Antibiotic, Healthcare Associated Infection
Conditions
Keywords
Antibiotic stewardship, Healthcare associated infection, Clinical decision support, Interrupted time series, Infection prevention and control, Antibiotic resistance
Brief summary
Antibiotic resistance is one of the most pressing health threats that mankind faces now and in the coming decades. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality. In order to tackle antibiotic resistance, a computerized-decision support system (CDSS) facilitating antibiotic stewardship and an electronic surveillance software (ESS) facilitating infection prevention and control activities will implement in our tertiary care university hospital. The investigators conduct a pragmatic, prospective, single-centre, before-after uncontrolled study with an interrupted time-series analysis 12 months before and 12 months after the introduction of the CDSS for antibiotic stewardship (APSS) and ESS for infection surveillance (ZINC). APSS and ZINC will assist respectively the antibiotic stewardship and the infection prevention and control teams of Nancy University Hospital (France). The investigators will evaluate the impact of the CDSS/ESS on the antibiotic use in adult (≥ 18 years) inpatients (hospitalised ≥ 48h). The primary outcome is the prescription rate by all healthcare professionals from the hospital of all systemic antibiotics expressed in defined daily doses/1 000 patients/month. Concurrently, the investigators will assess the safety of the intervention, its impact on the appropriateness of antibiotic prescriptions and on additional precautions (isolation precautions) as recommended in guidelines, and on bacterial epidemiology (multidrug-resistant bacteria and Clostridioides difficile infections) in the hospital. Finally, the investigators will evaluate the users' satisfaction and the cost of this intervention from the hospital perspective.
Interventions
DEVICEAntibiotic stewardship and healthcare-associated infections surveillance assisted by computer
Implementation - in our tertiary care university hospital - of a computerized-decision support system (CDSS) facilitating antibiotic stewardship and of an electronic surveillance software (ESS) facilitating infection prevention and control activities
Sponsors
Central Hospital, Nancy, France
Study design
Observational model
OTHER
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All inpatients ≥ 18 years and hospitalised ≥ 48h in Nancy University Hospital
Exclusion criteria
* The paediatric and gynaeco-obstetric departments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prescription rate of all systemic antibiotics | Calculated monthly during a 12-month before and 12-month after period | The prescription rate by all healthcare professionals from the Nancy University Hospital of all systemic antibiotics (J01 code according to the Anatomical Therapeutic Chemical - ATC - 2017 classification) expressed in DDDs/1 000 patients/month. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average length of stay | Calculated monthly during a 12-month before and 12-month after period | Total length of stay for each inpatient/number of stays/month |
| Incidence of healthcare associated infections | Calculated monthly during a 12-month before and 12-month after period | New cases of HCAI/ number of inpatients/month |
| Use of overall antibiotics and by therapeutic classes | Calculated monthly during a 12-month before and 12-month after period | DDDs/1 000 patients/month |
| Proportion of the antibiotic prescriptions compliant with guidelines | Calculated monthly during a 12-month before and 12-month after period | Number of antibiotic prescriptions compliant with guidelines/number of antibiotic prescriptions evaluated |
| All-cause intra-hospital mortality rate | Calculated monthly during a 12-month before and 12-month after period | All causes of death/1 000 inpatients/month |
| Proportion of C. difficile infections | Calculated monthly during a 12-month before and 12-month after period | Number of stays with C. difficile infections/number of stays with antibiotic treatment/month |
| Proportion of multidrug resistant bacteria identification | Calculated monthly during a 12-month before and 12-month after period | Number of stays with MDRB identification by bacterial sample done after 48h of hospitalization/number of stays with identification of bacterial isolates/month |
| Hospital costs | During the 12-month after period | * Costs of antibiotics (costs (in €) of all oral and intravenous antibiotics delivered by hospital pharmacy/month) * Average cost of hospital stays (costs (in €) of hospital stays for each inpatient/number of stays/month) * Costs of the implementation of the CDSS/ESS and of the purchased equipment (costs (in €) of installation and maintenance of the CDSS/ESS after 12 months of implementation) |
| Users' satisfaction and acceptability | During the 12-month after period | * Satisfaction (qualitative study after 6 months of use) * Proportion of APSS' alerts accepted by the AMS team (number of APSS' alerts accepted by the AMS team/number of alerts generated by APSS/month) * Proportion of AMS team's recommendations accepted by prescribers (number of AMS team's recommendations accepted by prescribers/number of recommendations given by the AMS team to prescribers/month) |
| Proportion of the additional precaution prescriptions compliant with hospital recommendations | Calculated monthly during a 12-month before and 12-month after period | Number of additional precaution prescriptions compliant with hospital recommendations/number of additional precaution prescriptions evaluated |
Contacts
Primary ContactArnaud Florentin, Dr
Backup ContactAlexandre Baudet, Dr
Outcome results
None listed