Collection:  Antibiotic Stewardship Guidelines and Algorithms Compendium

Compiled by IPRO HQIC

Urinary Tract Infection

UTI Guideline-6.9.21.pdf (mi-hms.org)

UTI.Complicated.Protocol.pdf (umich.edu)

clinicpath-nm-updated-uti-guidance_final-1.pdf (unmc.edu)

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases | Clinical Infectious Diseases | Oxford Academic (oup.com)

Urinary Tract Infection (UTI) | Agency for Healthcare Research and Quality (ahrq.gov)

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections – PMC (nih.gov)

Urinary Tract Infections – Adult (umich.edu)

Toolkit for Reducing CAUTI in Hospitals | Agency for Healthcare Research and Quality (ahrq.gov)

Appendix K. Infographic Poster on CAUTI Prevention (ahrq.gov)

Clinical-Pearl-Single-dose-Aminoglycosides-for-Cystitis-1.17.23.docx.pdf (kymdro.org)

Staphylococcus-aureus-in-urine-culture-4.26.23.pdf (kymdro.org)

Clinical-Pearl-Aminopenicillins-for-Enterococcus-cystitis-7.19.23.docx.pdf (kymdro.org)

Skin and Soft Tissue Infection

Cellulitis: A Review (JAMA)

Cellulitis: A Review (NIH)

Cellulitis: Information for Clinicians (CDC)

IDSA Skin & Soft Tissue guidelines 2014

Skin and Soft Tissue Infections: Treatment Guidance Updated May 2018 Jasmine R Marcelin MD, Trevor Van Schooneveld MD, Scott Bergman PharmD Reviewed by: Mark E Rupp MD, M. Salman Ashraf MBBS University of Nebraska. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. Am Fam Physician. 2015;92(6):474-483

AAFP patient education materials

UCSF Medical Center Guideline for the Management of Suspected Skin and Soft Tissue Infections in Adults Original Author(s): Jennifer S. Mulliken, MD and Sarah M. Doernberg, MD, MAS

SHC Clinical Guideline: Outpatient Management of Skin and Soft Tissue Infections

Prophylaxis/SSI

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update with essential practices. 

Additional guidelines (all adapted from consensus guidelines):

ASHP Clinical Practice Guidelines for Prophylaxis in Surgery.

Stanford Health Care- Surgical Prophylaxis Guidelines

University of Michigan- Surgical Prophylaxis Guidelines

University of California San Francisco- Surgical Prophylaxis Guidelines

ICHE Compendium 2022- Updated Surgical Site Infection Prevention Compendium

IV to PO Conversion

Article – Intravenous-to-Oral Switch Therapy: Overview, Antibiotics, Antidepressants (medscape.com)

Article – (2023) – Switching patients from IV to oral antimicrobials – The Pharmaceutical Journal (pharmaceutical-journal.com) (from the UK)

Guidelines

Galway Antimicrobial Prescribing Policy / Guidelines (GAPP) – Galway: GAPP (megsupporttools.com)

 (2018) Intravenous to Oral Conversion for Antimicrobials (northernhealth.ca)

SHC-IV-to-PO-Interchange-Protocol.pdf (stanford.edu)

A Resource To Help With Changing From IV To PO Antibiotics (idstewardship.com)

Public Health Ontario: https://www.publichealthontario.ca/-/media/documents/A/2016/asp-iv-oral-conversion.pdf

C Difficile

Clinical-Pearl-CDI-Risk-2.8.23.pdf (kymdro.org)

CDI Prevention Strategies- https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html

MN Department of Health C difficile guidelines  https://www.health.state.mn.us/diseases/cdiff/hcp/guidelines.html

UC Davis Guidelines 2021  https://health.ucdavis.edu/antibiotic-stewardship/pdfs/cdi_tx_ucd.pdf

University of Nebraska  2021 https://www.unmc.edu/intmed/_documents/id/asp/clinicpath-cdi_final.pdf

UNC Medical Center 2022  https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/gravity_forms/1-c06e424ddddee8826f29e1bc5926a251/2022/11/CASP-UNCMC-CDI-Guideline_FINAL.pdf

AHRQ  Best Practices in the Diagnosis and Treatment of C difficile 2019  

Management of C difficile in adults: review and comparison of IDSA/SHEA, ESCMID and ASID guidelines

IDSA C difficile clinical practice guidelines in adults: 2021 Update by SHEA/IDSA

Patient Stories Collection: Infectious Diseases

Compiled by IPRO HQIC

The following are websites where you can find patient stories related to infectious diseases:

1. Infectious Diseases Society of America (IDSA). IDSA Home [Internet]. Patient Stories: The Faces of Antimicrobial Resistance; [cited 2023 Aug 8]. Available from: https://www.idsociety.org/public-health/patient-stories/patient-stories/.

2. Pew Charitable Trusts. The Pew Charitable Trusts | The Pew Charitable Trusts [Internet]. True Stories of Antibiotic Resistance; 2017 Nov 13 [cited 2023 Aug 8]. Available from: https://www.pewtrusts.org/en/research-and-analysis/articles/2017/11/true-stories-of-antibiotic-resistance-3-personal-perspectives.

