, None

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