Patients in intensive care units (ICUs) are the sickest and most vulnerable patients in the hospital, and upwards of 70% of ICU patients are on antimicrobials. However, some of these antimicrobials may be unnecessary, and exposing patients to adverse drug events, and drug-resistant infections including C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and invasive fungal infections.
Through the establishment of the CAHO Antimicrobial Stewardship Program (ASP) in ICU Project, it is anticipated the resistance profile in ICUs to commonly used antimicrobials will improve considerably over time. Developed collaboratively by Mount Sinai Hospital and University Health Network, this program helped ICUs optimize the use of antimicrobials to improve patient outcomes while minimizing antimicrobial resistance and costs. It also worked with CritiCall to develop a system for hospitals to compare their results using the provincial Critical Care Information System, and developed best practices that will benefit the entire health care system.
The following hospitals participated in the CAHO ASP Project: Children’s Hospital of Eastern Ontario, Hamilton Health Sciences, Health Sciences North, Kingston General Hospital, London Health Science Centre, Mount Sinai Hospital, North York General Hospital, The Ottawa Hospital, The Hospital for Sick Children, St. Joseph’s Healthcare Hamilton, St. Michael’s Hospital and University Health Network.
The ASP team developed animation videos on common infectious diseases based on the six CAHO Educational Modules. The topics include:
Why is antimicrobial stewardship important?
Managing sepsis in the ICU
Managing intra-abdominal Infections in the ICU
Managing candidemia in the ICU
Managing hospital acquired pneumonia (HAP)/ventilator associated pneumonia (VAP) in ICU
Managing community acquired pneumonia in the ICU
You may view the animations by clicking here.
At project completion, all 14 participating ICUs (11 adult, 3 pediatric) successfully met the objective and project milestones. ASPs in adult ICUs showed a 23% reduction in antimicrobial consumption, and a 16% reduction in antimicrobial cost. Similarly, ASPs in pediatric ICUs showed a reduction in consumption ranging from 17 to 34% in days of antimicrobial therapy. Cost differences were modest and highly varied. C.difficile rates were too low to allow meaningful conclusions.