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Antimicrobial Resistance Interagency Task Force
2007 Annual Report (Released June 2008)

Action Items 21—26

Focus Area II: Prevention and Control

Action Item #21: Identify Factors That Promote or Impede Appropriate Drug Use in Hospitals, Extended Care Facilities, and Outpatient Settings In Collaboration with Partners.

Project Title: Research Projects (R01): 1. Improving Antibiotic Use in Acute Care Treatment (IMPAACT) Trial.
2. Implementing evidence-based guidelines for treating NHAP.

• Agency: AHRQ
• IMPAACT has examined patient, physician, and hospital factors relating to appropriate antimicrobial use and has tested different types of interventions to improve antimicrobial use in eight emergency departments located across the United States. 2. This quasi-experimental study is designed to test the translation of multidisciplinary guidelines on evaluating and treating nursing home-acquired pneumonia (NHAP) into practice in multiple nursing facilities.
• Results: Antimicrobial overuse is very common in emergency departments (EDs), especially for acute bronchitis. Emergency departments affiliated with ED training programs appear to prescribe fewer unnecessary antimicrobials (Gonzales R et al. Acad Emerg Med 2006; 13:288-94.). EDs located in hospitals with restrictive inpatient formularies prescribe fewer fluoroquinolones (Aspinall SL et al. Am J Manag Care 2007; 13:241-8.). A patient and physician educational intervention reduces overuse of antimicrobials, although significant room for improvement remains (Metlay JP et al. Ann Emerg Med 2007;50:221-30). 2. The intervention is complete. A no-cost extension was obtained to complete data analysis. Findings from the baseline study year that suggest that guideline compliance is related to nurse and CNA staffing and turnover are in press in J Gerontol A Biol Sci Med Sci.

Project Title: Research demonstration and dissemination project (R18): Improving otitis media care with HER-based clinical decision support and feedback.

• Agency: AHRQ
• Description: Otitis media is the second commonest disease in childhood and the most common reason for antibiotic prescriptions in the United States. Physicians tend to overuse antibiotics for otitis media because it can be hard to diagnose, medical care is often fragmented across multiple sites and clinicians, and some physicians are not aware of national guidelines that recommend more judicious use of these medicines.
• Results: The Children's Hospital of Philadelphia primary care network has been organized as a Pediatric Research Consortium with >180,000 children managed by >300 practitioners from 28 practices in three states. The project will use the Children's Hospital electronic health record to integrate care across time and to supply physicians with the knowledge they need about how to treat a patient at the point of care. Randomly allocating practices into usual care, full intervention, and full intervention without feedback, the project will asses the effects of intervention on quality, resource use, and clinician adoption of the technology.

Project Title: Research Demonstration (U18): Centers for Education and Research on Therapeutics (CERTs) program: a national initiative to increase awareness of the benefits and risks of new, existing, or combined uses of therapeutics through education and research.

• Agency: AHRQ
• Description: The University of Pennsylvania Center for Education and Research on Therapeutics has undertaken studies investigating the association between antibiotic use and antibiotic resistance, including the impact of different methods of categorizing prior antibiotic use. 2. The Harvard Pilgrim Healthcare CERT supports nine collaborating systems within an HMO Research Network to study antibiotic use in children and has evaluated the impact of a 16-community trial to promote judicious antibiotic use in Massachusetts.
• Results: Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from an antimicrobial stewardship program (ASP). Clinicians and ASP practitioners should work to confirm that critical data have been communicated accurately prior to use of that data in prescribing decisions (Linkin DR et al. Infect Control Hosp Epidemiol 2007; 28:1374-81.). 2. A substantial downward trend in antibiotic prescribing occurred, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greatest among Medicaid-insured children and for broad-spectrum agents. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends (Finkelstein JA et al. Pediatrics 2008;121:e15-23.).

