ICU handshake stewardship: a high cost for little gain or a small cost for big but unmeasurable gain?

Reviewed by S. Shaefer Spires, MD and Rebekah Moehring, MD; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC

The authors performed a 2-arm, cluster-randomized, crossover trial to study the intervention of handshake rounds in 5 different intensive care units. Each unit had 2 sides with distinct rounding teams, which served as control and intervention arms, then crossover occurred at 4 months. Intervention included detailed chart review, developing questions and recommendations, then in-person weekly scheduled meetings with the ICU team. Common recommendations were defining an end date or stopping the antibiotic that day (40.2%). The authors compared antimicrobial DOT per 1000 patient days in two ways: 1) compared to control patients and 2) overall trends in unit-level rates. Antibiotic use was statistically lower during the intervention periods for all units except the cardiothoracic ICU. Unit-level antimicrobial use trended down to a larger degree, suggesting some effects also occurred in control patients. Handshake rounds take lots of time and effort. This study demonstrated a measurable, but small, decline in antibiotic use. However, the stewardship strategy insights gained as a result of rounds (understanding unit culture, patient population, workflow) may be the bigger gain to guide future tailored interventions.

Jessica L Seidelman et al., “Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: A Prospective Cluster-Randomized Crossover Study,” Clinical Infectious Diseases 74, no. 11 (June 1, 2022): 1986–92.

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