Advancing Antimicrobial Stewardship in Outpatient Dialysis Centers Using the Positive Deviance Process

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Antimicrobial resistance (AMR) is a significant global health threat.
• Inappropriate antimicrobial use drives AMR, particularly in vulnerable populations like maintenance hemodialysis patients.
• The Centers for Disease Control and Prevention (CDC) advocates for antimicrobial stewardship programs (ASPs) to mitigate AMR.

Purpose of the Study:

• To detail a multifaceted antimicrobial stewardship intervention.
• To assess the intervention's impact on antimicrobial prescribing in outpatient hemodialysis units.
• To evaluate staff engagement and behavioral change in antimicrobial use.

Main Methods:

• Implementation of a multifaceted intervention including staff education and the Positive Deviance behavioral change process.
• Intervention deployed across six outpatient hemodialysis units.
• Data collection on antimicrobial doses per 100 patient months over a 12-month period.

Main Results:

• Achieved a 6% month-to-month reduction in antimicrobial doses per 100 patient months.
• Observed a significant decrease in mean antimicrobial doses from 22.6/100 to 10.5/100 patient months.
• Demonstrated successful staff engagement and improved antimicrobial prescribing patterns.

Conclusions:

• A multifaceted antimicrobial stewardship intervention is effective in reducing antimicrobial use in hemodialysis settings.
• The Positive Deviance approach, combined with education, can drive behavioral change in healthcare professionals.
• Targeted stewardship efforts are crucial for combating antimicrobial resistance in high-risk patient groups.