Project Title: HIV drug resistance and clinical epidemiology

• Agency: CDC
• Description: DHAP's Epidemiology Branch conducts a number of activities to assess the clinical relevance of HIV resistance. The Epi Branch will continue collecting commercial HIV genotype and phenotype antiretroviral resistance testing results from the convenience sample of ca. 3,000 active adult participants enrolled in the HIV Outpatient Study (HOPS) and the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (the "SUN" Study) and ca. 1,000 children and young adults in the Longitudinal Epidemiologic Study to Gain Insight into HIV and AIDS in Children and Youth (LEGACY). These data will be used to assess modifiable factors for reducing risk of developing clinically relevant antiretroviral resistance.
• Results: To summarize the data thus far:
• Among everyone in Legacy:
  887 genotype tests from among 536 participants (1.65 test per participant); 310 phenotype tests from among 226 participants (1.37 test per participant); and 85 virtual phenotype tests from among 68 participants (1.25 test per participant)
• In HOPS, since 1997, clinicians have ordered (and results available):
  3,420 genotype tests from among 1,995 patients (1.71 tests per patient) and 1,269 phenotype tests from among 819 patients (1.55 tests per patient)
• In the SUN study since March 2004, 701 participants have been enrolled into the study; of these 346 genotype tests have been completed among 235 participants (1.5 per patient) and 26 phenotype tests have been completed among 20 participants (1.3 per patient).

Project Title: Labeling Rule

• Agency: FDA
• Description: The new labeling is intended to educate physicians and the public about the resistance problem and to encourage physicians to prescribe systemic antibacterial drugs only when clinically necessary.
• Results: The Final Labeling Rule was published in the Federal Register on February 6, 2003. The rule went into effect February 6, 2004. Announcement of Labeling Rule (http://fda.gov/bbs/topics/NEWS/2003/NEW00869.html)

Project Title: Appropriate use of antimicrobials

• Agency: VA
• Description: The VHA has a national formulary, develops and implements care guidelines, and provides extraordinary educational opportunities for staff to deal with questions concerning appropriate use of antibiotics. This is an ongoing activity, but the effort will continue to be enhanced by further collaboration with federal agencies and other partners (including the private sector) since appropriate antibiotic usage involves many components such as physician education, education of the public, appropriate drug advertising, control of over-the-counter antibiotic use, and many other items that require intervention both inside and outside of the federal systems. Local VA facilities pilot and use standardized computerized medical records, templating and ordering for medication ordering (including antimicrobials) that incorporate use of clinical pathways for infectious diseases processes (e.g., pneumonia, peri-operative antimicrobial use) ; these all help to direct providers or care to preferred diagnostic and therapeutic strategies.
• Results: Ongoing. Infectious Diseases Field Advisory Committee has representation on the national Antimicrobial Medical Advisory Panel (MAP) for pharmacy. Local sites update pathways and order sets based on local feedback from front line providers and as newer regional and national recommendations are available; also as formulary choices change (either local, regional or national) there updates also can occur.

Action Item #22: Develop Appropriate Drug Use Policies and Evaluate the Impact (Including on Prescribing Patterns, Resistance Rates, Patient Outcomes, and Cost) of Implementing These Policies in Hospitals and Other Health Care Delivery Settings. Identify Ways To Increase Adherence to Appropriate Use Policies Proven To Be Beneficial in Collaboration with Partners.

Project Title: Appropriate use of antimicrobials

• Agency: VA
• Description: The VHA has a national formulary, develops and implements care guidelines, and provides extraordinary educational opportunities for staff to deal with questions concerning appropriate use of antibiotics.
• Results: Ongoing. Infectious Diseases Field Advisory Committee has representation on the national Antimicrobial Medical Advisory Panel (MAP) for pharmacy

Project Title: Surgical Site Infection Antibiotic Prophylaxis plan

• Agency: VA
• Description: b. VHA has introduced surgical site antibiotic prophylaxis (including both timing and appropriateness of choices, as well as timely cessation) as a performance measure for VHA systems nationwide. These performance measures constitute 50% of the annual evaluation for Executive Career Field (ECF) performance plans for VHA regional directors and individual medical center directors.
• Results: In Federal Fiscal Year 2005, VHA introduced surgical site antibiotic prophylaxis as a performance measure for VHA systems nationwide--ongoing into FY 2008 (considered a "mission critical" measure

Project Title: Community-acquired pneumonia performance measures

• Agency: VA
• Description: Along with b above, VHA Office of Quality and Performance has initiated quality measures for timing, diagnostics and treatment of community-acquired pneumonia.  
• Results: Implemented FY 2006 and ongoing into FY 2008 considered a "mission critical" measure.

