YNHH nationally recognized for efforts to keep antimicrobial-resistant bugs at bay

Antimicrobial Surveillance Team members include (l-r): Ellen Dowers, PharmD; Jeffrey Topal, MD; Dayna McManus, PharmD; and Matthew Davis, PharmD.

For the first time, Yale New Haven Hospital has earned national recognition for its work to ensure patients receive the “right drug, for the right bug, at the right dose, for the right duration.”

This work – formally called antimicrobial stewardship – aims to optimize antimicrobial use to decrease the risk of antimicrobial-resistant infections. These include Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin-Resistant Enterococci (VRE), among others.

YNHH recently became one of only 23 institutions nationwide to be designated an Antimicrobial Stewardship Center of Excellence by the Infectious Diseases Society of America. Organizations with this designation have protocols and processes to optimize infectious diseases treatment, provide ongoing education to clinicians and use the electronic health record to support the best use of antibiotics.

YNHH launched its formal antimicrobial stewardship team back in 2003, long before The Joint Commission, Centers for Medicare and Medicaid Services and other organizations required stewardship.

A key component of YNHH’s program is the Antimicrobial Surveillance Team (AST), which is overseen by infectious diseases physician Jeffrey Topal, MD, and infectious diseases-trained pharmacist Dayna McManus, PharmD. Additional team members include Ellen Dowers, PharmD, pharmacists on patient care units and pharmacy residents.

Antimicrobial-resistant infections have become a major concern throughout the world for a variety of reasons, McManus said. Clinicians may prescribe “broad-spectrum” antibiotics initially if they aren’t able to immediately identify their patients’ infection or infections.

Antimicrobial Surveillance Team members collaborate with clinicians to pinpoint the infection a patient has, then identify “the right drug, for the right bug, at the right dose, for the right duration,” Dr. Topal said.

The team uses tools such as rapid diagnostics implemented by Yale New Haven’s Microbiology Laboratory. Rapid diagnostics more quickly provide additional information about certain types of infections, shortening the time from blood testing to optimal treatment. In addition, the AST works with Information Technology Services to optimize Epic to identify patients requiring review of their antimicrobial treatments.

Use of these tools, along with AST members’ experience and knowledge of antimicrobial best practices, have helped reduce patients’ length of stay and mortality.

“An important part of our work involves building trust with the clinicians who are taking care of the patients,” Dr. Topal said. “We help people understand that antimicrobial stewardship isn’t just about preventing antimicrobialresistant infections – it’s about improving patient safety overall.”