Healthcare Consulting Services
PO Box 1230
Grantham, NH 03753
ph: 716-550-1106
btruax
Healthcare Consulting Services with a Focus on Patient Safety Solutions and Quality Improvement Across the Health Care Continuum. Your Patient Safety Resource Solution.
June 21, 2022
Pneumonia in Nervous System Injuries
Last week we focused on prevention of post-op pneumonia (see our June 21, 2022 Patient Safety Tip of the Week “Preventing Post-op Pneumonia”). But another form of hospital-acquired pneumonia that is even more frequent is that which is seen in patients admitted with a variety of neurological conditions. So, timely is a recent review article on pneumonia in nervous system injuries (Erfani 2022). Pneumonia is a significant contributor to mortality and prolonged lengths of stay in patients with neurological conditions.
Erfani and colleagues conducted an extensive literature search and review on the topic. They note that over a third of patients admitted to neurointensive care units (neuro-ICUs) for a period exceeding 48 hours develop nosocomial infections with pneumonia being the most common type of infection. Ventilator-associated pneumonia is frequent in those patients.
But pneumonia also occurs frequently as a complication in neurological patients not on ventilators or in neuro-ICU’s.
They identify risk factors for hospital-acquired pneumonia (HAP) in general: Glasgow Coma Scale (GCS) less than 8, mechanical ventilation, impaired airway reflexes, supine positioning, aspiration, preexisting diseases like chronic obstructive pulmonary disease (COPD), burns, prolonged ICU stay, use of positive end expiratory pressure (PEEP) during mechanical ventilation, high disease severity, multiple organ dysfunction, older age, prior administration of antibiotics, malnutrition, use of the nasogastric tube, use of paralytic agents, male gender, enteral feeding, immunosuppression, and trauma.
But they note that the nature of the critical conditions in CNS leads to higher susceptibility to developing pneumonia, due to factors such as brain injury-induced immune dysregulation and immunosuppression, high prevalence of dysphagia, and interventions such as placement of external ventricular drains (EVDs).
We have always focused on dysphagia and impairment of consciousness, with consequent aspiration, as the major mechanism for pneumonia in neurological inpatients. However, Erfani and colleagues point out some interesting contributing factors that we had not been aware of. One such contributing factor is brain injury-induced immune dysregulation. That is caused primarily caused by an elevated inflammatory response which leads to central and peripheral production of chemokines, proinflammatory cytokines, and cell adhesion molecules in these patients. Development of the inflammatory response is a crucial part of clearing cellular debris in the CNS following an injury. But chronic and prolonged inflammation response can lead to dysregulation in the immune system. Such is commonly seen in acute events, like trauma, brain surgery, subarachnoid hemorrhage (SAH), or spinal cord injury. When it occurs after stroke, it is named stroke-induced immunodepression syndrome (SIDS). SIDS is considered to be biphasic, the first phase starting as soon as 12 hours after the initial injury with early transient activation lasting up to 24 hours, and a second phase consisting of a systemic immunodepression that can last for several weeks. They also discuss the immunosuppression that may occur due to prolonged catecholamine release which accompanies many of these conditions.
They go on to discuss pneumonia in a variety of neurological conditions.
Known risk factors for stroke-associated pneumonia (SAP) include dysphagia, higher National Institutes of Health Stroke Scale (NIHSS), non-lacunar basal-ganglia infarction, age, large middle cerebral artery (MCA) infarction, multiple hemispheric or vertebrobasilar infarction, mechanical ventilation on admission, and impaired vigilance. The presence of intubation also increases the risk of pneumonia independently of the presence of known aspiration. Conversely, a lower risk of SAP was seen in small-vessel occlusions (We, however, would remind all that bilateral lacunar infarcts, which we often refer to as the “double whammy” syndrome, may lead to pseudobulbar palsy that increases the risk of aspiration). They also note that brain injury-induced immunosuppression may be more common with more massive strokes and strokes impacting certain structures, such as the insular cortex.
They, of course, do go on to discuss dysphagia and impaired consciousness as major factors contributing to development of pneumonia after stroke.
In terms of pneumonia prevention, they do stress that addressing dysphagia is one of the most important interventions. It is critical that, in patients with stroke or the other mentioned neurological conditions, that an assessment of swallowing be performed prior to giving food or anything via mouth. Improved screening for dysphagia and nurse education has been shown to decrease the risk of pneumonia as was demonstrated in a single-center study which showed a decrease in pneumonia prevalence from 6.5% to 2.8% after the screening and education changes were implemented.
