Page 182 - policy and procedure infection control

Policies and Procedures on Infection Control

1. Each hospital shall send report on DDD every 6 months to National Infection
Control and Antibiotic Control Committee. Data on DDD aggregated from all
hospitals will be used as national benchmark data (aggregated from all
hospitals) as a comparison to individual local data.
2. However, individual local data shall be reported according to discipline/
department on regular basis
3. It is recommended to have a national benchmark data specifically for Intensive
Care Unit (ICU), considering its high usage of antimicrobial and higher
incidence of antimicrobial resistance
4. It is also beneficial if each state have their own benchmark data from their
secondary and tertiary hospitals which can be used to compare the
prescribing pattern
5. A report of local monitoring data for hospital compared with national
benchmark (i.e aggregate summary data from all hospital in this program)
should be disseminated to all hospital
6. The aggregate benchmark data included numeric presentation of pooled
means, medians, and key percentile distributions of prevalence of selected
antimicrobial-resistant organisms and maybe stratified by certain specific
discipline, such as ICU.
7. This report shall recognized excessive use of specific antimicrobial agents
against problematic pathogen. Upon receiving the report, the respective
hospital; through Hospital Infection and Antibiotic Control Committee (HIACC)
shall give feedback and report to the main committee on any antimicrobial
control practice and strategies to improve their control on specific
antimicrobial of concern.

12.3.3 Correlation between antimicrobial use and resistance rate
Recent reports from the special task force of the American Society for Microbiology
and from a joint committee of the Society of Healthcare Epidemiology of America
and the Infectious Disease of America advocate that individual hospitals monitor the
relationship between antimicrobial use and resistance within specific patient-care
areas (Reports of the ASM Task Force on Antibiotic Resistance, 1995).

A graphic analysis done by Harbath et al (2001) can be used as an example to
assess this relationship, it is done by plotting DDDs per 1000 patients days for
specific antibiotic class of interest agains susceptibility percentages of unique
nosocomial isolates, according to time and space (i.e year and ward), third
generation cephalosporin was plotted against Enterobacteriaceae for example
(refer to Appendix 1).
Since we are monitoring both data of antimicrobial use and resistance rate, it
will be more meaningful if we can plot both data in one graph. Therefore the
committee have to select which antimicrobial use is to be plotted against which
resistance rate of concern. Here are a few suggestions :
• Third generation cephalosporins and ESBL
• Cefoperazone/sulbactam and Acinetobacter spp

Ministry of Health Malaysia 171