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

Community Acquired Pneumonia- Updated Recommendations ATS and IDSA 2020

ATS/IDSA Guidelines for Diagnosis and Treatment of Adults with Community Acquired Pneumonia 2019

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

Using the IPRO HQIC Planning Tool to Implement a PFAC in Your Hospital

Prepared by IPRO

The Self-Directed Learning Series for IPRO HQIC Hospitals is Now Available

  • Purpose
    • The goal of this learning series is to help a team of hospital employees and a patient and family advisors implement a functioning and sustainable patient and family advisory council or PFAC to meet PFE Best Practice.
    • You will learn the process and steps required to plan and initiate a PFAC.
    • The learning series includes an introductory video and five learning modules—one for each of the five steps of the process (illustrated below).

What is PFE Best Practice 5?
Hospitals are required to have at least one active Person and Family Engagement Committee, Patient and Family Advisory Council (PFAC), or other committee (e.g., Patient Safety) with full membership positions for patient or family representatives.

Background
The series has two major components (1) the PFAC Planning Tool which includes tools and activities that your hospital can use to create and sustain a Patient and Family Advisory Council (PFAC); (2) six pre-recorded learning modules of the Creating and Sustaining a Patient and Family Advisory Council to Improve Patient Safety and Enhance Quality Improvement.

  • How to Access
    • Go to IPRO Learn: Log in to the site to login or create a new account. More information about this process is available on the IPROLearn Account Creation Instructions.
    • Under “all courses” search for PFAC Learning Series.
    • Start with the introductory video and work your way through the five learning modules at your own pace!

View slides and the webinar recording from the Using the IPRO HQIC PFAC Learning Series to Implement a PFAC in Your Hospital to:

  • Learn about how to meet PFE Practice 5: PFAC or Representatives on Hospital Committee.
  • Learn about the new self-directed learning series on IPRO Learn, Creating and Sustaining a Patient and Family Advisory Council (PFAC) to Improve Patient Safety and Enhance Quality Improvement.
  • Discuss how your hospital can use the learning series to develop or strengthen your PFAC.

Opioid Stigma Resources Collection

Compiled by IPRO HQIC

The following are websites where you can resources related to Opioid Stigma:

Articles:

  1. CDC. “Patients’ Frequently Asked Questions | CDC’s Response to the Opioid Overdose Epidemic | CDC.” Www.cdc.gov, 19 Oct. 2021, www.cdc.gov/opioids/patients/faq.html. Spanish Language version available here.
  2. CDC. “Stigma Reduction.” Www.cdc.gov, 25 July 2023, www.cdc.gov/stopoverdose/stigma/index.html. Accessed 10 Oct. 2023.
  3. IPRO HQIC. “Naloxone Saves Lives – HQIC Resource Library.” IPRO HQIC Resource Library, 20 Sept. 2022, hqic-library.ipro.org/2022/09/20/naloxone-saves-lives/. Accessed 10 Oct. 2023. Spanish language version available here.
  4. IPRO HQIC. “People Matter, Words Matter – IPRO QIN-QIO Resource Library.” IPRO HQIC Resource Library, 28 July 2023, qi-library.ipro.org/2023/07/28/people-matter-words-matter/. Accessed 10 Oct. 2023.
  5. Where Opioid Use Disorder Stigma Comes From and How to Prevent It Opioid Use Disorder Stigma: Causes, Impact, Prevention (healthline.com) 
  6. 4 Factors That Add to Stigma Surrounding Opioid Use Disorder 4 factors that add to stigma surrounding opioid-use disorder | American Medical Association (ama-assn.org) 
  7. Stop Overdose: Stigma Reduction Stigma Reduction (cdc.gov) (PDF flyer REDUCING STIGMA (cdc.gov)
  8. The stigma that undermines care The stigma that undermines care (apa.org) 
  9. Stigma: Overcoming a Barrier to Pain Treatment and Addiction Recovery Stigma: Overcoming a Barrier to Pain Treatment and Addiction Recovery | NIH HEAL Initiative 
  10. Substance Use Disorder Stigma: What it is and How You Can Prevent it Substance Use Disorder Stigma: What it is and How You Can Prevent it | USU 
  11. Punishing Drug Use Heightens the Stigma of Addiction Punishing Drug Use Heightens the Stigma of Addiction | National Institute on Drug Abuse (NIDA) (nih.gov) 
  12. Medical Stigma and Patients with Substance Abuse Disorder Medical Stigma and Patients with Substance Abuse Disorders | Psychology Today 
  13. Panel Discussion: Stigma Around Opioid Use Disorder Presents Challenges to Treatment Stigma Around Opioid Use Disorder Presents Challenges to Treatment | The Pew Charitable Trusts (pewtrusts.org) 
  14. Stigma of opioids a hurdle to solving crisis Stigma of opioids keeps users from seeking help, taints views of medical professionals – Harvard Gazette 
  15. Why Opioid Addiction Should Be Viewed-And Treated-Like a Chronic Disease Opioid Use Disorder: Managing Stigma & Treatment | The Well by Northwell 