Project Title: d. Transformational measures for VHA-Infection Rate Reduction

• Agency: VA
• Description: VHA Office of Quality and Performance has espoused as Transformational Measure 1, Infection Rate Reduction which included central line-associated bloodstream infections, ventilator-associated pneumonias and methicillin-resistant Staphylococcus aureus prevention. Transformational measures are incremental measures designed to support long term strategic goals. They are visionary and identify areas of significant system impact, but may not be attainable in a single performance year.
• Results: Formally adopted as transformational measures for FY 2008. Ventilator-associated pneumonia and central-line-associated bloodstream infections in the ICUs have been in effect since FY 2006 through the VA Inpatient Evaluation Center (IPEC). MRSA Prevention Initiative started in FY 2007. All are ongoing.

Action Item #24: Help Individual Hospitals and Healthcare Systems Analyze How the Availability of AR Data and Computer-Assisted Decision Support Systems Influences Prescriber Behavior, Health Outcomes, and Costs. This Plan May Include the Provision of Computer Software and the Establishment of Projects That Involve the Medicare Peer Review Organizations (PROs).

Project Title: Emerging Pathogens Initiative (EPI)

• Agency: VA
• Description: Data on antimicrobial resistance with quartile rankings in the VHA nationwide are provided to the Networks, including reporting site-specific data by using the EPI, an automated surveillance system. This will be an ongoing initiative since it is not entirely clear what the best method for AR feedback will be in the final analysis.  
• Results: Ongoing at VA sites across the country. Enhancements that acquire additional information on antimicrobial resistance of specified organisms were distributed to reporting stations in July 2004  

Project Title: b. AHRQ 1 UC1 HS014237 Toward a Safety Culture: Reducing Nosocomial Infections

• Agency: VA
• Description: VA personnel led a regional research study sponsored by AHRQ designed to look at rapid-cycle implementation strategies of evidence-based practices that are known to reduce health care associated infections.
• Results: b. Primary study accrual has completed and review however reporting of results is ongoing. This regional cooperative project received the 2005 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Ernest Amory Codman award and demonstrated findings of: i) reduced central line infections by 50 percent. ii) increased adherence to evidence-based practices to 95 percent from 30 percent. iii) created a new model for facilitating improvement as a community, with an increased chance of success, sharing of successful strategies, reducing rework across the sites, and speeding the implementation process. 

Project Title: Inpatient Evaluation Center (IPEC)

• Agency: VA
• Description: c. The IPEC is a national program to improve outcomes (risk adjusted mortality and length of stay) in VA ICUs and eventually in inpatient care through feedback of outcomes and implementation of evidenced-based practices.
• Results: Implemented nationwide during FY 2006. Ongoing. Due to its ease of use and navigation, the IPEC data entry portal has also been used for data entry for the Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative

Project Title: Review of commercially available computer software to be used for infection prevention, control and containment 

• Agency: VA
• Description: VA is actively reviewing computer off-the-shelf software products to assist in infection control processes for prevention and control of infectious diseases including antimicrobial resistant organisms; computer-assisted decision support systems will be a key element in VA's choice.
• Results: Review and evaluation of off-the-shelf products remains in process for issue of antibiotic resistance, as well as having features that will assist in evaluation of healthcare-associated infection analysis. At this time, one vendor product has been selected for further development nationwide that will include antibiogram monitoring and possibly decision support regarding antibiotic choices. Provided successful pilot and beta-site testing, system wide implementation would be anticipated within 3 years.

