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Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  28 March 2016

Daniel J. Morgan ,
Lindsay D. Croft ,
Valerie Deloney ,
Kyle J. Popovich ,
Chris Crnich ,
Arjun Srinivasan ,
Neil O. Fishman ,
Kristina Bryant ,
Sara E. Cosgrove  and
Surbhi Leekha
Daniel J. Morgan*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology, Veterans Affairs Maryland Health Care System, Baltimore, Maryland Center for Disease Dynamics, Economics and Policy, Washington, DC
Lindsay D. Croft
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Valerie Deloney
Affiliation:
The Society for Healthcare Epidemiology of America, Arlington, Virginia
Kyle J. Popovich
Affiliation:
Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Chris Crnich
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Neil O. Fishman
Affiliation:
Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Kristina Bryant
Affiliation:
University of Louisville, Louisville, Kentucky
Sara E. Cosgrove
Affiliation:
Johns Hopkins University, Baltimore, Maryland
Surbhi Leekha
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Address correspondence to Daniel J. Morgan, MD, MS, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore St, MSTF 334, Baltimore, MD 21201 ([email protected]).
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Abstract

OBJECTIVE

To identify Choosing Wisely items for the American Board of Internal Medicine Foundation.

METHODS

The Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA–Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board.

RESULTS

Ninety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don’t perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don’t continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included.

CONCLUSIONS

These 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse.

Infect Control Hosp Epidemiol 2016;37:755–760

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 755 - 760
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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