However, individual local data shall be reported according to discipline
12.5 Antimicrobial management programstrategies
Success of antimicrobial restriction in hospitals varies on the basis of the genesis of the antimicrobial resistance program. Workshop on Antimicrobial Resistance in Hospitals: Strategies to Improve Antimicrobial Use and Prevent Nosocomial Transmission of Antimicrobial-Resistant Microorganisms in 1994 under CDC have identify five strategic goals to optimize antimicrobial use Goldman et al, 1996 : • Optimizing antimicrobial prophylaxis for operative procedures • Optimizing choice and duration of empiric therapy • Improving antimicrobial prescribing by educational and administrative means • Monitoring and providing feedback regarding antibiotic resistance • Defining and implementing local guideline National Antibiotic Guideline as reference Paterson, 2006 have recommended implementation of a program using a front-end approach and back end approach through discussion with and endorsements from the clinical departments that will be affected e.g., the ICU, surgical department, emergency department, and outpatient clinics, as well as other affiliated hospitals. 1. Use of front end approach • Pre-approval before administration of restricted agents • Use of special antimicrobial request forms • Antimicrobial cycling 2. Use of back end approach • Post-prescription reviewAutomatic stop order A back-end approach to antimicrobial management permits empirical use of broad- spectrum antimicrobial agents, followed by post-prescription review and, then, by streamlining de-escalation or discontinuing antimicrobial therapy on day 2 or 3, if this decision is supported by culture and susceptibility testing results and by the patient’s clinical response. 3. However, it should be noted that reacting to resistance against individual antibiotics by instituting antibiotic restriction may lead to increased use of alternate antibiotics, which, in turn, leads to increased resistance to other antibiotic classes. 4. Feedback mechanism There are many possible intervention could be proposed to reduce inappropriate or excessive antimicrobial use but deciding which one is the most effective measures in any particular setting can be difficult. It is best that each individual hospitals institute their own programs to improve antimicrobial prescribing practice and to do comparison before and after each programs is initiated. These programs can be conducted as quality improvement activities as a continuous process.12.6 Antimicrobial policy
Addressing the problem of antimicrobial resistance requires both infection control and regulation of antimicrobial use; addressing either alone is insufficient. Therefore, collaboration with Infectious Disease physicians, clinical microbiologist and infection control nurses is necessary to developed strategies to developed antimicrobial policy to improved antimicrobial control.Parts
» Bacaan Penuh ( bersaiz 5.5 MB)
» Roles of Hospital Infection and Antibiotic Control Committee
» Infection Control Doctor ICD
» Chairman of HIACC Bacaan Penuh ( bersaiz 5.5 MB)
» HOSPITAL INFECTION AND ANTIBIOTIC CONTROL COMMITTEE
» Frequency of meetings Circulation of minutes
» Emergency meetings and outbreak control
» Duties and responsibilities of the infection Control Nurse
» HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE
» Types of Surveillance Bacaan Penuh ( bersaiz 5.5 MB)
» Data Collection Tabulation of Data
» Analysis and interpretation of data
» Preparation and dissemination of reports
» ISOLATION PRECAUTION Standard Precautions
» Respiratory hygienecough etiquette: Instruct symptomatic persons and health
» Signs, BHT, Isolation traytrolley
» Visitor Policy for Infection Control
» Dishes, Glasses, Cups, Eating Utensils and Medications
» Transportation of patients Transmission-based
» Hand Hygiene Bacaan Penuh ( bersaiz 5.5 MB)
» Natural ventilation Personal Protective Equipment PPE
» Use of mechanical ventilation
» Minimizing bacteria at entry points
» Maintaining sterility of instruments disposable items during a procedure
» Catheter change interval Urinary Catheter Care
» General principles of wound care 1.
» Spatial separation of catheterized patients Technique
» Environment Urinary Catheter Care
» Wound Care Bacaan Penuh ( bersaiz 5.5 MB)
» Procedure for insertion of catheter
» A dedicated lumen used for PN line should be identified and not be used for
» Nursing considerations for PN
» Storage Replacement of PN tubing and filters
» General Principles. Replacement of PN tubing and filters
» Specific practices transport, storage, transfusion, dispose
» Blood and Blood Products Transfusion
» Hand hygiene Urinary Tract Infection
» Catheter Insertion Urinary Tract Infection
» Closed Sterile Drainage Urinary Tract Infection
» Irrigation Urinary Tract Infection
» Specimen Collection Urinary Tract Infection
» Urinary Flow Urinary Tract Infection
» Meatal Care Urinary Tract Infection
» Catheter Change Interval Urinary Tract Infection
» Critical items - instruments or objects that enter directly into the vascular
» Semi-critical items - instruments or objects that come into contact with
» Developed a good surveillance system to study the incident of SSI.