Early administration of prophylactic antibiotics has not been shown to be effective in decreasing mortality or functional outcome in these patients and is not indicated. They also note that oropharyngeal decontamination with povidone-iodine has not been effective in the prevention of ventilator-associated pneumonia (VAP) in patients with critical brain injuries or cerebral hemorrhages.
.
The timing of tracheostomy placement in such patients who require continuous ventilation does not seem to affect the mortality rate but, in some studies, early tracheostomy placement may decrease the duration of ventilation. (Note that a just-published study (Bösel 2022) on the effect of early vs standard approach to tracheostomy among patients with severe stroke receiving mechanical ventilation showed no difference in the rate of survival without severe disability at 6 months. In that study, pneumonia within 48 hours of tracheostomy was more frequent in the early tracheostomy group but that did not reach statistical significance. There were no significant differences in the total duration of mechanical ventilation or ICU length of stay.)
Erfani and colleagues also discuss another potential prevention strategy: addressing brain injury-induced immunosuppression. Since this immunosuppression is mainly due to sympathetic nervous system activation, they discuss the potential use of β-adrenergic receptor blockers but caution that further assessment of β-blocker administration needs to be carried out in order for it to be confirmed as a routine choice for the prevention of pneumonia in NICU’s.
In our June 2022 What's New in the Patient Safety World column “Guideline Update: Preventing Hospital-Acquired Pneumonia” we discussed the 2022 update of “Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals” (Klompas 2022). That update was collaborative work of the Society for Healthcare Epidemiology (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with input from multiple other organizations and societies.
That update included a new section on prevention of nonventilator hospital-acquired pneumonia (NV-HAP). That section notes there is actually a scant evidence base for strategies to prevent NV-HAP. This section emphasizes oral care, recognizing and managing dysphagia, early mobilization, and implementing multimodal approaches to prevent viral infections. Regarding diagnosis and management of dysphagia, the updated guideline had the following recommendations:
One surprising omission from the discussion of pneumonia in neurological conditions is OSA (obstructive sleep apnea). We know that OSA is common in acute stroke patients and some of the other conditions, and that OSA has been linked as a possible contributing factor to community-acquired pneumonia (Chiner 2016). It would certainly be of interest to see if OSA is a risk factor for development of pneumonia in these and other inpatient conditions.
For those that are interested, the Erfani review also discusses pneumonia is subarachnoid hemorrhage, brain traumatic injury, intracerebral hemorrhage, spinal cord injury, status epilepticus, neuromuscular diseases, and multiple sclerosis (MS) and demyelinating diseases. It also has sections on radiographic findings and treatment of pneumonia. The Erfani review has 139 references with links. We think you will find this very useful.
References:
Erfani Z, Jelodari Mamaghani H, Rawling J, et al. Pneumonia in Nervous System Injuries: An Analytic Review of Literature and Recommendations. Cureus 2022; 14(6): e25616
Bösel J, Niesen W, Salih F, et al. Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation: The SETPOINT2 Randomized Clinical Trial. JAMA 2022; 327(19): 1899-1909
https://jamanetwork.com/journals/jama/article-abstract/2792016
Klompas M, Branson R, Cawcutt K, et al.. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 20: 1-27
Chiner E, Llombart M, Valls J, et al. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia. PloS One 2016; 11(4): e0152749
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822965/
Print “Pneumonia in Nervous System Injuries”
To get "Patient Safety Tip of the Week "emailed to you, click here and enter "subscribe" in the subject field.
If you don't see the search term you expected to see here, its probably because that tip already went to our Tip of the Week Archive. We do a new tip every week. Click here to search the entire site or you can Go to Tip of the Week Archive a patient safety resource solution loaded with tips, tools, and techniques you can use in your patient safety and quality improvement initiatives. Or it may have moved to our What's New Archive.
Click here to see the consulting services and patient safety solutions that we provide.
What's New in the Patient Safety World
In our April 12, 2022 Patient Safety Tip of the Week “A Healthcare Worker’s Worst Fear” we mentioned that, after the Vanderbilt neuromuscular blocking agent (NMBA) case, ISMP began recommending the entry of a minimum of five characters of a drug name during searches in ADC’s. ISMP’s “Guidelines for Safe Electronic Communication of Medication Information” also include that requirement for medication searches on other forms of electronic communication.