** TOP PRIORITY **

Action Item #25: Conduct a Public Health Education Campaign To Promote Appropriate Antimicrobial Use as a National Health Priority. The Health Campaign Should Involve Many Partners.

Project Title: "Get Smart: Know When Antibiotics Work" national media campaign

• Agency: CDC, FDA
• Description: This national media education campaign was developed to promote appropriate antimicrobial drug use in the community for upper respiratory infections, e.g., to decrease patient requests for antibiotics for illnesses for which they offer no benefit. Target audiences are parents of young children and healthy adults. The campaign uses a variety of health communication materials based on concepts tested in focus groups, and its effectiveness will be evaluated when support is available.
• Results: Ogilvy Public Relations Worldwide was awarded the media contract in September 2001 to implement a three phase media plan. Phase I focused on research and development while Phase II culminated with a nationwide launch of the media campaign. The TV PSA generated 86.5 million impressions; the radio PSA 160 million impressions; the print ads were viewed by 185 million; and traffic to the Get Smart website substantially increased (unique visitors jumped from just 4,927 in August 2003 to 28,604 in December 2004). Phase III of the media plan involved continuing the outreach efforts implemented in Phase II. During the final phase, appropriate antibiotic use messages and media were developed and tested for Spanish speaking parents of young children, English speaking healthy adults 21- 49, and American Indian/Native American groups, in an effort to expand the campaign's reach. The new materials were released as part of a media re-launch in early 2005. In FY2006, TV and Radio PSAs were made available for download on the Get Smart website.

Project Title: Get Smart: Know When Antibiotics Work - multicultural outreach/diversity initiative

• Agency: CDC
• Description: Several projects are in development or implementation stages to increase awareness of antibiotic resistance and appropriate antibiotic use among minority communities and those who do not speak English. Projects include: development of educational materials for Spanish-speakers and American Indian/Native American (AI/NA) communities, train-the-trainer sessions with Latino and AI/NA community members, speaking engagements, promotora outreach in California, and development of partnerships to further develop and sustain the initiative.
• Results: The Spanish and AI/NA materials were launched as part of the Phase III media release (see media campaign). Numerous presentations and train-the trainer sessions have been conducted with Latino interest associations and the Indian Health Service Community Health Representative members. A contest was conducted in early 2006 among the CHRs to distribute educational materials and appropriate antibiotic use messages to AI/NA audiences. Since early 2005, this initiative has developed 17 new partnerships. In FY 2006, Get Smart worked with the Indian Health Service to disseminate culturally-appropriate messages/tools to American Indian communities. In FY2008, with CDC assistance, the Get Smart New Mexico program will develop a curriculum for American Indian communities.

Project Title: Get Smart: Know When Antibiotics Work - pharmacy initiative

• Agency: CDC
• Description: Several projects are in development or implementation stages to increase awareness among consumers about antibiotic adherence, and to educate pharmacists about counseling consumers/clients on appropriate antibiotic use. Projects include: hospital pharmacist CE program, distribution of adherence messages for consumers, and development of partnerships to develop and sustain initiative.
• Results: Pharmacist CE: In FY07, Get Smart campaign partner, Society of Infectious Diseases, continued development of a CE program for hospital pharmacists to teach about the issue of antibiotic resistance and give tools to communicate with consumers. Upon final CDC clearance, the program will be hosted online by CE provider, Pharmacy Choice (rxschool.com). In fall 2008, a 5th-year pharmacy student will do a 5 week rotation with the Get Smart campaign and revise the hospital pharmacist CE into a CE for community pharmacists.
  Adherence piece distribution: the antibiotic adherence education piece has been developed, tested, printed and distributed to key partners in the pharmacy setting. Get Smart is working to partner with more pharmacy chains, especially the ones which distribute free or low cost antibiotics.

Project Title: Get Smart: Know When Antibiotics Work on the Farm

• Agency: CDC
• Description: Conduct a public health education campaign to promote appropriate antimicrobial use as a national health priority, involving many partners.
• Results: Completed. 10 funded state-based campaigns completed state-based projects addressing appropriate antimicrobial use. This work resulted in 7 peer-reviewed publications, 8 oral/poster presentations, 2 publicly accessible web pages, 2 behavioral surveys, 9 electronic veterinary curricular modules addressing treatment in food animal species, and printed materials that were distributed to over 50,000 food animal producers.

