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antibiotic resistance
24
SEPT / OCT 2015
I
Healthcare Journal of baton rouge
“The solution to these kinds of challenges
is sometimes just as much about human
connections as technological issues,”said Dr.
Percak. “I oversee bringing people together
from the different departments to help them
make better prescribing decisions.”Not that
technology isn’t important. Dr. Percak cited
several recent advances in testing technol-
ogy that now greatly aids doctors in decid-
ing quickly if a patient has a viral or bacte-
rial infection. This is key, as in the past it was
often the clinical practice to prescribe anti-
biotics first and get the lab results second.
“We’ve been using the same Gram stains
and Petri dishmethods for the past 50 years,”
Dr. Percak explained. “These are still needed,
but these are also old tools. Just as there have
been technological advances in imaging and
cardiac testing, thanks to technology, doc-
tors get excited when they see that we can
get c-diff (clostridiumdifficile) bacterial test
results back now as quickly as 45 minutes
and results for tuberculosis, which is highly
contagious in hospitals, in two hours or less.”
One of the stated outcomes of NAPCARB
is the “the establishment of State Antibi-
otic Resistance Prevention Programs in
all 50 states to monitor regionally impor-
tant multi-drug resistant organisms and
provide feedback and technical assistance
to health care facilities.” Such data collec-
tion and sharing has been in place at Baton
Rouge General Medical Center.
“We started an antimicrobial steward-
ship program five years ago and have
already reduced inappropriate use of anti-
biotics by 60 percent. We’ve been data shar-
ing with the CDC for a while and are now in
the early stages – two months – of infor-
mation sharing with other city-wide hospi-
tals,” said Kenny Cole, MD, Clinical Trans-
formation officer at Baton Rouge General.
“The only way to decrease antibiotic resis-
tant infections is for all hospitals in a com-
munity to work together. It doesn’t work for
just one hospital to make changes.”He said
that otherwise, the drug-resistant strains can
re-emerge in other facilities.
Dr. Cole said the NAPCARB goals are rea-
sonable for any hospital to achieve. He said
that in 2008 Baton Rouge General adopted
the Six Sigma Lean process improvement
program hospital-wide to make the reduc-
tion of inappropriate antibiotic use and
other quality improvements part of a cul-
tural change. As at Tulane, Baton Rouge
General adopted a protocol that allowed
nurses to participate in the initiative, adopt-
ing a similar catheter removal policy. He also
said that physician engagement, including
working withmedical residents, was a criti-
cal in achieving their improvement.
“This effort has been part of the trans-
formation to value-based purchasing under
the Affordable Care Act. We got buy-in by
sharing evidence-basedmedicine to change
practice patterns of use of broad spec-
trum antibiotics on the inpatient side and
by working with ER and the primary care
physicians in the outpatient clinics,”Dr. Cole
explained.
He also said that use of broad-spectrum
antibiotics, as opposed to narrow-spectrum
antibiotics, is a prescribing practice that has
promoted resistance. Broad-spectrumanti-
biotics kill both good and bad bacteria in our
“We developed and instituted a new
protocol that allowed registered
nurses to remove catheters within
24 hours without a doctor’s order.”
–
Todd Burstain, MD, Chief Medical Officer at Tulane University Hospitals
“...doctors get excited when they see
that we can get c-diff (clostridium
difficile) bacterial test results back now
as quickly as 45 minutes and results for
tuberculosis, which is highly contagious
in hospitals, in two hours or less.”
–
Jeffrey Percak, MD, Assistant Professor of Clinical Medicine
Todd Burstain, MD
Jeffrey Percak, MD