Using Data to Assess High Use of an Individual SAAR Category

Example Scenario: Your hospital has just begun submitting data into NHSN and you are eager to begin using the data to inform stewardship work at your facility.   

Background: The NHSN AU Option has several reports as part of the Targeted Assessment for Antimicrobial Stewardship (TAS) Strategy that aid facilities in doing initial assessments of antimicrobial use data.  This is an excellent place to help identify initial areas for further assessment.  Once a target is identified, such as high use of a particular SAAR category, stewards can navigate the NHSN data to better identify targets for a stewardship intervention.  Often high use of an SAAR category can be pinpointed to a specific hospital location.  Knowing this allows stewards to design specific stewardship interventions that can rapidly address the problem at the specific source.

---

Potential Stewardship Interventions:

To address the high rate of antifungal drug use, there are some proven antifungal stewardship strategies that may be implemented. 

• Does your facility have adequate diagnostics to guide antifungal therapy:
  • Are non-culture based diagnostic tests (i.e. galactomannan)?
• Are there protocols in place that drive unnecessary antifungal agent use?  If so, consider modifying or eliminating these protocols.
  • Some examples of these include routine prophylaxis and empiric sepsis treatment protocols that include antifungal agents for all patients
• Is there a role for diagnostic stewardship?  Unnecessary antifungal drug use has been noted in several scenarios common in the ICU including:
  • Treatment of Candida colonization in the urine
  • Treatment of Candida isolated in the sputum, which is often not true infection
• Review cases of antifungal use to see if treatment is appropriate per national or institutional guidelines

 

Resources:

Core Recommendations for Antifungal Stewardship:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403757/

IDSA Antifungal Treatment Guidelines: https://www.idsociety.org/practice-guideline/practice-guidelines/#/+/0/date_na_dt/desc/

Suggestions for Ongoing Monitoring:

For ongoing monitoring of this scenario, it makes sense to track the SAAR data specific for the ICU.  A quarterly interval should be adequate because particularly at the individual unit level, month to month variations may be difficult to interpret.  There are two easy ways to do this right within NHSN.

What you will need for data visualization for Table 3 and Figure 1:

1. Access to NHSN AU data in the Analysis tab in NHSN

 

Table 3:  Antifungal SAARs for the Adult ICUs Displayed Quarterly

[Data Obtained From: NHSN-Analysis-Reports-Antimicrobial Use and Resistance Module- Antimicrobial Use Data-SAAR Report- All Adult and Ped SAARS by Location- modified under Display Options to select ‘summaryYQ’ and under Filters to add SAARType-2017 equal to Antifungal agents predominantly used for invasive candidiasis used in adult SAAR ICUs.].

Figure 1.  SAAR Plot for Antifungal SAARs in the Adult ICUs Displayed Quarterly

[Data Obtained From: NHSN-Analysis-Reports-Antimicrobial Use and Resistance Module- Antimicrobial Use Data-SAAR Plot- All Adult and Pediatric SAARS (2017 Baseline)- modified under Display Options to select ‘summaryYQ’ in the Group By drop down and under Filters to add SAARType-2017 equal to Antifungal agents predominantly used for invasive candidiasis used in adult SAAR ICUs.].