Page 183 - policy and procedure infection control

Policies and Procedures on Infection Control

• Antipseudomonal cephalosporin/carbapenem/quinolone and Pseudomonas spp
• Vancomycin and MRSA

12.4 Determine and identify antimicrobial use of concern that necessitate for a audit/
feedback report.
1. Compliance to guidelines -Appropriateness –base on NAG
2. High usage – antibiotic specific
3. Resistance problems
4. High collateral damage (such as quinolones),
5. Antimicrobial use of concern as reported to HIACC shall necessitate for measure to
improve antimicrobial control. Measures can be either for specific antimicrobial,
specific area (such as surgical ward) or specific indication (such as antimicrobial for
pneumonia).
6. We can adopt certain strategies to prevent and control the spread of antimicrobial
resistance from Goldman et al (1996) and Rekha (2001). Goldman et al (1996)
recommended a few outcome measures in monitoring empiric antimicrobial therapy:
 No of patients infected with resistant strain to antimicrobial use/
No of patients given these antimicrobial
7. Cost/quantity of empiric antimicrobial administered in a specified period.
Recommendations by Rekha (2001) can be divided into antimicrobial prophylaxis
and empiric antimicrobial therapy. Process measures for antimicrobial prophylaxis
are recommended as follows:
 No of patients received inappropriate prophylactic antimicrobial
No of patients having procedures
 No of patients received antimicrobial prophylaxis for <24 hours
No of patients received antimicrobial prophylaxis
 No of patients received antimicrobial within 30 min -1H preceding surgical incision
No of patients received antimicrobial prophylaxis
Process measures for empiric antimicrobial therapy is as follows :
 No of inappropriate empiric regimens
No of patients received empiric therapy
 No of patients given empiric therapy without having a culture obtained
No of patients given empiric therapy
Mean/median time interval between initiation of empiric therapy and arrival of
microbiology diagnosis in patients who eventually have a diagnosis
 No of patients with microbiology diagnosis received inappropriate empiric therapy
No of patients given empiric therapy
 Mean/median/duration of empiric therapy

172 Ministry of Health Malaysia