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Interview with Dr Andrew Seaton (Part 2)

UoD and BSAC
So it sounds as if you made sure that everybody knew about the new policy, but how did you then ensure that it had been effectively implemented? So this was the key thing, was to measure the results of the outcomes of the intervention. So there are three ways, really. First is to measure the volume of antibiotic prescribing, so measurements of defined daily doses adjusted for activity, so adjusted for 1,000 occupied-bed days, so to look at the volume of antibiotic being prescribed over time. The second thing was to do more targeted point prevalence surveys. And initially, we did these very frequently in the Vale of Leven Hospital, and then we started to do them throughout all our acute hospitals.
And that would give us more qualitative information about prescribing and particular for specific indications. And then the third thing would be targeted audits of prescribing in particular areas that might crop up to be found to be maybe using high volumes of certain antibiotics so we could get a better, more detailed understanding of what was going on. Initially, obviously, there was a lot of scrutiny, particularly on the Vale of Leven Hospital, so a lot of our focus was there. But very rapidly, we started measuring, prescribing across all our different hospital sites. So we see, then, that measurement has really been a key activity for your team in dealing with this problem.
Absolutely, and it’s the real sort of barometer of your success of your intervention. What we found was, very rapidly once we started measuring this and once we had implemented our new guidance, very rapidly we saw this precipitous drop in prescribing of the antibiotics we targeted, so really reflecting the engagement and proving to us that really the message was getting across. So the antibiotics that were targeted, the cephalosporins, the co-amoxiclav, and the quinolones, and clindamycin, we saw– well, particularly with the cephalosporins and the co-amoxiclav, because the volume of use for those particular groups of antibiotics was so much higher– we saw a really very precipitous drop very rapidly.
So after these interventions had taken place, can you tell us what happened to the C. diff rate and the Vale of Leven Hospital where the initial problem was and also the other hospitals within your region? Well, really Clostridium difficile stopped really in the Vale of Leven Hospital. We saw very little after these interventions. And I should mention also there were infection control issues which were being enhanced also at the time, so this was a joint effort. But essentially Clostridium difficile stopped, and we saw very, very little, very, very occasional and sporadic cases thereafter.
Stepping back and looking more broadly at our broader health board across all the hospital sites, we saw a mass reduction in Clostridium difficile, so up to 80%, 85% reduction over the following six to nine months, so really a very, very dramatic effect. And obviously, this wasn’t something that we kept to ourselves and it’s something that’s clearly this was a fairly major intervention which we shared with colleagues from throughout Scotland and through our national stewardship programme. And really about that time, everybody else was realising that they were maybe having a significant Clostridium difficile infection.
So we were lucky in that we had a national forum to engage other colleagues from throughout the country to learn from some of these very quick lessons that we were learning in our own region and to help facilitate changes elsewhere. OK, thanks, Andrew, for sharing your experience of using quality improvement to address C. diff. I think it’s also worth saying that this wasn’t just in Scotland and that throughout the UK, C. diff was a problem and similar approaches were taken and largely it’s a much less prevalent infection now.

In Part 2 Dr Seaton describes how the guidelines were implemented, the measuring procedures used and how successful the implementation was.

Some of the terms which Dr Seaton uses in this video will be explained by Mr William Malcolm in Step 3.12.

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Antimicrobial Stewardship: Managing Antibiotic Resistance

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