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Don’t use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence.
Choosing Wisely®
Society for Healthcare Epidemiology of America
C. difficile can be a life threatening illness and is generally caused by antibiotics killing normal bacteria in the intestine. Patients recovering from C. difficile are three times as likely to have a recurrence if they receive an antibiotic in the following month. However, unnecessary antibiotics are often used in this population – primarily for misdiagnosed urinary tract infection or pneumonia.
ver más ... 2015Don’t perform urinalysis, urine culture, blood culture or C. difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to over diagnosis and ...
Choosing Wisely®
Society for Healthcare Epidemiology of America
Although important for diagnosing disease when used in patients with appropriate signs or symptoms, these tests often are positive when an infection is not present. For example, in the absence of signs or symptoms, a positive blood culture may represent contamination, a positive urine culture could represent asymptomatic bacteriuria, and a positive test for C. difficile could reflect colonization. There are no perfect tests for these or most infections. If these tests are used in patients with ...
ver más ... 2015Avoid invasive devices (including central venous catheters, endotracheal tubes and urinary catheters) and, if required, use no longer than necessary. They pose a major risk for infections.
Choosing Wisely®
Society for Healthcare Epidemiology of America
Invasive devices are often necessary for patient support; however, they are a major risk for healthcare-associated infections (HAIs). We are learning they can often be avoided and, if used, can be quickly removed with the help of clinical reminders and protocols. They should never be used for convenience.
ver más ... 2015Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection.
Choosing Wisely®
Society for Healthcare Epidemiology of America
Antibiotics are often started when a patient is possibly infected. After three days, laboratory and radiology information is available and antibiotics should either be deescalated to a narrow-spectrum antibiotic based on culture results or discontinued if evidence of infection is no longer present. Lessening antibiotic use decreases risk of infections with Clostridium difficile (C. difficile) or antibiotic-resistant bacteria.
ver más ... 2015Manual anal stretch has a higher risk of fissure persistence than internal sphincterotomy and a significantly higher risk of minor incontinence than sphincterotomy.
Cochrane Quality and Productivity topics
National Institute for Health and Clinical Excellence (NICE)
Anal fissure is an ulcer of the skin that lines the anus, causing pain on defecation. A number of procedures have been trialled for treatment of this condition, including manual anal stretch and sphincterotomy. Manual anal stretch has a higher risk of fissure persistence than internal sphincterotomy and a significantly higher risk of minor incontinence than sphincterotomy. This Cochrane review therefore suggests there is no evidence to support the ongoing use of this procedure.
ver más ... 2015