But ISMP also has seen reports where even entry of 5 letters has been associated with errors (ISMP 2021). For example:
ISMP offers some potential solutions:
There have also been suggestions that vendor functionality should be more tailored and specific to individual, problematic drugs that require the five-character search via override, rather than requiring an all-inclusive change for all drug name searches via override. Another suggestion is to allow users to “opt out” certain drugs from the five-character search rule but ISMP notes that could be confusing to require two different levels of drug name searches. ISMP also suggests that vendors might develop algorithms that would allow users to enter the exact number of characters to get only one unique drug name to appear on the screen, making emergency kits and key emergency drugs always accessible (ISMP notes that a separate code cart should always be maintained for emergency equipment and drugs to use during a cardiac and/or respiratory arrest).
As a precaution, ISMP recommends that before implementing the five-character search requirement for medications obtained from an ADC via override, hospitals should analyze the workflow, especially the searchability of emergency medications, and conduct a failure mode and effects analysis (FMEA) to identify and manage potential challenges (the ISMP article has some nice examples of risk points to consider during the FMEA). Prior to implementation, organizations must develop a robust and effective communication plan, and obtain feedback from frontline staff. After any changes, collect data to assess whether unintended consequences are occurring and make appropriate adjustments if needed.
And ISMP strongly recommends that, whenever possible, orders should be entered and verified by a pharmacist to allow medication or product removal within the patient’s profile, bypassing the requirement to enter five characters and limiting the necessity for ADC overrides.
The 5-letter entry requirement for drug searches on ADC’s or CPOE or any electronic medication system is certainly a step in the right direction. ISMP has done its usual great job of identifying barriers, challenges, and potential unintended consequences to implementing this important patient safety intervention.
Our prior columns related to ADC’s (automated dispensing cabinets):
December 2007 “1000-fold Heparin Overdoses Back in the News Again”
August 23, 2016 “ISMP Canada: Automation Bias and Automation Complacency”
December 11, 2018 “Another NMBA Accident”
January 1, 2019 “More on Automated Dispensing Cabinet (ADC) Safety”
February 12, 2019 “From Tragedy to Travesty of Justice”
April 2019 “ISMP on Designing Effective Warnings”
June 11, 2019 “ISMP’s Grissinger on Overreliance on Technology”
September 7, 2021 “The Vanderbilt Tragedy Gets Uglier”
April 12, 2022 “A Healthcare Worker’s Worst Fear”
References:
ISMP (Institute for Safe Medication Practices). Guidelines for Safe Electronic Communication of Medication Information. ISMP 2019; January 16, 2019
https://www.ismp.org/resources/guidelines-safe-electronic-communication-medication-information
ISMP (Institute for Safe Medication Practices). Challenges with Requiring Five Characters During ADC Drug Searches Via Override. ISMP Medication Safety Alert! Acute Care Edition 2021; October 21, 2021
Print “July 2022 Five-Character Drug Search Has Problems, Too”
The role of fatigue in causing errors in healthcare or any industry is well established. But there is one glaring example that seems to defy this concept. In our September 2015 What's New in the Patient Safety World column “Surgery Previous Night Does Not Impact Attending Surgeon Next Day” we discussed a Canadian study (Govindarajan 2015) that showed outcomes for the “next day” case do not seem to be adversely impacted by the surgeon’s previous night procedures.
Now a new study (Sun 2022) from more than 50 hospitals across 18 states and 2 countries (US and the Netherlands) confirms the results seen in the Canadian study. Sun et al. looked at outcomes of almost 500,000 surgeries, of which 2.6% involved an attending surgeon who operated the night before.
After adjusting for operation type, surgeon fixed effects (indicator variables for each surgeon), and patient characteristics such as age and comorbidities, the incidence of in-hospital death or major complications was 5.89% among daytime operations when the attending surgeon operated the night before compared with 5.87% among daytime operations when the same surgeon did not. There was also no difference in several secondary outcomes studied except for a slight decrease in the length of daytime operations.
Several sensitivity analyses also suggested no difference between overnight work and the primary outcome. There was no statistically significant difference in the incidence of death or major complication for daytime procedures based on procedure length. Each additional hour worked the previous night was associated with a statistically nonsignificant decrease in the probability of death or a major complication for daytime procedures.
