864 infection control & hospital epidemiology july 2017, vol. 38, no. 7


table 1. Respondent Demographics Variable


Hospital type (N=223) Community hospital Teaching hospital


Academia/College of Pharmacy Veterans Affairs Medical Center Othera


Institution size (N=224) 0–200 beds


201–500 beds >500 beds


Not applicable


Pharmacist FTEs dedicated to stewardship (N=173) <0.5 FTE


0.5 – 1 FTE >1 FTE


Time dedicated to stewardship (N=223) Not involved <25%


25–50% 51–75% 76–99% 100%


Time in practice (N=220) 0–5 y


6–10 y


11–15 y >15 y


Additional training beyond pharmacy degree (N=224) None


Stewardship certificate program (SIDP, MAD-ID, other)


General pharmacy practice residency Infectious diseases pharmacy residency Infectious diseases pharmacy fellowship Board certification (no AQ ID) Board certification (+ AQ ID)


Respondents indicated a variety of personnel receiving No. (%)


107 (48) 79 (35) 11 (5) 9 (4)


17 (7.6) 55 (24.5)


93 (41.5) 71 (31.7) 5 (2.2)


21 (12.1) 118 (68.2) 34 (19.7)


11 (4.9) 54 (24.2) 57 (25.6) 30 (13.5) 36 (16.1) 35 (15.7)


85 (38.6) 54 (24.5) 20 (9.1) 61 (27.7)


6 (2.7)


143 (63.8) 87 (38.8) 19 (8.5)


109 (48.7) 32 (14.3) (36.2)


NOTE. FTE, full-time equivalent; AQ-ID, board-certified pharmacotherapy specialist with added qualifications in infectious diseases; SIDP, Society of Infectious Diseases Pharmacists; MAD ID, Making a Difference in


Infectious Diseases. aOther: rural referral/critical access hospital (n =5), ambulatory care/outpatient clinic (n=1), long-term care/rehabilitation (n=1), long-term acute-care facility (n=1), or unspecified (n=9).


In decreasing order of familiarity, 211 respondents (94%) reported familiarity with PCR, 176 respondents (79%) repor- ted familiarity with MALDI-TOF, 154 respondents (70%) reported familiarity withNA PCR, and 158 respondents (70%) reported familiarity with PNA FISH. Familiarity with multi- plex PCR was lowest, with only 130 respondents (58%) reporting familiarity. Different factors were associated with respondent’s selecting “very familiar” with RDTs. Formal ID training was the only statistically significant factor across all familiarities surveyed (Table 2).


RDT alerts. Of 260 responses, 81 (31.2%) were pharmacists, followed by 60 (23.1%) nurses. A total of 162 respondents commented on timing of alerts received: 86 respondents (53.1%) reported receiving alerts in real time. The rest were limited to day and/or evening shifts. Of 166 respondents, 112 (67.5%) had not assessed institutional outcomes secondary to RDT implementation. Only 47 (28.3%) reported decreased time to de-escalation/targeted therapy. Measurement of RDT impact on length of stay was reported by 16 respondents (9.6%) impact on mortality was reported by 5 respondents (3.0%), and impact of RDT on antimicrobial use was reported by 26 respondents (15.7%) and impact on hospital-associated costs reported by 15 respondents (9.0%).


discussion


The RDT most familiar to respondents was PCR, yet multiplex PCR was most often used. This finding may reflect confusion with regard to nuances inRDT types.Most institutions reported familiarity and use of a PCR-typeRDT, which reflects the length of time this technology has been available. Familiarity withRDT type did not vary by institution type. Formal ID training was associated with higher rates of RDT familiarity compared to those without formal training. However, formal ID training programs are lacking,5 and pharmacists without formal ID-training are increasingly more involved with ASPs than those with formal training.6 Approximately one-third of respondents reported completing an ASP certificate program (eg, SIDP’s Antimicrobial Stewardship Certificate, Making a Difference in Infectious Diseases (MAD-ID’s) Antimicrobial Stewardship Programs) that included RDT education as part of the curriculum.7,8 The use of RDT in ASP activities is becoming commonplace; therefore, it is imperative that clinicians are familiar with these technologies and certification and training programs maintain current and adequate content. Similar to the medication formulary review process, each ASP, in collaboration with microbiology, should consider a proactive review of new and emerging RDTs to determine feasibility, utility and priority in its facility. Additionally, nurses often reported receiving alerts. Basic information about RDT and the benefit of timely action should be incorporated into other health sciences curricula and postgraduate residency programs. Our results corroborate those of the recent NHSN survey


demonstrating that pharmacists receive RDT results most fre- quently.4 However, only approximately half of the respondents reported that alerts were received or acted upon in real time. Achieving maximal benefit from RDT requires prompt communication and understanding the patient management implications.10 Furthermore, most respondents (67.5%) had not evaluated the impact of these technologies since employing them, highlighting a great opportunity to assess the added benefit of combined RDTresults with stewardship interventions


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