» Nosocomial Respiratory Infection Bacaan Penuh ( bersaiz 5.5 MB)
» Introduction INFECTION CONTROL IN SPECIFIC HEALTHCARE SETTING
» Personal Protective Equipment Personnel .1
» Neonatal Intensive Care Unit
» Outer zone: This zone should contain:
» Laminar Flow Ventilation Ultra Clean Ventilation
» Wall Mounted Air Conditioners:
» Protective Clothing for Use in the Operating Theatre
» Surgical Hand Scrubbing Refer to hand hygiene section
» Gowning Free-standing Air Conditioners:
» Gloving Free-standing Air Conditioners:
» Draping Free-standing Air Conditioners:
» Establishing a Sterile Field
» Dispensing of the Sterile Supplies
» Maintaining the Sterile Field
» Waste and Linen Post operative
» Cleaning of the Operation theatre
» Intra operative Initial cleaning at the beginning of the day
» Concurrent cleaning between cases
» Haemodialysis unit water supply and air conditioning
» Staff health Terminal cleaning end of the day
» Hand hygiene Terminal cleaning end of the day
» Nephrology and Hemodialysis Unit
» Instrument processing area in the dental clinic
» Instrument cleaning refer to CSSD chapter
» Cleaning and Disinfection of Treatment Room 1.
» Dental Radiology Asepsis Components permanently attached to dental unit waterlines
» Dental Laboratory Materials and Equipment
» Storage and preparation rooms
» Movement of instruments Safety
» Collection of body from ward
» Routine case autopsy Mortuary
» Specimen handling Procedure for post-mortem examination of known or suspected CJD
» Clinical waste Procedure for post-mortem examination of known or suspected CJD
» Visitors Procedure for post-mortem examination of known or suspected CJD
» Quality control Procedure for post-mortem examination of known or suspected CJD
» Care Givers For Patient In The Burn Unit 1.
» Visitors Full time Care givers
» Culturing and Surveillance Full time Care givers
» Antibiotic Policy Full time Care givers
» Haematology and Oncology Unit
» Laboratory Bacaan Penuh ( bersaiz 5.5 MB)
» Introduction Bacaan Penuh ( bersaiz 5.5 MB)
» Personel protective equipment PPE
» Screening for HCW TUBERCULOSIS
» Infection control in specific area .1
» HOSPITAL OUTBREAK MANAGEMENT Steps in Outbreak Investigation and Management
» Introduction Introduction Bacaan Penuh ( bersaiz 5.5 MB)
» Policy Statement Training Bacaan Penuh ( bersaiz 5.5 MB)
» Arrangements Bacaan Penuh ( bersaiz 5.5 MB)
» Infection Control During Construction and Renovation
» Operation Theatre Commissioning Bacaan Penuh ( bersaiz 5.5 MB)
» Administrative monitoring Mechanical Monitoring
» Distribution of sterile items
» Establish a system Bacaan Penuh ( bersaiz 5.5 MB)
» Monitoring antimicrobial use using aggregated data on Defined Daily
» Each hospital shall send report on DDD every 6 months to National Infection
» However, individual local data shall be reported according to discipline
» It is recommended to have a national benchmark data specifically for Intensive
» It is also beneficial if each state have their own benchmark data from their
» A report of local monitoring data for hospital compared with national
» The aggregate benchmark data included numeric presentation of pooled
» Correlation between antimicrobial use and resistance rate
» Costquantity of empiric antimicrobial administered in a specified period.
» Antimicrobial management programstrategies Antimicrobial policy
» Multi-Resistant Organism 13. Bacaan Penuh ( bersaiz 5.5 MB)
» Methicillin Resistant Staphylococcus Aureus
» Vancomycin Resistant Enterococci Bacaan Penuh ( bersaiz 5.5 MB)
» HIV Bacaan Penuh ( bersaiz 5.5 MB)
» Dengue Bacaan Penuh ( bersaiz 5.5 MB)
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