The authors conclude that, combined with previous studies, their results provide reassurance concerning the practice of having attending surgeons take overnight call and still perform procedures the following morning. They state their results do not establish that this practice is always safe or that fatigue does not affect outcomes, but that the potential risk was managed well enough to avoid patient harm in this sample of
surgeons. They do note that these cases were done mostly at academic institutions and that the results may not be generalizable to other settings.
Again, this is a very different question from one we have addressed on numerous occasions. Several of our columns have questioned whether surgery should be done “after hours”, particularly for procedures that may not be true emergency ones (see our What’s New in the Patient Safety World columns for September 2009 “After-Hours Surgery – Is There a Downside?”, October 2014 “What Time of Day Do You Want Your Surgery?”, December 2014 “Another Procedure to Avoid Late in the Day or on Weekends” and January 2015 “Emergency Surgery Also Very Costly”).
In those columns we have pointed out that such surgeries and procedures involve considerations far beyond just the surgeon. Why should “after hours” surgery be more prone to adverse outcomes than regularly scheduled elective surgery? There are many reasons aside from the fact that patients needing emergency and after hours surgery are generally sicker. You are operating with a team that is likely different from your daytime team. All members of that team (physicians, nurses, anesthesiologists, techs, etc.) may not have the same level of expertise as your regular daytime team and the team dynamics between members is likely to be different. The post-surgery recovery unit is likely to be staffed much differently after-hours as well. The staff may be more likely to be unfamiliar with things like location of equipment. And some of the other hospital support services (eg. radiology, laboratory) may have lesser staffing after-hours. Just as importantly, many or all of the “on-call” staff that make up the after-hours surgical team have likely worked a full daytime shift that day so fatigue enters as a potential contributory factor. And there are always time pressures after hours as well. In addition, one of the most compelling reasons surgery is done at night rather than deferred to the next morning is the schedule of the surgeon or other physician for that next morning (either in surgery or the cath lab or his/her office). Because the surgeon does not want to disrupt that next day schedule, he/she often prefers to go ahead with the current case at night. Similarly, many hospitals run very tight OR schedules and adding a case from the previous night can disrupt the schedule of many other cases.
It is reassuring, however, that both the studies by Sun et al. and Govindarajan et al. seem to indicate that surgeons operating the day following a night procedure have managed potential risk well enough to avoid patient harm.
Some of our other columns on the role of fatigue in Patient Safety:
November 9, 2010 “12-Hour Nursing Shifts and Patient Safety”
April 26, 2011 “Sleeping Air Traffic Controllers: What About Healthcare?”
February 2011 “Update on 12-hour Nursing Shifts”
September 2011 “Shiftwork and Patient Safety
November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”
January 2012 “Joint Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety
January 3, 2012 “Unintended Consequences of Restricted Housestaff Hours”
June 2012 “June 2012 Surgeon Fatigue”
November 2012 “The Mid-Day Nap”
November 13, 2012 “The 12-Hour Nursing Shift: More Downsides”
July 29, 2014 “The 12-Hour Nursing Shift: Debate Continues”
October 2014 “Another Rap on the 12-Hour Nursing Shift”
December 2, 2014 “ANA Position Statement on Nurse Fatigue”
August 2015 “Surgical Resident Duty Reform and Postoperative Outcomes”
September 2015 “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”
September 29, 2015 “More on the 12-Hour Nursing Shift”
September 6, 2016 “Napping Debate Rekindled”
April 18, 2017 “Alarm Response and Nurse Shift Duration”
July 11, 2017 “The 12-Hour Shift Takes More Hits”
February 13, 2018 “Interruptions in the ED”
April 2018 “Radiologists Get Fatigued, Too”
August 2018 “Burnout and Medical Errors”
September 4, 2018 “The 12-Hour Nursing Shift: Another Nail in the Coffin”
August 2020 “New Twist on Resident Work Hours and Patient Safety”
August 25, 2020 “The Off-Hours Effect in Radiology”
September 2020 “Daylight Savings Time Impacts Patient Safety?”
January 19, 2021 “Technology to Identify Fatigue?”
October 12, 2021 “FDA Approval of Concussion Tool – Why Not a Fatigue Detection Tool?”
February 2022 “Does Time of Day Matter?”
