Improving Antimicrobial Prescribing Practices in the Neonatal Intensive Care Unit, PI: L. Saiman

Grant # R01 NR010821
Title: IMPROVING ANTIMICROBIAL PRESCRIBING PRACTICES IN THE NEONATAL INTENSIVE CARE UNIT
PI: Lisa Saiman, MD, MPH, Professor of Clinical Pediatrics, Department of Pediatrics, College of Physicians & Surgeons of Columbia University
Funder: National Institute of Nursing Research, National Institutes of Health
Dates: 7/24/2008 - 4/30/2013
Funding: $4,553,052

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.

| Project Summary | Research Team | View in CRISP Database |

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
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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
Luis Alba	Database Manager	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

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