Hospital Epidemiology and Antimicrobial Stewardship

Healthcare Epidemiology

Calfee, Simon, Singh, Torres

The Infection Prevention & Control Department at NewYork-Presbyterian Hospital/Weill Cornell Medical Center (NYP/Weill Cornell) has research activities ranging from traditional epidemiologic studies of infection risk factors and outcomes to intervention trials of infection control protocols and procedures. The primary goal of the research program is to improve patient safety by reducing the risk of healthcare-associated infections and antimicrobial resistance. Observational studies can be carried out utilizing infection control surveillance data, clinical microbiology data, and a robust hospital-based clinical database, which can be queried electronically.

Previous and ongoing projects have studied patient-oriented and systems-based factors associated with transmission of multidrug-resistant organisms, device-related infections, procedure-related infections, antimicrobial stewardship, and diagnostic stewardship. In addition, the program has the potential for performing individual and cluster randomized trials of infection control interventions at NYP/Weill Cornell and in collaboration with NYP/Columbia University Medical Center and other NewYork-Presbyterian locations. Fellows, residents, and students interested in epidemiologic research can choose from a wide variety of large or small projects depending on their needs.

All fellows participate in a two-week healthcare epidemiology/infection control rotation during the first year of fellowship. For fellows interested in a career in hospital epidemiology and/or antimicrobial stewardship, there is opportunity to receive intensive training in this exciting field by participating in the Masters of Science in Clinical and Translational Investigation Program, or the Graduate Program in Clinical Epidemiology and Health Services and through direct participation in the Hospital Epidemiology Program in years 2 and 3 of fellowship.

Bernstein D, Salsgiver E, Simon MS, Greendyke W, Eiras D, Saiman L, Furuya EY, Calfee DP. Understanding barriers to optimal cleaning and disinfection in hospitals: a knowledge, attitudes, and practices survey of environmental services workers. Infect Control Hosp Epidemiol 2016;37:1492-1495. PMID: 27619896

Trzebucki AM, Westblade LF, Loo A, Mazur S, Jenkins SG, Calfee DP, Satlin MJ, Simon MS. Real-world implementation and impact of a rapid carbapenemase detection test in an area endemic for carbapenem-resistant Enterobacterales. Infect Control Hosp Epidemiol. 2022;43:92-95. PMID: 33583476

Wang TZ, Simon MS, Westblade LF, Saiman L, Furuya EY, Calfee DP. Quantitative characterization of high-touch surfaces in emergency departments and hemodialysis facilities. Infect Control Hosp Epidemiol 2021;42:474-476. PMID: 33021193

Wang TZ, White KN, Scarr JV, Simon MS, Calfee DP. Preparing your healthcare facility for the new fungus among us: An infection preventionist's guide to Candida auris. Am J Infect Control. 2020 Jul;48(7):825-827. PMID: 32591096

Kondo M, Simon MS, Westblade LF, Jenkins SG, Babady NE, Loo AS, Calfee DP. Implementation of infectious diseases rapid molecular diagnostic tests and antimicrobial stewardship program involvement in acute care hospitals.  Infect Control Hosp Epidemiol 2021;42:609-611. PMID: 33059776

Antimicrobial Stewardship

NewYork-Presbyterian Hospital has a long-standing antimicrobial stewardship program (ASP). The ASP is a joint effort between the Divisions of Infectious Diseases, the Departments of Pharmacy and the Departments of Microbiology across NYP/WCMC, NYP/Columbia and other NYP campuses. In 2018, the IDSA recognized NYPH as an Antimicrobial Stewardship Center of Excellence for exceeding the CDC’s Core Elements for hospital ASPs. The program aims to

  1. Optimize antimicrobial use through promoting judicious and effective antimicrobial prescribing, and
  2. Improve patient outcomes by reducing antimicrobial resistance, the likelihood of adverse drug reactions, the risk of Clostridium difficile infection (CDI), and healthcare costs.
  3. Assist in hospital-wide response to emerging infectious disease threats, such as COVID-19, through institutional guideline development, management of potential drug shortages and optimizing evidence-based delivery of therapeutic interventions such as antimicrobials, monoclonal antibodies and immunomodulatory agents.

Two outstanding ID-trained clinical pharmacists, Angela Loo, PharmD and Shawn Mazur, PharmD are pharmacy leaders for the ASP, provide in-person pharmacist support for the ID consult service rounds and educate fellows on antimicrobial prescribing. There is ample opportunity for fellows to participate in ASP-related activities and research at Cornell and collaborate across all NYPH campuses. Examples of recent ASP-related research include:

Berger RE, Singh HK, Loos AS, Cooley V, Osorio SN, Lee JI, Simon MS. Improving antibiotic stewardship for inpatients with reported beta-lactam allergies and limited access to penicillin skin testing. Jt Comm J Qual Patient Saf 2022;48:147-153. PMID: 35031256  

Kubin CJ, Loo AS, Cheng J, Nelson B, Mehta M, Mazur S, So W, Calfee DP, Singh H, Greendyke WG, Simon MS, Furuya EY. Antimicrobial stewardship perspectives from a New York City hospital during the COVID-19 pandemic: challenges and opportunities. Am J Health-Syst Pharm 2021;78:743-750. PMID: 33543233

Tang SJ, Gupta R, Lee JI, Majid AM, Patel P, Efird L, Loo A, Mazur S, Calfee DP, Archambault A, Jannat-Khah D, Dargar SK, Simon MS. Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center. Jt Comm J Qual Patient Saf. 2019 Mar;45(3):207-216. PMID: 30482662

Kapadia S, Abramson E, Carter E, Loo A, Kaushal R, Calfee DP, Simon MS. The Expanding Role of Antimicrobial Stewardship Programs in US Hospitals: Lessons Learned from a Multisite Qualitative Study. Jt Comm J Qual Patient Saf. 2018 Feb;44(2):68-74. PMID: 29389462

Salsgiver E, Bernstein D, Simon MS, Eiras D, Greendyke W, Kubin CJ, Mehta M, Nelson B, Loo A, Ramos LG, Saiman L, Furuya EY, Calfee DP. Knowledge, attitudes, and practices regarding antimicrobial stewardship among antimicrobial prescribers at five acute care hospitals. Infect Control Hosp Epidemiol. 2018 Mar;39(3):316-322. PMID: 29402339

Greendyke WG, Carter EJ, Salsgiver E, Bernstein D, Simon MS, Saiman L, Calfee DP, Furuya EY. Exploring the Role of the Bedside Nurse in Antimicrobial Stewardship: Survey Results From Five Acute-Care Hospitals. Infect Control Hosp Epidemiol. 2018 Mar;39(3):360-362. PMID: 29382409

Simon MS, Sfeir MM, Calfee DP, Satlin MJ. Cost-effectiveness of ceftazidime-avibactam for treatment of carbapenem-resistant Enterobacteriaceae bacteremia and pneumonia. Antimicrob Agents Chemother. 2019;63:e00897-19. PMID 315481887