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Grant # R01 NR010821 The long-term objectives of this clinical trial are to reduce antimicrobial resistance by implementing innovative interdisciplinary interventions aimed to improve antibiotic prescribing practices in the neonatal intensive care unit and thereby define the optimal interventions for this population. |
| Lisa Saiman, MD, MPH |
| Project Summary | Research Team | Publications and Presentations |
View the December 2009 issue of the iNAP Newsletter!
In April 2009, Dr. Saiman delivered the following lecture to each of the study NICUs:
"Improving Antimicrobial Use in the NICU"
Download the Powerpoint Presentation.
Content consisted of:
- Antimcirobial Stewardship
- CDC 12 Step Program to Prevent Antibiotic Resistance in Hospitalized Children
- Antimicrobial Stewardship in Pediatrics
- Pilot Study conducted in NICUs
- NIH-funded iNAP study
PROJECT SUMMARY
The increased emergence of antibiotic resistance has been linked to the overuse of antibiotics, particularly in hospitals. Antimicrobial stewardship programs are widely acknowledged as essential to improve appropriate antibiotic use, decrease antimicrobial resistance, and reduce cost. However, few data exist describing the efficacy of such programs in pediatric populations, particularly in the neonatal intensive care unit (NICU).
The long-term objectives of this study are to reduce antimicrobial resistance by implementing innovative interdisciplinary interventions aimed to improve antibiotic prescribing practices in the NICU and thereby define the optimal interventions for this population.
The Specific Aims are to: 1) measure the impact of three interdisciplinary intervention bundles on inappropriate antimicrobial use as categorized by the CDC 12 Step Campaign Program to Prevent Antimicrobial Resistance; 2) determine the impact of these intervention bundles on resistance density, i.e., changes in the rate of infant infections and colonization with multidrug-resistant organisms (MDROs) and changes in the proportion of MDROs carried on NICU staff hands; and 3) determine the cost effectiveness of the intervention bundles in preventing bloodstream infections caused by MDROs.
The Study Design is a quasi-experimental prospective clinical trial whereby 4 study NICUs in the United States (total beds – 214, annual discharges – 3649) will be randomized to successive bundles of interventions versus usual care to determine which combinations of interventions have the greatest impact on appropriate antibiotic use, antimicrobial resistance, and cost. The interventions have been developed using the PRECEDE-PROCEED health promotion planning model which suggests that programs to change health behavior should include predisposing, enabling, and reinforcing factors. Thus, the Education intervention in this study addresses the predisposing knowledge and beliefs of staff regarding antimicrobial resistance and helps set goals for improving prescribing practices. The Clinical Decision Support-Computerized Provider Order Entry intervention provides computer prompts in the electronic health record to enable better decisions about stopping, changing, or continuing antibiotic treatment. The Audit and Prescriber Feedback intervention reinforces desired prescribing practices as providers can monitor the success of their prescribing decisions on health outcomes and receive praise and encouragement from the study team.
