Campbellford Memorial Hospital’s antibiotics stewardship program puts patient safety in the hands of caring physicians

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It’s been a little over two years since Campbellford Memorial Hospital (CMH) initially introduced its Antibiotics Stewardship Program and Dr. Richard Schabas is delighted with the results so far.

Since the introduction of the Antibiotic Stewardship Program and the hospital’s full public reporting on patient safety indicators including Clostridium Difficile (C. diff) in August, 2008, CMH has almost eliminated the presence of this disease in the hospital, having had only one C. diff case in the past two years.

CMH is a 34-bed health-care facility located in Trent Hills, Ontario. It serves approximately 30,000 area residents, as well as a large seasonal population of cottagers and tourists enjoying the beautiful Kawartha Lakes Region and the Trent River System. As the only hospital located between Belleville and Peterborough, Ontario, CMH provides a comprehensive array of acute care services. The Hospital’s 24-hour Emergency Department has approximately 22,000 visits each year.

Dr. Schabas, pictured here, is a consultant internist at the hospital and also serves as the Medical Officer of Health for Hastings and Prince Edward Counties. He is the former Ontario Chief Medical Officer of Health. In 2008, working together with other hospital physicians and personnel, he championed the introduction of the Antibiotics Stewardship Program at CMH.

At the time, like many other hospitals, CMH took proactive steps to tackle the presence of Clostridium Difficile (C. diff) among its patients. This included recognizing that early detection of C. diff with the appropriate attention to infection prevention and control practices is vital to its prevention and control.

“C. diff is almost always associated with treatment using a particular group of antibiotics and those most vulnerable to acquiring C. diff are sick, elderly patients whose health is already compromised,” says Dr. Schabas. “C. diff is a problem in many hospitals across Canada and new strains of the bacteria have made the problem worse. To the extent that we can, Campbellford Memorial Hospital has proactively addressed the three key factors, including proper hand washing, environmental cleanliness, and the use of certain antibiotics, significantly reducing the presence of C. diff in this hospital.”

A large portion of the hospital’s patients are elderly people with more complex and multiple health issues. Those most susceptible to acquiring C. diff are elderly patients:

With a history of antibiotic usage

With pneumonia being treated with antibiotics such as clindamycin, fluoroquinolones, and cephalosporins or

Who have had bowel surgery, chemotherapy, or prolonged hospitalization.

“As physicians, we can’t take care of patients effectively if we have to address complications related to their treatment. C. diff is a miserable disease and it was essential for us to tackle this problem in a serious way,” explains Dr. Schabas, adding: “We adopted an Antibiotic Stewardship Program to find reasonable alternatives to and discourage the use of those antibiotics most typically associated with the presence of C. diff and most likely prescribed to treat pneumonia. This includes antibiotics such as clindamycin, fluoroquinolones, and cephalosporins. Ultimately this was an education program to discourage the use of these antibiotics and eventually, to restrict their use in this hospital.”

The Program included sending memos to physicians and posting notices requesting that they avoid the use of fluorquinolones for inpatients. There was special emphasis on reducing moxifloxacin use because of the particularly strong association with this antibiotic. As well, all orders for moxifloxacin for inpatients were automatically reviewed by the hospital pharmacist and consultant internist and alternative antibiotics recommended to the most responsible physician. Fluorquinolones was removed as the first choice for treatment on the pneumonia care map and order set. A Clostridium Difficile order set was developed with antibiotic stewardship as a focal point.

“The Antibiotic Stewardship Program is another of example of CMH’s leadership in rural health care and is fundamental to our on-going efforts to ensure the care patients receive here is top-notch,” says Dr. Schabas.

CMH’s Antibiotics Stewardship Program will be included in the Ontario Hospital Association’s (OHA) 2010 Patient Safety Leading Practices Guidebook. The guidebook is entitled Advancing Patient Safety through Ideas and Innovations, and showcases a diverse range of 30 excellent hospital projects in the area of quality and patient safety. The OHA puts out a call for success stories every two years, and showcases this collection of unique and innovative quality and patient safety initiatives by various hospitals all across Ontario in its Patient Safety Leading Practices Guidebook. This year, CMH’s submission was one of 141 responses assessed by an expert review panel for publication in the guidebook.