Effective stewardship: less antibiotic use and more hand hygiene

Rossana Rosa (bio below) writes a guest post, reflecting on this recent review and meta-analysis on the effectiveness of antimicrobial stewardship (AMS) programmes…

The first reports on the effects of Antimicrobial Stewardship Programmess date back to the mid-90s, and the interest in them has taken off in the past decade.

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A health economist’s guide to the AMS galaxy

Guest blogger Nikki Naylor (bio below) has written this post about a recent review on the cost-effectiveness of antimicrobial stewardship…

I’ll start this blog post off with a promise – I promise not to use any equations or unnecessarily complex terms that just describe logical concepts (something us economists do like to do on occasion). In return, I hope that you will see past the standard and not-to-exhilarating conclusion of “more evidence is needed” and see some of the more useful messages that sit within this recent review that we have published.

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The ethics of MDRO screening

I heard an interesting talk by Dr Michael Miller last week on the ethics of screening for MDROs. Whilst we need to think carefully about the ethics of all medical procedures (great and small), I think the benefits to the individual and the population generally outweigh downsides for MDRO screening programmes.

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CPE screening Q&A: the who, when, and how

I gave a talk yesterday as part of a PHE London event on the whys and wherefores of screening for MDROs – my talk was focussed on CPE, and you can download my slides here: “CPE: seek and ye shall find”. I thought a quick Q&A would be the best way to summarise the content.

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Need to save some money? Then universal admission screening for CPE is for you!

Many guidelines now recommend screening some patients on admission for carriage of CPE. However, very few cost-effectiveness analyses have been performed. A Canadian group have just published a modelling study with a tantalising conclusion: universal admission screening for CPE is likely to be cost-effective, and may even be cost-saving!

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Norovirus: to close or not to close?

Noroviruses belong to the genus norovirus and the family caliciv

The Journal of Infectious Diseases has just published a special issue on norovirus, which is well worth reading. When norovirus strikes, there is an inclination to close the ward to new admissions at the earliest available opportunity in order to protect incoming patients. But when should the ward closure trigger be pulled? Not at all, as recommended by latest UK guidelines (risking continuation of the outbreak, fed by a steady stream of new victims…I mean admissions), when you get a single case of vomiting or diarrhoea (lots of unnecessary ward closure) or only when you have a lab confirmed outbreak on your hands (by which time the horse has already bolted and galloped through your hospital). The special issue included a useful modelling study providing some idea of the impact of various approaches to ward closure in response to noro outbreaks.

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