** TOP PRIORITY **

Action Item #26: In Collaboration with Many Partners, Develop and Facilitate the Implementation of Educational and Behavioral Interventions That Will Assist Clinicians in Appropriate Antimicrobial Prescribing.

Project Title: Mentored Clinical Scientist Award (K08): improving care for acute respiratory infection

• Agency: AHRQ
• Description: The recipient is developing and implementing an electronic medical record-based template for acute respiratory infection (ARI) visits, the ARI Smart Form. The ARI Smart Form will standardize documentation of care and give clinicians easy access to clinical information, patient-education materials, and clinical decision support with a goal of reducing inappropriate antibiotic prescribing.
• Results: The ARI Smart Form underwent usability testing in Summer 2005 and was pilot-tested in Fall 2005 (Linder JA et al. AMIA Annu Symp Proc 2007: pp. 468-72.). A full randomized controlled trial in some 24 practices took place during the 2005-2006 cold and influenza season (manuscript in preparation). The recipient has also developed and is testing a performance measurement tool for comparing providers' antibiotic prescribing for ARIs, the ARI Quality Dashboard (Jung E et al. In: Teich JM et al. AMIA Annual Symposium Proceedings; November 10-14, 2007; Washington DC. Washington DC: American Medical Informatics Association; 2007; p. 1035.).

Project Title: Campaign to prevent antimicrobial resistance in healthcare settings

• Agency: CDC
• Description: The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings (the Campaign) was launched in March 2002. The Campaign's overall goal is to reduce antimicrobial resistance (AR) by decreasing inappropriate antimicrobial use and improving adherence to proven infection control precautions. Five 12-step Programs with evidence-based action steps have been developed to target physicians who provide care to the following populations: hospitalized adults, dialysis patients, surgical patients, hospitalized children, and long-term care residents. Didactic tools and materials also have been developed and tested and accompany each of the 12-step Programs to promote the implementation of the recommended steps. In addition, materials have been developed that focus on the prevention of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
• Results: The Campaign is currently undergoing an overhaul in an attempt to better focus the messages and action steps to enhance its impact. The Campaign now has a medical director and a dedicated public health advisor. Major 2007 activities included: 1) Funded eight states through the Epidemiology and Laboratory Capacity (ELC) mechanism to conduct educational activities to prevent AR in healthcare settings and CA-MRSA. 2) Collaborated with AMA and IDSA to develop a clinical management algorithm to assist outpatient healthcare providers with the diagnosis and treatment of patients with MRSA skin and soft tissue infections. 3) Co-branded with the Massachusetts Department of Public Health a series of four posters to address prevention of MRSA among athletes. 4) Developed a series of eight posters targeted at general audiences with prevention messages for MRSA. 5) Collaborated with the National Collegiate Athletic Association to develop a series of six posters to address prevention of MRSA among athletes.

Project Title: Reporting antimicrobial susceptibility data to clinicians

• Agency: CDC
• Description: Assist CLSI to produce guidelines for clinical microbiology laboratories on how to report unique resistance patterns, improve detection of inducible resistance, and how to compile and report summaries of cumulative antimicrobial susceptibility data (antibiograms) in a standardized manner to aid in clinical decisions.
• Results: More extensive explanations of resistance patterns or cautions in prescribing antimicrobial agents are being incorporated into the Clinical and Laboratory Standards Institute (CLSI) guidelines, which are updated annually. Numerous seminars, teleconferences and educational efforts were presented by DHQP microbiologists to educate clinicians and microbiologists about which antimicrobial agents to override on a patient's report and when further characterization of the pathogen (MRSA, C. difficile, multidrug-resistant gram negative rods) would or would not impact the selection of antimicrobial therapy.

