We assessed healthcare workers’ knowledge, attitudes, and practices around disposable personal protective equipment (PPE) use. We observed that healthcare workers are interested in sustainable policies and identified areas for policy changes to reduce PPE waste.

Background: National guidelines recommend penicillins (PCN) as first-line treatment for many common pediatric infections in the outpatient setting. Although less than 1% of the United States population has a true, IgE-mediated PCN-allergy, approximately 10% of patients are labeled with a PCN-allergy. Accurate adverse drug reaction (ADR) documentation plays an important role in this over-labeling. We have previously shown that nurses feel assessment and documentation of PCN-allergies are critical to their role. However, additional evidence purports nurse hesitancy to interrogate allergy accuracy or reclassify parent’s response to side effect. Our objective was to explore frontline clinicians’ confidence in assessing, documenting, and responding to PCN-allergy labels. Methods: To expose barriers and prioritize improvement ideas for a multidisciplinary quality improvement (QI) project aimed to improve PCN-allergy labeling in our pediatric urgent care clinics, we deployed this investigator-developed survey to prescribers and nurses. It’s comprised of 14-questions scored on a 5-point Likert scale (4 demographic, 4 PCN/safety, 3 allergy types, 4 allergy documentations, 3 treatment options), and 1 optional free-text. We used descriptive statistics to compare survey responses between prescribers and nurses and evaluated free text comments for themes. Results: Eighty-seven clinicians across 3 sites participated, with a response rate of 35%, with variation by sites (25.3% to 41.4%). Forty-one percent of (n=36) responders have been in practice >15 years and 40.2% (n=35) have worked at our hospital > 15 years (Table 1). Overall, perceived knowledge of PCN-allergies and safety was favorable (Table 2). Prescribers reported higher confidence with: 1) perceiving many patients who believe they are allergic to PCN can safety take PCN (prescribers median=5 [IQR: 4, 5] vs. nurses median=4 [4,4], p = 0.003); and 2) perceiving that time pressures influenced their ability to reconcile allergies and side effects (prescribers median=4 [4, 5] vs. nurses median=3 [2, 4], p = 0.001). Both prescribers and nurses reported lower confidence in continuing to administer or prescribe an antibiotic in the setting of a reported ADR. Thirteen respondents (15%) provided comments with specific requests for additional family education and practice guidance, including the referral process to subspecialty clinics for PCN-allergy testing. Conclusions: Our survey results identified barriers to accurate PCN-allergy labels, including knowledge on documentation, time pressures, hesitancy to challenge parent report, and uncertainty on referral process for PCN-allergy testing. This survey will inform future drivers for our QI. Opportunities include electronic medical record refinement, improving referrals to PCN-allergy de-labeling clinics, and the development of scripted education to guide family discussions.

Disclosure: Rana El Feghaly: Merck- grant funding. Amanda Nedved: Contracted Research – Merck

This article explores the utility of implementation science (IS) as a method to promote the effective uptake of antimicrobial stewardship processes. Elements of IS can be readily incorporated into QI work and used as a platform to extend stewardship reach. As stewards are stretched to do more, IS can be a potential vehicle to ensure that our collective work is impactful, sustainable, and contributes more broadly to clinically relevant improvements.

Antimicrobial stewardship programs (ASPs) exist to optimize antibiotic use, reduce selection for antimicrobial-resistant microorganisms, and improve patient outcomes. Rapid and accurate diagnosis is essential to optimal antibiotic use. Because diagnostic testing plays a significant role in diagnosing patients, it has one of the strongest influences on clinician antibiotic prescribing behaviors. Diagnostic stewardship, consequently, has emerged to improve clinician diagnostic testing and test result interpretation. Antimicrobial stewardship and diagnostic stewardship share common goals and are synergistic when used together. Although ASP requires a relationship with clinicians and focuses on person-to-person communication, diagnostic stewardship centers on a relationship with the laboratory and hardwiring testing changes into laboratory processes and the electronic health record. Here, we discuss how diagnostic stewardship can optimize the “Four Moments of Antibiotic Decision Making” created by the Agency for Healthcare Research and Quality and work synergistically with ASPs.

This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.

To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

Nurses view patient safety as an essential component of their work and have reported a general interest in embracing an antibiotic steward role. However, antibiotic stewardship (AS) functions have not been formally integrated into nursing practice despite nurses’ daily involvement in clinical activities that impact antibiotic decisions (e.g., obtaining specimens for cultures, blood drawing for therapeutic drug monitoring). Recommendations to expand AS programs to include bedside nurses are generating support at a national level, yet a practical guidance on how nurses can be involved in AS activities is lacking. In this review, we provide a framework identifying selected practices where nurses can improve antibiotic prescribing practices through appropriate obtainment of Clostridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of penicillin allergy histories and through the prompting of antibiotic time outs. We identify reported barriers to engagement of nurses in AS and offer potential solutions that include patient safety principles and quality improvement strategies that can be used to mitigate participation barriers. This review will assist AS leaders interested in advancing the contributions of nurses into their AS programs by discussing education, communication, improvement models, and workflow integration enhancements that strengthen systems to support nurses as valued partners in AS efforts.