Article Figures & Tables
Tables
Characteristic No. (%) of responding hospitals
n = 97Total no. (%) in Ontario*
n = 131Hospital type Acute teaching 15 (15.0) 16 (12.2) Large community 44 (45.4) 57 (43.5) Small community 27 (27.8) 44 (33.6) Complex continuing care/inpatient rehabilitation 11 (11.3) 14 (10.7) Region† North 22 (22.7) 36 (27.5) West 11 (11.3) 19 (14.5) Central-West 14 (14.4) 18 (13.7) Central 31 (32.0) 34 (26.0) East 19 (19.6) 24 (18.3) > 1 site 38 (39.2) - No. of inpatient beds > 200 46 (47.4) - 100-200 12 (12.4) - 51-99 19 (19.6) - ≤ 50 20 (20.6) - *Hospital organizations excluding those providing primarily mental health or ambulatory services.
†Defined according to Public Health Ontario regional Infection Prevention and Control office boundaries.11
Hospital type No. (%) with formal program No. (%) in process of implementing formal program No. (%) without formal program Acute teaching (n = 15) 14 (93) 0 (0) 1 (7) Large community (n = 44) 41 (93) 0 (0) 3 (7) Small community (n = 27) 21 (78) 4 (15) 2 (7) Complex continuing care/inpatient rehabilitation (n = 11) 9 (82) 1 (9) 1 (9) Total (n = 97) 85 (88) 5 (5) 7 (7) - Table 3: Resource allocation at acute teaching and large community hospitals with an antimicrobial stewardship program
Hospital type No. (%) with designated resources for antimicrobial stewardship program No. (%) with resources allocated for antimicrobial stewardship physician and/or pharmacist FTE Average FTE per 1000 beds Physicians Pharmacists Acute teaching (n = 14) 12 (86) 12 (86) 0.57 2.16 Large community (n = 41) 28 (68) 27 (66) 0.65 2.55 Note: FTE = full-time equivalent.
Strategy No. (%) of hospitals Acute teaching
n = 15Large community
n = 44Small community
n = 27Complex continuing care/inpatient rehabilitation
n = 11Overall
n = 97Prescribing guidance Intravenous to oral conversion 11 (73) 36 (82) 17 (63) 5 (45) 69 (71) Disease-specific treatment guidelines/pathways/algorithms and/or associated order forms 10 (67) 36 (82) 15 (56) 8 (73) 69 (71) Empiric antibiotic prescribing guidelines 12 (80) 29 (66) 13 (48) 7 (64) 61 (63) Prescriber education 13 (87) 30 (68) 9 (33) 5 (45) 57 (59) Facilitation of appropriate and timely antimicrobial administration in severe sepsis/septic shock 7 (47) 24 (54) 9 (33) 1 (9) 41 (42) Clinical decision support systems/computerized physician order entry 5 (33) 4 (9) 2 (7) 1 (9) 12 (12) Clinical Therapeutic drug monitoring (with feedback) 12 (80) 39 (89) 23 (85) 9 (82) 83 (86) Dosage optimization 12 (80) 37 (84) 17 (63) 6 (54) 72 (74) Deescalation and streamlining 11 (73) 31 (70) 16 (59) 5 (45) 63 (65) Prospective audit with intervention and feedback 12 (80) 36 (82) 9 (33) 6 (54) 63 (65) Targeted review of redundant therapy or therapeutic duplication 5 (33) 31 (70) 18 (67) 4 (36) 58 (60) Identification of inappropriate pathogen/antimicrobial combinations ("bug-drug mismatch") 7 (47) 30 (68) 14 (52) 7 (64) 58 (60) Targeted review of patients with Clostridium difficile infection 5 (33) 34 (77) 11 (41) 6 (54) 56 (58) Preventing treatment of noninfectious conditions 6 (40) 26 (59) 7 (26) 3 (27) 42 (43) Targeted review of patients with bacteremia/fungemia 7 (47) 24 (54) 7 (26) 2 (18) 40 (41) Scheduled antimicrobial reassessments ("antibiotic time outs") 4 (27) 16 (36) 7 (26) 2 (18) 29 (30) Microbiology-related Antibiograms 14 (93) 41 (93) 19 (70) 5 (45) 79 (81) Reporting of cascading microbiology susceptibility 12 (80) 35 (80) 4 (15) 2 (18) 53 (55) Reporting of strategic microbiology results 12 (80) 31 (70) 7 (26) 3 (27) 53 (55) Promotion of timely and appropriate microbiologic sampling 10 (67) 27 (61) 12 (44) 2 (18) 51 (52) Improved diagnostics 12 (80) 25 (57) 8 (30) 2 (18) 47 (48) Structural/process-related Automatic stop orders 8 (53) 39 (89) 24 (89) 7 (64) 78 (80) Drug use evaluation/medication use evaluation 9 (60) 23 (52) 11 (41) 7 (64) 50 (52) Optimization of surgical antibiotic prophylaxis 13 (87) 27 (61) 5 (18) 1 (9) 46 (47) General antimicrobial order forms 1 (7) 14 (32) 8 (30) 4 (36) 27 (28) Systematic antibiotic allergy verification 1 (7) 15 (34) 3 (11) 6 (54) 25 (26) Improved antimicrobial documentation 2 (13) 10 (23) 6 (22) 4 (36) 22 (23) Checklists 4 (27) 5 (11) 1 (4) 4 (36) 14 (14) Formulary-related Formulary review/streamlining 10 (67) 35 (80) 23 (85) 5 (45) 73 (75) Formulary automatic substitution/therapeutic interchange policies 10 (67) 37 (84) 18 (67) 4 (36) 69 (71) Formulary restriction 11 (73) 26 (59) 11 (41) 4 (36) 52 (54) Formulary restriction with preauthorization 6 (40) 15 (34) 4 (15) 3 (27) 28 (29)
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