Some of our previous columns on “after-hours” surgery:
References:
Govindarajan A, Urbach DR, Kumar M, et al. Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work. N Engl J Med 2015; 373: 845-853
https://www.nejm.org/doi/full/10.1056/NEJMsa1415994
Sun EC, Mello MM, Vaughn MT, et al. Assessment of Perioperative Outcomes Among Surgeons Who Operated the Night Before. JAMA Intern Med 2022; Published online May 23, 2022
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2792088
(Sun 2022)
Print “July 2022 Outcomes OK When Surgeon Operated the Night Before”
A community hospital within an academic health care system was struggling with high hospital-onset C. diff infection (HO-CDI) rates. An interdisciplinary team put together evidence-based interventions to successfully reduce HO-CDI rates (Walter 2022). Interventions included: diagnostic stewardship, enhanced environmental cleaning, antimicrobial stewardship and education and accountability. After one year, they achieved a 63% reduction in HO-CDI and have sustained a 77% reduction. The infection rate remained below national benchmark for HO-CDI for over 4 years at a rate of 2.80 per 10,000 patient days.
Interventions recommended in CDC’s “CDI Prevention Strategies” (CDC 2021) were used. A key to any quality improvement program is having clinical champions. Their interdisciplinary team had both unit nurse champions and physician champions. In addition to a strong nursing team leader, they had an infection preventionist, a clinical microbiologist, an epidemiologist, an antimicrobial stewardship pharmacist, and an environmental services representative on the interdisciplinary team.
One important element was development of a new clinical testing protocol. This allowed nurses to test any unformed stool for C. diff without the need for a provider order. The patient with a loose stool would be placed on contact enteric isolation until a negative test result was received.
Another important element was reinforcement that staff members conduct hand hygiene with soap and water rather than hand sanitizer. Programs to improve hand hygiene have often focused on increased use of alcohol-based hand sanitizers. But those don’t kill C. diff spores. Use of soap and water is the best way to eliminate C. diff spores.
Another key was enhancement of environmental cleaning. Environmental services workers changed to a more effective sporicidal disinfectant and started using that in all patient rooms regardless of isolation status. In addition, in patient rooms that were placed under contact enteric isolation for a C. diff infection, cleaning was intensified, including a terminal cleaning with disinfectant and UV light disinfection, and cleaning equipment with bleach wipes.
Their antimicrobial stewardship program focused on reducing the use of fluoroquinolones. Clinical staff could now only order them fluoroquinolones as part of an order set and clinical decision support was built into the electronic medical record to prevent standalone orders for fluoroquinolones.
The educational component utilized multiple modalities, including emails, flyers, meetings, educational sessions, and huddles. New hires also learned about the new protocols during orientation.
The addition of an accountability processes further improved compliance with standards of practice. Staff on the team and units received emailed notices about compliance issues and held meetings to discuss how to improve compliance.
Kudos to the team at Emory Saint Joseph's Hospital in Atlanta, Georgia for this successful project!
Some of our prior columns on C. diff infections:
References:
Walter C, Soni T, Gavin MA, et al. An interprofessional approach to reducing hospital-onset Clostridioides difficile infections. American Journal of Infection Control 2022; Published:May 11, 2022
https://www.ajicjournal.org/article/S0196-6553(22)00096-7/fulltext
CDC (Centers for Disease Control and Prevention). CDI Prevention Strategies
Strategies to Prevent Clostridioides difficile Infection in Acute Care Facilities. CDC
Page last reviewed: December 17, 2021
https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html
Print “July 2022 C. diff Success Story”
Inappropriate antibiotic prescribing can lead to emergence of antibiotic resistance, adverse drug reactions, development of opportunistic infections like C. diff, and add to unnecessary healthcare costs. Hence, the need for antibiotic stewardship programs.
One area of inappropriate antibiotic prescribing where attention has been focused is asymptomatic bacteriuria. Guidelines from the Infectious Diseases Society of America (Nicolle 2019) and Choosing Wisely recommend we do not treat asymptomatic bacteriuria with antibiotics.
But University of Maryland researchers recently identified a disturbing trend regarding how physicians approach asymptomatic bacteriuria. Baghdadi and colleagues (Baghdadi 2022) reported the results of a survey of 723 primary care clinicians (physicians and advanced practice clinicians) in active practice regarding their approach to a hypothetical patient with asymptomatic bacteriuria. Results were striking. 71% of respondents indicated that they would prescribe antibiotic treatment for asymptomatic bacteriuria in the absence of an indication. The tendency was more pronounced among family medicine physicians and those with a high score on the Medical Maximizer-Minimizer Scale (individuals with a stronger orientation toward medical maximizing prefer treatment even when the value of treatment is ambiguous). The tendency was less common among resident physicians and clinicians in the US Pacific Northwest.