Project Title: Get Smart: Know When Antibiotics Work-
State-based multifaceted interventions for clinicians and patients to promote the appropriate use of antibiotics  for outpatient upper respiratory infections

• Agency: CDC
• Description: The campaign assists states in implementing broad-based multi-faceted health communication and behavioral interventions to promote appropriate antibiotic use for outpatient upper respiratory infections. State health departments develop broad-based coalitions (e.g., state medical societies, healthcare delivery organizations, healthcare purchasers, consumer groups), use CDC educational materials, develop materials of their own, launch campaigns targeting providers and the general public , and evaluate various aspects of their local campaigns and/or appropriate antibiotic use knowledge, behaviors, and attitudes . Controlled trials have demonstrated success of this program in decreasing inappropriate prescribing; also, nationwide antibiotic prescribing rates for children are declining.
• Results: In FY05, 31 local programs were funded (29 program, 2 travel-only). In FY06, 34 local programs were funded (25 program, 9 travel-only). In FY07, 31 programs were funded (20 program, 11 travel). In FY08, 15 program were funded (14 program, 1 carryover, 0 travel). The Get Smart campaign maintains a comprehensive website that funded sites can utilize to gain access to campaign resources and educational tools and to learn more about national campaign activities. The Get Smart campaign conducts regularly scheduled phone calls to provide technical assistance as well as document ongoing activities. In November 2007, Get Smart hosted a meeting for its funded state programs.

Project Title: Get Smart: Know When Antibiotics Work-Development and distribution of evaluation manual for programs promoting appropriate antibiotic use in the community

• Agency: CDC
• Description: CDC distributes funds to state and local health departments to develop local campaigns to promote appropriate antibiotic use, and all funded sites are required to include an evaluation component. However, with limited resources, the vast majority of sites do not adequately evaluate the success of their work. In addition, our grantees have repeatedly requested assistance in planning and implementing these evaluations. Data gathered during evaluation enables managers and staff to create the best possible programs, identify lessons learned, make modifications as needed, monitor progress toward program goals, and judge the success of the program in achieving its short-term, intermediate, and long-term outcomes.
• Results: During FY 2004, meetings with the evaluation manual working group focused on reviewing manual content, coordinating writing styles, and planning for the completion and distribution of the manual. Completed drafts of two appropriate antibiotic use case studies, sent them to program coordinators of some of our funded sites to solicit feedback, and revised the case studies accordingly. The manual was finalized and cleared in fall 2005. The manual underwent final revisions and proofreading in early 2006 and was released to all CDC-funded state programs and other interested parties in April 2006 via electronic message board, Epi X. In FY2007, a hard copy of the manual was provided to all interested groups The manual is also available for download on the Get Smart website. A Program Evaluation Officer has been hired as a contractor to assist Get Smart and its funded sites with all program evaluation activities.

Project Title: Get Smart: Know When Antibiotics Work-Medical professional curricula promoting appropriate use of antibiotics

• Agency: CDC
• Description: Developing and promoting three appropriate antibiotic use curricula for providers:
1.  Curriculum for medical students regarding appropriate antibiotic use. Topics include extent of antibiotic resistance, diagnostic techniques, and appropriate antibiotic use. Case studies focus on diagnosis, treatment, and provider-patient communication. This course is designed to meet the needs of a variety of medical schools with components that can be used separately or as a whole.
2.  Curriculum for primary care residents on appropriate antibiotic use based on the medical school curriculum.
3. Curriculum for family practice and pediatric residents for diagnosing otitis media.
4.  Continuing Education course for MDs, PAs, and NPs
• Results: Medical school curriculum, ongoing: The curriculum is intended to be distributed nationally in FY2008. 2) Primary care residents curriculum, ongoing: The Oregon Health and Science University developed a curriculum for primary care residents based on the medical school curriculum. The study team extended the pilot testing phase of the project due to difficulties recruiting primary care residents for testing. After testing and refinement, the curriculum will be used in additional Oregon programs, and later made available nationally. 3) Otitis media curriculum, completed The Children's Hospital of Pittsburgh has developed a curriculum for family practice and pediatric residents to improve training in the diagnosis and treatment of otitis; available at: http://pedsed.pitt.edu/. 4) Get Smart funded the Colorado Get Smart campaign to develop and promote an online video-based CE course for acute respiratory infections; it will be available in early FY2009.

