Infectious Disease

The effort of the Eisenhower Medical Center (EMC) Antibiotic Stewardship program has been very successful in addressing pneumonia. Patients admitted with pneumonia routinely receive the standard of care as defined by our internal clinical policies and while there are occasional failures to de-escalate, the problem has largely been addressed. Urinary tract infections were also considered, but current guideline recommendations for therapy limit the feasibility of pursuing this. However, patients with skin and soft-tissue infections without an apparent lesion (cellulitis) are fairly common in our hospital population and represent an area where opportunities to de-escalate therapy are often missed. The objectives of this improvement project are as follows:

1. Reduce the overall use of vancomycin therapy in patients at low risk for communityacquired methicillin-resistant Staphylococcus aureus (CA-MRSA)
2. Reduce length of hospital stay
3. Reduce time to clinical improvement (time to resolution of fever, reduction of erythema)

The project described in this proposal is a team-based learning and improvement project aimed at improving the management of patients admitted to our hospital with complicated skin and soft-tissue infections who are perceived upon admission to be at risk for CA-MRSA. The project will involve an infectious disease physician champion, the infection prevention and control staff within the Quality Management department, pharmacy, and nursing.