Physician Champion

Ed Septimus, MD, FACP, FIDSA, FSHEA
Medical Director Infection Prevention and Epidemiology

Source: HCA Clinical Services Group, Nashville, TN

Selection

Education-academic detailing one-on-one or in small groups best sustainable approach (clinical decision support when available in Meditech)
Formulary management which responds to local patterns
Teaching to facilitate understanding and use of antibiograms
Microbiology partnership-review local lab methods (must be able to detect ESBL, hVISA, KPCs etc.)
Adoption of locally customized published practiced guidelines with measurements. These must be continually reviewed and updated. Below are a few for consideration: (prophylaxis and treatment building on core measures)
- CAP
- SIP
- CR-BSI
- UTI (look at treatment of asymptomatic bacteriuria)
- CDI
Standardize definition and diagnosis of an infection based on national guidelines and NHSN definitions
Colonization vs. contamination
Approve criteria for IV to PO conversion
Based on cost analysis implement criteria for linezolid and echinocandins use (use either front-end or back-end approach based on local resources and culture)

Surviving sepsis protocol
Empiric therapy guidelines based on local antibiograms
De-escalation after 72 hours based on pathogen specific diagnosis-may want to start with only positive blood cultures
Renal and hepatic dosing (could be in phase 1)
Antimicrobial optimization to include weight-based dosing, pharmacokinetics, and duration
Review all patients on ≥3 antibiotics for 72 hours, duration >10 days, microbiology mismatches
Add additional drug reviews based on prescribing patterns and cost (e.g. daptomycin, tigycycline)
Review expanded application of molecular diagnostics (MRSA, MSSA, CDI, VRE etc.)
Vaccine preventable infections