1013. Antimicrobial Stewardship Program Development and Enhancement in Small Hospitals and Rural Hospitals, California 2011-2012
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek_poster_SmallRural v5.pdf (133.4 kB)
  • Background: In 2010 – 2011, a California Department of Public Health assessment revealed that small hospitals (<100 licensed beds) and rural hospitals (census area population <15,000) were less likely to have antimicrobial stewardship programs (ASP) than other hospitals.  Informational calls conducted with these hospitals identified Clostridium difficile infection (CDI) prevention and ASP development as high priorities.  Thus, a CDI Prevention/ASP collaborative was formed to prevent CDI, develop ASPs and assess effectiveness of reducing hospital-associated (HA)-CDI (sum of hospital-onset and community-onset) rates. 

    Methods: Monthly conference calls were held October 2011 – September 2012 to discuss content and provide expert consultation.  A web-based ASP assessment tool was provided in December 2011 to collect hospital demographics, presence or absence of an ASP (defined as programs promoting the use of antibiotics) and ASP strategies.  Each ASP assessment was critically analyzed, “low-hanging fruit” identified and findings shared in March 2012.  The pre-intervention (January – June 2011) and post-intervention (July – December 2012) HA-CDI rates were compared using CDC’s National Healthcare Safety Network.  Negative binomial regression models were used to calculate rate ratios adjusting for testing methodology.

    Results: Ten hospitals participated in the assessment:  five small and rural, four small and one rural. Eight reported presence of an ASP and five utilized formulary restriction.  Common “low-hanging fruit” included identification of pharmacy and physician champions and antimicrobial utilization data mining to direct formulary restriction.  Of eight collaborative hospitals, HA-CDI rates decreased from 3.60 to 3.23/10,000 patient-days pre- versus post-intervention (Adjusted Rate Ratio: 0.68; 95% Confidence Interval 0.17 – 2.67).    

    Conclusion: ASP development was enhanced in collaborative small hospitals and rural hospitals by identifying “low-hanging fruit” in setting clear ASP goals.  Collaborative efforts may have contributed to an overall decrease in HA-CDI rates but did not achieve statistical significance.  Novel approaches such as one-on-one consultation should be considered to enhance ASPs in similar settings.

    Kavita K. Trivedi, MD, Mary Nennig, RN, BSN, N. Neely Kazerouni, DrPH, MPH and Jon Rosenberg, MD, Healthcare Associated Infections Program, California Department of Public Health, Richmond, CA


    K. K. Trivedi, None

    M. Nennig, None

    N. N. Kazerouni, None

    J. Rosenberg, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.