The authors suggest that clinician characteristics should be considered when designing antibiotic stewardship interventions. Specifically, physician culture (rather than urine culture) may be an important determinant of inappropriate prescribing. The concept of “medical maximizers” was especially of interest. “Medical maximizers favor errors of commission over errors of omission, preferring to treat even when treatment has uncertain value and may introduce a chance of harm.” The authors note that their finding of an association between medical maximizing and inappropriate antibiotic prescribing is important because it suggests that certain tendencies among clinicians may pose a barrier to initiatives, such as Choosing Wisely, that are intended to combat the emergence of antimicrobial resistance.
Though not specifically addressing the issue of prescribing antibiotics for asymptomatic bacteriuria, there have been several other recent studies addressing physician characteristics related to inappropriate antibiotic prescribing. In our May 24, 2022 Patient Safety Tip of the Week “Requiring Indication for Antibiotic Prescribing” we noted a study (Neels 2020) citing many factors that contribute to inappropriate antibiotic prescribing in general practice. These include automatic repeat prescriptions, inappropriate durations and quantities and the extended period of time during which a prescription may be filled. In addition, some prescriptions are dispensed more than 60 days after the prescription date, suggesting likely usage for an alternate indication to that intended by the prescriber. Patient expectations may also lead to inappropriate antibiotic prescribing. They implemented an educational intervention in a large general practice clinic in Australia. It included face-to-face education sessions with physicians on antimicrobial stewardship principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. This resulted in a significant reduction in prescriptions without a listed indication for antimicrobial therapy, prescriptions without appropriate accompanying microbiological tests and the provision of unnecessary repeat prescriptions. There were significant improvements in appropriate antimicrobial selection, appropriate duration, and compliance with guidelines. And two recent studies in BMJ Quality & Safety discussed factors related to long-term and repeat antibiotic prescriptions in primary care in the UK (Krockow 2022, Van Staa 2022).
Some of our prior columns on antibiotic stewardship:
Our other columns on urinary catheter-associated UTI’s:
References:
Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 2019; 68(10): e83-e110
https://academic.oup.com/cid/article/68/10/1611/5481760
Choosing Wisely Campaign. Infectious Diseases Society of America. Don’t treat asymptomatic bacteruria with antibiotics. Released February 23, 2015
Baghdadi JD, Korenstein D, Pineles L, et al. Exploration of Primary Care Clinician Attitudes and Cognitive Characteristics Associated With Prescribing Antibiotics for Asymptomatic Bacteriuria. JAMA Netw Open 2022; 5(5): e2214268
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792752?resultClick=3
Neels AJ, Bloch AE, Gwini SM, Athen E. The effectiveness of a simple antimicrobial
stewardship intervention in general practice in Australia: a pilot study. BMC Infectious Diseases 2020; 20: 586
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05309-8
Krockow EM, Harvey EJ, Ashiru-Oredope D. Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach. BMJ Quality & Safety 2022; Published Online First: 15 June 2022
https://qualitysafety.bmj.com/content/early/2022/06/14/bmjqs-2022-014821
Van Staa T, Li Y, Gold N, et al. Comparing antibiotic prescribing between clinicians in UK primary care: an analysis in a cohort study of eight different measures of antibiotic prescribing. BMJ Quality & Safety 2022; Published Online First: 03 March 2022
https://qualitysafety.bmj.com/content/early/2022/03/02/bmjqs-2020-012108
Print “July 2022 Asymptomatic Bacteriuria Still Problematic”
Print “July 2022 What's New in the Patient Safety World (full column)”
Print “July 2022 Five-Character Drug Search Has Problems, Too”
Print “July 2022 Outcomes OK When Surgeon Operated the Night Before”
Print “July 2022 C. diff Success Story”
Print “July 2022 Asymptomatic Bacteriuria Still Problematic”
Go to the "Whats New Archive"
Click on the "Contact Us" button at the left to send us your comments on our "What's New in the Patient Safety World" columns.
To get "Patient Safety Tip of the Week "emailed to you, click here and enter "subscribe" in the subject field.
Copyright 2012 The Truax Group Healthcare Consulting Patient Safety Solutions Tools Tips & Resources. All rights reserved.
PO Box 1230
Grantham, NH 03753
ph: 716-550-1106
btruax