APIC 2023 conference highlights: Infection prevention strategies from top presentations on reducing asymptomatic bacteriuria treatment and non-ventilator pneumonia.
The APIC 2023 annual conference provided a wealth of presentations, posters, and abstracts, as well as innumerable resources for infection preventionists. In this article, we dive into two specific presentations, Reducing Asymptomatic Bacteriuria Treatment – a Collaborative Approach and A Collaborative Approach to Reducing Non-ventilator Acquired Pneumonia.
Antimicrobial and diagnostic stewardship
Under the antimicrobial and diagnostic stewardship track, Maddison B. Stone, MPH, CIC, LSSGB, and Jordan M. Chiasson, PharmD, BCIDP, from Genesis Health System presented, Reducing Asymptomatic Bacteriuria Treatment – a Collaborative Approach.
A positive urine culture, in the absence of clinical symptoms of a UTI, is asymptomatic bacteria. 15-30% of asymptomatic bacteriuria is inappropriately identified and treated in the U.S. Key tenets of antimicrobial stewardship were reviewed. These include rational antimicrobial use, optimization of patient outcomes, decreased antimicrobial resistance, and decrease costs.
Diagnostic stewardship, the selection of the most appropriate tests, at the right time, for patients, was also integral. In reviewing the UTI predictive value of microscopic components of a Urinalysis (WBC, nitrites, leukocyte esterase, bacteria), the absence of pyuria is most significant.
A UTI treatment bundle was developed to update the following:
- Diagnostic stewardship (update reflex urine culture process based on the presence of pyuria)
- A treatment algorithm (pathway to guide the diagnosis and treatment of UTIs)
- Specific goals were established (reduce treatment of asymptomatic bacteriuria, improve antimicrobial selection, and improve resistance rates)
Initially, a reduction in the inappropriate ordering of urine cultures was observed. Continual education and communication are two ongoing challenges in adopting the UTI treatment bundle.
Reducing non-ventilator hospital-acquired pneumonia
Under the implementation science and research track, Lisa Caffery, MS, BSN, RN, BC-Med, and Angela McGonegle, MSN, RN, CIC, from Genesis Health System, presented A Collaborative Approach to Reducing Non-ventilator Acquired Pneumonia, with an emphasis on meticulous, standardized oral care processes for all patients.
Non-ventilator healthcare-acquired pneumonia (NV-HAP) is hospital-acquired pneumonia not associated with mechanical ventilation. While there are currently no requirements to monitor or externally report NV-HAP at the federal level, NV-HAP contributes to extending hospital stays by over 13% and a patient mortality rate of 15.8%.
Reducing oral pathogens and identifying modifiable NV-HAP risk factors are critical. Oral biofilms can proliferate within hours. Aspiration of oral microbes represents a high risk, rendering meticulous oral care as critical to preventing NV-HAPs. In a study, patients identified oral care as the number one commonly missed aspect of nursing care, while nurses reported oral care as the third most missed element of nursing care.
NV-HAP prevention strategies
Reduce pathogenic colonization of oropharyngeal cavity
Develop/update an oral hygiene protocol for all patients.
Reduce aspiration
Swallow assessments when indicated, elevated head of bed, NG/OG tube assessment and care.
Strengthen host defenses
Early mobility, adequate nutrition, stress ulcer prophylaxis, glycemic control, and up-to-date immunizations.
Access more presentations from APIC 2023.