3. National Foundation for Infectious Diseases (NFID). NFID [Internet]. Real Stories, Real People – NFID; [cited 2023 Aug 8]. Available from: https://www.nfid.org/resources/real-stories-real-people/.

4. Sepsis Alliance [Internet]. Faces of Sepsis; [cited 2023 Aug 11]. Available from: https://www.sepsis.org/education/patients-family/faces-of-sepsis/.

5. Summa Health | Nonprofit Healthcare System in Akron, Ohio [Internet]. Infectious Disease Patient Stories | Summa Health; [cited 2023 Aug 11]. Available from: https://www.summahealth.org/specializedservices/infectious-diseases/patient-stories

6. Cleveland Clinic [Internet]. Infectious Disease Patient Stories | Cleveland Clinic; [cited 2023 Aug 11]. Available from: https://my.clevelandclinic.org/patient-stories/infectious-disease

7. St. Jude Children’s Research Hospital [Internet]. Infectious Diseases Treatment Patient Stories; [cited 2023 Aug 11]. Available from: https://www.stjude.org/treatment/disease/infectious-diseases/patient-stories.html

8. Patient Stories and Patient Safety [Internet] CDC. Published September 13, 2023. [Cited September 18, 2023]. Available from: https://blogs.cdc.gov/safehealthcare/category/patients/

9. COVID-19 Patient Stories. [Internet] www.hopkinsmedicine.org. [Cited September 18, 2023]. Available from: https://www.hopkinsmedicine.org/coronavirus/patient-stories

10. HQIC Antibiotic Stewardship Workgroup: Clostridioides difficile Module. [Internet] IPRO NQIIC. [Cited September 18, 2023]. Available from: https://qi.ipro.org/2022/04/21/hqic-antibiotic-stewardship-workgroup-clostridioides-difficile-module/

The Prevention of Surgical Site Infection in Elective Colon Surgery

Pubmed Article

Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.

Partnering with Patients and Families to Strengthen Approaches to the Opioid Epidemic

Institute for Patient and Family Centered Care (IPFCC)

This whitepaper showcases the many opportunities for patients, families, and individuals with lived experience to collaborate in shaping and implementing policies and programs related to the opioid epidemic. While work in this area is evolving, several “spotlight examples” provide a starting point for thinking about new strategies and opportunities and reflect existing structures that can be utilized and expanded to accelerate the process of building meaningful partnerships.

Assessment of the Appropriateness of Antimicrobial Use in US Hospitals

Journal of the American Medical Association (JAMA) & Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Importance Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited.

Objective  To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment.

Conclusions and Relevance The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.

Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel

National Pressure Injury Advisory Panel (NPIAP)

The purposes of this National Pressure Injury Advisory Panel (NPIAP) Position Paper are to:

  1. Summarize the current NPIAP position regarding unavoidable pressure injuries.
  2. Examine the effects of the COVID-19 crisis on the scope of what is considered an unavoidable pressure injury.
  3. State the position of the NPIAP regarding determinations of unavoidable pressure injuries during the COVID-19 crisis.
  4. Renew the NPIAP call to collaborate on the development of criteria for the determination of unavoidable pressure injuries in acute care.

Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel

National Pressure Injury Advisory Panel (NPIAP)

The purposes of this National Pressure Injury Advisory Panel (NPIAP) Position Paper are to:

  1. Summarize the current NPIAP position regarding unavoidable pressure injuries.
  2. Examine the effects of the COVID-19 crisis on the scope of what is considered an unavoidable pressure injury.
  3. State the position of the NPIAP regarding determinations of unavoidable pressure injuries during the COVID-19 crisis.
  4. Renew the NPIAP call to collaborate on the development of criteria for the determination of unavoidable pressure injuries in acute care.

Skin Manifestations with COVID-19

National Pressure Injury Advisory Panel (NPAIP)

Many reports are occurring concerning areas of purpuric/purple skin and purple toe lesions in patients diagnosed with COVID-19 (SARS-CoV-2). Wound care providers are being asked if these skin lesions are forms of Deep Tissue Pressure Injury and/or “skin failure”. Early reports of COVID-19 related
skin changes included rashes, acral areas of erythema with vesicles or pustules (pseudo-chilblain), other vesicular eruptions, urticarial lesions, maculopapular eruptions, and livedo or necrosis. The pattern and presentation of skin manifestations with COVID-19 is more than rashes. The purpose of this paper is to guide the wound care clinician in determining if the “purple skin” being seen is a deep tissue pressure injury or a cutaneous manifestation of COVID-19.

COVID-19 Lessons Learned (whitepaper): A Resource for Recovery

Co-authored by Deloitte & Joint Commission Resources

The whitepaper catalogues a broad array of lessons learned identified during the period of March through August 2020. These lessons learned are based on discussions with a diverse group of health care leaders; assessments of readiness/preparedness efforts across national, regional and local stakeholders; and a review of public documents. The considerations in this whitepaper include observed best practices adopted by organizations throughout the COVID-19 response. For each health care domain and associated issues, it lays out specific actions that organizations have taken to address them and provides access to guidance and tools that health care leaders can use to create and enact their own plan to address these challenges. Some of the wide array of health care domains covered in this in-depth resource include:

  • Leadership
  • Emergency readiness and crisis response
  • Infection control
  • Patient safety and high reliability
  • Communications and change management