Project Title: Get Smart: Know When Antibiotics Work - Influenza antiviral education for physicians and patients (in collaboration with the Influenza Division)

• Agency: CDC    
• Description: Develop and promote educational materials for providers and patients about recognizing flu and appropriate use of antivirals, which will in turn decrease inappropriate use of antibiotics. This will consist of evaluating the effectiveness of materials and key messages; conducting focus groups, surveys, and in-depth interviews, and incorporating key messages into web and print materials.
• Results: A contract has been awarded to the Academy for Educational Development to conduct this project with oversight from CDC. All research will take place by fall 2008. New materials will be available by Winter 2008/09.

Project Title: Get Smart: Know When Antibiotics Work- New message development involving adverse drug events and healthcare quality promotion.

• Agency: CDC
• Description: In FY2007, Get Smart convened an External Review Panel to assess the progress of the Get Smart program. While the expert panel stated that significant inroads had been made, they recommended that more should be done. They recommended to shift the focus of Get Smart's messages to include patient safety and healthcare quality promotion.
• Results: Get Smart staff will develop, test and implement new messages that highlight quality promotion and patient safety (e.g. adverse drug events). The staff will work with the Oak Ridge Institute for Science and Education, which has been awarded a contract to develop materials and conduct formative research. Focus groups with the general public and in-depth-interviews with physicians will be conducted in FY2008. New materials should be available in early FY2009. CDC's Division of Healthcare Quality Promotion is a partner in this effort.

Project Title: Performance measures for surgical antibiotic prophylaxis and antibiotic therapy for community-acquired pneumonia have been rolled out within the last year or are in process.

• Agency: VA
• Description: VHA Office of Quality and Performance has instituted nationwide measures related to antibiotic prescribing regarding timing of antibiotic prophylaxis relative to surgical procedures. Additionally, plans are in process to gather performance data on use of appropriate antibiotics relative to surgical prophylaxis, as well as with regard to treatment of hospitalized patients with community-acquired pneumonias.
• Results: Office of Quality and Performance measures began implementation in FY 2005 and continue through FY 2006 with plans for additional measures in FY 2008.

Project Title: Development of national ICU Inpatient Evaluation Center (IPEC)

• Agency: VA
• Description: The IPEC is a national program to improve outcomes (risk adjusted mortality and length of stay) in VA ICUs and eventually in inpatient care through feedback of outcomes and implementation of evidenced-based practices. Currently two of the initiatives deal with issues related to infection prevention--catheter-related bloodstream infections and ventilator-associated pneumonias--both of which may involve resistant organisms These data are reported back immediately to the local facilities who can track their rates over time and compliance with performance, as well as see the national mid-range statistical analysis results.
• Results: IPEC program initiated nationwide during FY 2006 with initial data demonstrating a decrease in ventilator-associated pneumonias and central catheter related bloodstream infections nationwide for each of the past two years.

Project Title: National MRSA Prevention Initiative

• Agency: VA
• Description: In January 2007 VHA administration took strong directive action in plan to address infection with MRSA nationwide as a prototype agent for multidrug resistance issues; this national plan employs a bundle approach which includes hand hygiene, contact precautions, active surveillance culturing and cultural change. Seventeen VA medical centers ("beta-sites") across the country are also participating in a cooperative evaluation of this process with the Centers for Diseases Control and Prevention (CDC)
• Results: Initiated FY 2007 (all acute care facilities to have at least one unit active in program by March 15, 2007, with all acute care inpatient units participating in the prevention initiative as of December 31, 2007. Data collection has begun for measures of prevalence of MRSA upon admission to the medical center facility along with prevalence upon admission to each unit within a medical center facility, healthcare-associated infection rate with MRSA and MRSA transmission rates. Ongoing.

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