Blogs Posts:

  1. Part 1: Guiding Principles for Addressing the Stigma on Opioid Addiction Guiding Principles for Addressing the Stigma on Opioid Addiction | Bloomberg American Health Initiative (jhu.edu) 
  2. Part 2: A Roadmap to Reduce Stigma on Opioid Addiction A Roadmap to Reduce Stigma on Opioid Addiction | Bloomberg American Health Initiative (jhu.edu) 

Journal Articles:

  1. Confronting the Stigma of Opioid Use Disorder- and Its Treatment Confronting the Stigma of Opioid Use Disorder—and Its Treatment | Substance Use and Addiction Medicine | JAMA | JAMA Network 
  2. Social Stigma Toward Persons with Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health–Oriented Policies | Psychiatric Services (psychiatryonline.org) 
  3. Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination – ScienceDirect 
  4. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy – PubMed (nih.gov) 
  5. Stigma, discrimination and the health of illicit drug users Stigma, discrimination and the health of illicit drug users – PubMed (nih.gov) 
  6. The role of stigma in U.S. primary care physicians’ treatment of opioid use disorder The role of stigma in U.S. primary care physicians’ treatment of opioid use disorder – ScienceDirect 
  7. Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review – PubMed (nih.gov) 
  8. Opioid use-related stigma and healthcare decision-making Opioid use-related stigma and health care decision-making – PubMed (nih.gov) 

AHA Series: Social Determinants of Health

Prepared by the American Hospital Association (AHA)

The AHA is working to support hospitals and health systems as they address social determinants of health, eliminate health care disparities and provide comprehensive care to every patient in every community—all of which improve community health.

This series is organized by topic, and currently includes modules for: food, housing, transportation, health behaviors, violence, and more.

Connecting PFE Best Practices to All-Cause Harm Reduction

Prepared by AIR for IPRO

This tool provides a crosswalk of the five Person and Family Engagement Best Practices being implemented by HQIC hospitals with the eight all-cause harms that HQIC hospitals are working to reduce. This tool provides a table of examples demonstrating how each PFE Best Practice can be used to engage patients in actions that contribute to the reduction or prevention of each of the eight all-cause harm areas. Not every hospital may need to apply all five PFE Best Practices to every all-cause harm. Hospitals can identify patients at greatest risk of any harm to prioritize partnership at the point of care (PFE Best Practices 1, 2, & 3). Additionally, harm measurements of concern for the hospital may be the focus of partnership in hospital operations (PFE Best Practices 4 & 5). For user convenience, each Row of the table (showing how a single PFE Best Practice can be applied to all eight all-cause harms) has been separated in Appendices A – H, and each Column of the table (showing how each all-cause harm can be applied to the five PFE Best Practices) has been separated in Appendices I – M.