RESEARCH TEAM
Click on name to view faculty profile or send e-mail
| COLUMBIA UNIVERSITY | ||
| Name | Role | Institution / Department |
|
Lisa Saiman,
MD, MPH Professor of Clinical Pediatrics and Hospital Epidemiologist |
Principal Investigator | Department of Pediatrics, Division of Infectious Diseases, Columbia University, and Morgan Stanley Children's Hospital of NewYork-Presbyterian |
|
Elaine L. Larson, RN, PhD Professor of Therapeutic and Pharmaceutical Research and Professor of Epidemiology |
Co-Investigator |
Columbia University School of Nursing
and Department of Epidemiology, Mailman School of Public Health, Columbia University |
|
David Evans, PhD Professor of Clinical Sociomedical Sciences (in Pediatrics) |
Biobehavioralist | Department of Pediatrics, Pulmonary Division, Columbia University |
|
Sameer J. Patel, MD Instructor in Clinical Pediatrics |
Co-Investigator | Department of Pediatrics, Division of Infectious Diseases, Columbia University, and Morgan Stanley Children's Hospital of NewYork-Presbyterian |
|
Sherry
A. Glied, PhD Professor of Health Policy and Management and Department Chair |
Co-Investigator | Department of Health Policy and Management, Mailman School of Public Health, Columbia University |
|
Haomiao Jia, PhD Assistant Professor of Clinical Biostatistics (in Nursing) |
Biostatistician | Columbia University School of Nursing and Department of Biostatistics, Mailman School of Public Health, Columbia University |
|
Phyllis Della-Latta, PhD Professor of Clinical Pathology in Medicine |
Microbiology Lab Director | Department of Pathology, College of Physicians & Surgeons of Columbia University |
| Elizabeth Garber | Microbiology Lab Supervisor | Department of Pediatrics, Division of Infectious Diseases, Columbia University |
| Jennifer Wong-McLoughlin, RN | Research Coordinator (Columbia and Cornell) | Columbia University School of Nursing |
| Yu-hui Ferng, MPA | Project Manager | Columbia University School of Nursing |
|
Luis Alba |
Database Manager | Department of Pediatrics, Division of Infectious Diseases, Columbia University |
| Megan Wendelken | Microbiology Lab Technologist | Department of Pediatrics, Division of Infectious Diseases, Columbia University |
|
KOMANSKY CHILDREN'S HOSPITAL OF WEILL CORNELL MEDICAL CENTER |
||
| Name | Role | Institution / Department |
|
Jeffrey Perlman, MD Professor of Pediatrics and Division Chief, Newborn Medicine |
Site Principal Investigator | Department of Pediatrics, Division of Newborn Medicine, Weill Medical College of Cornell University |
|
Patricia DeLaMora, MD Clinical Instructor of Pediatrics |
Site Co-Investigator | Pediatric Infectious Diseases, Weill Medical College of Cornell University |
| CHILDREN'S HOSPITAL OF PENNSYLVANIA | ||
| Name | Role | Institution / Department |
|
Theoklis Zaoutis, MD Assistant Professor of Epidemiology |
Site Principal Investigator | University of Pennsylvania School of Medicine and Children's Hospital of Pennsylvania |
| Priya Prasad | Research Coordinator | Children's Hospital of Pennsylvania |
| CHRISTIANA CARE | ||
| Name | Role | Institution / Department |
|
David A.
Paul, MD Associate Professor of Pediatrics and Attending Neonatalogist |
Site Principal Investigator | Department of Pediatrics, Thomas Jefferson Medical College, and Christiana Care Health Services |
| Pamela Douglas-Fontello | Research Coordinator | Christiana Care Health Services |
PUBLICATIONS AND PRESENTATIONS
Patel S, Landers T, Larson E, Wong-McLoughlin J, Ferng Y, Paul D, Saiman L. Increasing an Understanding of Antibiotic Prescribing Practices in the Neonatal Intensive Care Unit (NICU) by Using Clinical Case Vignettes. Fifth Decennial International Conference on Healthcare-Associated Infections 2010, Atlanta, GA, March 18-22, 2010.
In April 2009, Dr. Saiman delivered the following lecture to each of the study NICUs:
"Improving Antimicrobial Use in the NICU"
Download the Powerpoint Presentation.
Content consisted of:
- Antimcirobial Stewardship
- CDC 12 Step Program to Prevent Antibiotic Resistance in Hospitalized Children
- Antimicrobial Stewardship in Pediatrics
- Pilot Study conducted in NICUs
- NIH-funded iNAP study
Saiman L. Antimicrobial Stewardship in Pediatrics. Accepted for presentation at the SHEA Annual Scientific Meeting symposium entitled, "Protecting Our Children." Sheraton San Diego Hotel, San Diego, CA, March 19-22, 2009.