A Novel Metric to Monitor the Influence of Antimicrobial Stewardship Activities

Livorsi, Daniel J; O’Leary, Erin; Pierce, Tamra; Reese, Lindsey; Santen, Katharina L. van; Pollock, Daniel A.; Edwards, Jonathan R.; Srinivasan, Arjun

doi:10.1017/ice.2017.54

Cited by 9 publications

(8 citation statements)

References 8 publications

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Section: Discussionsupporting

confidence: 58%

“…In this single-center study, the SAAR for total antimicrobial use significantly and immediately decreased in response to PAF implementation, a finding described in at least 1 other study. 6 Before PAF, the baseline SAAR at the facility was <1, which indicates that antimicrobial use was already lower than the predicted utilization for a comparable hospital. Nevertheless, the SAAR decreased even further upon implementation of PAF, while antimicrobial-prescribing outcomes and patient safety outcomes remained stable or improved.…”

Section: Discussionmentioning

confidence: 97%

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Understanding changes in the standardized antimicrobial administration ratio for total antimicrobial use after implementation of prospective audit and feedback

Griebel

Alexander

Egge

et al. 2018

Infect. Control Hosp. Epidemiol.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 97%

Understanding changes in the standardized antimicrobial administration ratio for total antimicrobial use after implementation of prospective audit and feedback

Griebel

Alexander

Egge

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…Encouraging healthy competition between multiple hospitals within a large healthcare system seemed to enhance the implementation of existing multi-faceted ASP interventions based primarily on local data. These findings support existing literature demonstrating the value of the SAAR as an antimicrobial stewardship metric for the identification of trends in antimicrobial use and opportunities for improvement [9,[13][14][15][16].…”

Section: Discussionsupporting

confidence: 86%

“…The value of antimicrobial use participation for ASPs has been previously demonstrated [11][12][13][14][15][16]. The present literature describes the utility of the SAAR as an identifier of outlier patient care areas and antimicrobial categories requiring additional ASP support and as a metric to measure the impact of targeted interventions [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System

et al. 2021

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The standardized antimicrobial administration ratio (SAAR) is a novel antimicrobial stewardship metric that compares actual to expected antimicrobial use (AU). This prospective cohort study examines the utility of SAAR reporting and inter-facility comparisons as a motivational tool to improve overall and broad-spectrum AU within a three-hospital healthcare system. Transparent inter-facility comparisons were deployed during system-wide antimicrobial stewardship meetings beginning in October 2017. Stakeholders were advised to interpret the results to foster competition and incorporate SAAR data into focused antimicrobial stewardship interventions. Student’s t-test was used to compare mean SAARs in the pre- (July 2017 through October 2017) and post-intervention periods (November 2017 through June 2019). The mean pre-intervention SAARs for hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Hospital B experienced significant reductions in SAAR for overall AU (from 1.09 to 0.83; p < 0.001), broad-spectrum antimicrobials used for hospital-onset infections (from 1.36 to 0.81; p < 0.001), and agents used for resistant gram-positive infections in the intensive care units (from 1.27 to 0.72; p < 0.001) after the interventions. The alignment of the SAAR across the health-system and sustained reduction in overall and broad-spectrum AU through implementation of inter-facility comparisons demonstrate the utility in the motivational application of this antimicrobial use metric.

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“…Feedback from AU Option users emphasizes the utility of the SAAR in stewardship efforts and the desire for additional patient care locations in SAAR models. 18,19 Many hospitals do not yet report neonatal data to the AU Option, and the CDC is working with the VON and other partner organizations to close that reporting gap. Some success has been achieved recently, In preparation for neonatal SAAR modeling, which the CDC plans to begin in summer 2019, the ASP-SIG group developed 6 survey questions (Supplemental Fig 3) to capture information thought to be important for risk adjustment.…”

Section: Discussionmentioning

confidence: 99%

Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

O’Leary

Santen

Edwards

et al. 2019

Hospital Pediatrics

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BACKGROUND: The Antimicrobial Use (AU) Option of the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) is a surveillance resource that can provide actionable data for antibiotic stewardship programs. Such data are used to enable measurements of AU across hospitals and before, during, and after stewardship interventions. METHODS: We used monthly AU data and annual facility survey data submitted to the NHSN to describe hospitals and neonatal patient care locations reporting to the AU Option in 2017, examine frequencies of most commonly reported agents, and analyze variability in AU rates across hospitals and levels of care. We used results from these analyses in a collaborative project with Vermont Oxford Network to develop neonatal-specific Standardized Antimicrobial Administration Ratio (SAAR) agent categories and neonatal-specific NHSN Annual Hospital Survey questions. RESULTS: As of April 1, 2018, 351 US hospitals had submitted data to the AU Option from at least 1 neonatal unit. In 2017, ampicillin and gentamicin were the most frequently reported antimicrobial agents. On average, total rates of AU were highest in level III NICUs, followed by special care nurseries, level II-III NICUs, and well newborn nurseries. Seven antimicrobial categories for neonatal SAARs were created, and 6 annual hospital survey questions were developed. CONCLUSIONS: A small but growing percentage of US hospitals have submitted AU data from neonatal patient care locations to NHSN, enabling the use of AU data aggregated by NHSN as benchmarks for neonatal antimicrobial stewardship programs and further development of the SAAR summary measure for neonatal AU.

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A Novel Metric to Monitor the Influence of Antimicrobial Stewardship Activities

Cited by 9 publications

References 8 publications

Understanding changes in the standardized antimicrobial administration ratio for total antimicrobial use after implementation of prospective audit and feedback

Understanding changes in the standardized antimicrobial administration ratio for total antimicrobial use after implementation of prospective audit and feedback

Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System

Using NHSN’s Antimicrobial Use Option to Monitor and Improve Antibiotic Stewardship in Neonates

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