Connecting PFE Best Practices to All-Cause Harm Reduction

APPENDIX A: SEPSIS

APPENDIX B: CAUTI

APPENDIX C: CLABSI

APPENDIX D: C DIFFICILE AND ANTIBIOTIC STEWARDSHIP

APPENDIX E: ADVERSE DRUG EVENTS

APPENDIX F: UNPLANNED READMISSION

APPENDIX G: PRESSURE INJURY

APPENDIX H: OPIOID STEWARDSHIP/BEHAVIORAL HEALTH

APPENDIX I: PFE 1

APPENDIX J: PFE 2

APPENDIX K: PFE 3

APPENDIX L: PFE 4

APPENDIX M: PFE 5

HQIC Antibiotic Stewardship Workgroup- Clostridioides difficile Module

Prepared by IPRO QIN/QIO

Video interview with a nurse describing her own C.  difficile survival story. The story includes a first-person accounting of her yearlong hospitalization, the impact of antibiotic therapy, prevention of C. difficile and the long-term effects of this devastating antibiotic adverse event.

HQIC Antibiotic Stewardship Workgroup: Penicillin Allergy Module

Developed by the Network of Quality Improvement and Innovation Contractors for the Centers of Medicare and Medicaid Services Quality Improvement and Innovation Group – QIN/QIO HQIC

This resource contains two video conversations on how to develop and maintain a successful penicillin allergy program, and how to initiate and sustain an antibiotic allergy clarification program. Additional resources include CDC fact sheet, allergy poster, and Evaluation and Diagnosis of Penicillin Allergy for Healthcare Professionals documentation.

NATIONAL HEALTHCARE SAFETY NETWORK (NHSN):How to Use the Patient Impact and Hospital Capacity Module

National Center for Emerging and Zoonotic Infectious Diseases. Division of Healthcare Quality Promotion and the CDC

As part of CDC’s ongoing COVID-19 response, a new Patient Impact Module has been created in NHSN to help facilities track and monitor the number of cases reported in their facilities daily. The new module collects summary data which can be viewed in a table form without generating new analysis datasets. In addition, the summary data can be exported to excel/CSV for additional analysis outside the application. The data collected using this module will be informative and provide situational awareness at both state and national levels.

The StAT Learning Series for Hospital Clinical Staff and Leader

This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS).

This resource includes a variety of interactive, self-paced learning modules on infection prevention and control in the hospital setting.

The series of 15-minute learning modules is produced by the Centers for Medicare & Medicaid Services (CMS). The series is tailored to teams leading hospital infection prevention programs and care teams in hospital settings of all sizes, including small, rural or critical access facilities. To demonstrate commitment and expertise, users can receive Certificates of Participation upon completion.

Pressure Injury Prevention and Treatment in the Acute Care Setting (6 Modules)

Hospital and Healthsystem Association of Pennsylvania (HAP)

  1. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting
  2. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting: It Takes a Village
  3. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting: Prevention of Pressure Injuries
  4. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting: Treatment of Pressure Injuries
  5. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting: Measuring Performance
  6. Overview: Pressure Injury Prevention and Treatment in the Acute Care Setting: Process Improvement

Note: In 2019, a full set of Clinical Practice Guidelines were developed, by the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guidelines, The International Guideline and can be purchased for a fee. In addition, a Quick Reference Guide (QRG), which provides a summary of the recommended guidelines can be downloaded for no charge.

Please refer to the most updated guidelines for clinical practice.

Citation: European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.

Interactive Training Series: CDC Guidelines for Prescribing Opioids for Chronic Pain

Centers for Disease Control and Prevention (CDC)

This interactive, web-based training features self-paced learning, case-based content, knowledge checks, and integrated resources to help healthcare providers gain a deeper understanding of the CDC Guideline for Prescribing Opioids for Chronic Pain. Find tips on implementing the Guideline in primary care practice and overcoming challenges. Earn free CE.