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Children's Hospital Colorado handshake stewardship program yields 10.9 percent slash in antibiotic use

Research measured antibiotic use hospital-wide and by unit before, during and after the implementation of program.

Jeff Lagasse, Associate Editor

Children's Hospital Colorado in Aurora (Google Earth)Children's Hospital Colorado in Aurora (Google Earth)

In examining the fight against antibiotic resistance, a unique type of antimicrobial stewardship program at Children's Hospital Colorado has been so effective that it cut inpatient use of antibiotics from 2010 to 2014 by 10.9 percent, research shows.

According to the Centers for Disease Control and Prevention, more than 23,000 deaths and $20 billion in indirect healthcare costs are attributed to resistant bacteria in the United States each year.

The program -- dubbed "handshake stewardship," due to the personal and trust-fostering traits associated with handshakes -- is characterized by three main factors: a lack of the restriction and preauthorization commonly found in antimicrobial stewardship programs; daily pharmacist-physician review of every inpatient antibiotic prescription, including dosages, type of medication and type of infection; and daily rounding on inpatient floors by a pharmacist-physician team to monitor antibiotic usage and give advice in-person to every unit in the hospital that is using antibiotics.

Led by Sarah Parker, M.D., pediatric infectious diseases physician and medical director of the Antimicrobial Stewardship Program at Children's Colorado, the research retrospectively measured antibiotic use hospital-wide and by unit before, during and after the implementation of the handshake stewardship program. All antibiotics prescribed to inpatients between October 2010 and September 2014 were included in the review.

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The study found that handshake stewardship led to a 10.3 percent decrease in antibacterial use hospital-wide, a 12.1 percent decrease in antifungal use, and a 16.4 percent decrease in antiviral use. That averaged out to the 10.9 overall decrease in antimicrobial use.

"Very few hospitals have a medical doctor involved in the day-to-day running of this kind of program," said Parker in a statement. "And very few programs review every single antibiotic prescription. However, the risks associated with antibiotics require that we find an effective way to limit their use. Not only do 30 percent of children who take antibiotics experience a side effect such as diarrhea, but antibiotics can also kill good bacteria in the body, which can lead to more serious illnesses down the line.

"This type of stewardship also helps ensure the appropriate use of antibiotics -- that is, that they are only used when needed, and that they are given at the right dosage for the right duration of time," continues Parker. "Ultimately, this leads to better patient outcomes."

Twitter: @JELagasse

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