An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

Background

Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles.

Methods

A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test.

Results

Participants' mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants' confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001).

Conclusions

Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.

Development and implementation of "handshake rounds": An antibiotic stewardship intervention for hospitalized adult patients with hematologic malignancies

Objective

To design and implement "handshake rounds" as an antibiotic stewardship intervention to reduce inpatient intravenous (IV) antibiotic use in patients with hematologic malignancies.

Design

Quasi-experimental analysis of antibiotic use (AU) and secondary outcomes before and and after handshake rounds were implemented.

Setting

Quaternary-care, academic medical center.

Patients

Hospitalized adults with hematologic malignancies receiving IV antibiotics.

Methods

We performed a retrospective review of a preintervention cohort prior to the intervention. A multidisciplinary team developed criteria for de-escalation of antibiotics, logistics of handshake rounds, and outcome metrics. Eligible patients were discussed during scheduled handshake rounds between a hematology-oncology pharmacist and transplant-infectious diseases (TID) physician. Prospective data were collected over 30 days in the postintervention cohort. Due to small sample size, 2:1 matching was used to compare pre- to and postintervention AU. Total AU in days of therapy per 1,000 patient days (DOT/1,000 PD) was reported. Mean AU per patient was analyzed using Wilcoxon rank-sum test. A descriptive analysis of secondary outcomes of pre- and postintervention cohorts was performed.

Results

Total AU was substantially lower after the intervention, with 517 DOT/1,000 PD compared to 865 DOT/1,000 PD before the intervention. There was no statistically significant difference in the mean AU per patient between the 2 cohorts. There was a lower rate of 30-day mortality in the postintervention cohort and rates of ICU admissions were similar.

Conclusions

Conducting handshake rounds is a safe and effective way to implement an antibiotic stewardship intervention among high-risk patient population such as those with hematologic malignancies.

Evaluation of healthcare-associated infection rates in patients with hematologic malignancies and stem cell transplantation during the coronavirus disease 2019 (COVID-19) pandemic

Objective

To evaluate whether rates of healthcare-associated infections (HAIs) changed during the coronavirus disease 2019 (COVID-19) pandemic in malignant hematology and stem cell transplant patients.

Design

A retrospective, cohort study.

Patients

The study included malignant hematology and stem cell transplant patients admitted between March 1, 2019, through July 31, 2019, and March 1, 2020, through July 31, 2020.

Methods

Rates of catheter-associated urinary tract infections (CAUTIs), central-line-associated bloodstream infections (CLABSIs), central-line-associated mucosal barrier injury infections (CLAMBIs), and Clostridioides difficile infections (CDIs) during the pandemic were compared to those in a control cohort. Secondary outcomes included the rate of non-COVID-19 respiratory viruses.

Results

The rate of CAUTIs per 1,000 hospital days was 0.435 before the pandemic and 0.532 during the pandemic (incidence rate ratio [IRR], 1.224; 95% confidence interval [CI], 0.0314-47.72; P = .899). The rate of CLABSIs was 0.435 before the pandemic and 1.064 during the pandemic (IRR, 2.447; 95% CI, 0.186-72.18; P = .516). The rate of CLAMBIs was 2.61 before the pandemic and 1.064 during the pandemic (IRR 0.408, 95% CI 0.057-1.927; P = .284). The rate of CDIs was 2.61 before the pandemic and 1.579 during the pandemic (IRR, 0.612; 95% CI, 0.125-2.457; P = .512). Non-COVID-19 respiratory virus cases decreased significantly from 12 (30.8%) to 2 cases (8.3%) (P = 0.014).

Conclusions

There was no significant difference in HAIs among inpatient malignant hematology and stem cell transplant patients during the COVID-19 pandemic compared to those of a control cohort. Rates of infection were low among both cohorts. Rates of community-acquired respiratory viruses decreased significantly during the pandemic among this population.

Content, costs, and characteristics of United States prepharmacy curricula

INTRODUCTION

The objective of this study was to examine pharmacy prerequisites and estimate the costs prospective students may incur to complete those requirements.

METHODS

Prepharmacy requirements for doctor of pharmacy (PharmD) degree programs in the United States (US) (n = 137) were sourced from school websites in 2018. Credit hour costs for community colleges, public four-year institutions, and private four-year institutions were collected. Chi-square and independent t-tests compared group differences.

RESULTS

Schools required 66.12 ± 8.15 prerequisite credit hours (range 41 to 91  hours). All schools required one course in general chemistry and organic chemistry. A higher proportion of schools in 2018 required anatomy/physiology and statistics when compared to 2009. Estimated costs to complete prerequisites ranged from US $16,359 at a community college to US $187,800 for a bachelor's degree at a private institution.

CONCLUSIONS

Trends in healthcare and education make it timely for schools to reconsider prerequisites. Renewed consideration should be given to identifying what is core to the profession and the minimum competencies students must demonstrate for entry into PharmD programs.

Characterization of school of dentistry prerequisite courses and recommendations for admission

PURPOSE

There is minimal research characterizing admission prerequisites courses across schools of dentistry. The purpose of this study was to typify didactic and laboratory course requirements and compare requirements based on institution demographics.

METHODS

In July 2019, the researchers evaluated websites from 76 North American dental schools to collect information on required and recommended courses, credit hour requirements, and institution demographics. Sub-group analyses evaluated differences in course and credit hour differences based on institution funding, degree program, location, and Carnegie Classification.

RESULTS

The most common required courses were general chemistry (97.4%), physics (93.4%), organic chemistry (92.1%), general biology (90.8%), communication (86.8%), and biochemistry (80.3%). The most common required laboratory courses were general chemistry (63.2%), organic chemistry (59.2%), general biology (55.3%), and physics (51.3%). Several institutions included unique course recommendations such as histology (40.7%), psychology (30.3%), art (18.4%), business (18.4%), sociology (15.8%), and embryology (14.5%). There were few differences based on institution classifications; however, differences were observed most often between institutions within and outside the United States. The study also identified 65.8% (n = 50) of schools have letter of recommendation requirements and 46.1% (n = 35) of schools require or recommend shadowing experiences with programs requesting a median of 60 hours (range 20-300 hours).

CONCLUSIONS

The study offers a contemporary characterization of prerequisite requirements and recommendations. In addition, the study raises critical questions about whether these standards reflect expectations for entering learners, if these requirements truly relate to learner success, and if these requirements prepare learners to be future-ready graduates.