Deverick J. Anderson, MD, MPH, FIDSA, FSHEA1
1Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
Small, rural hospitals often have difficulty implementing best practices for infection prevention, developing strategies for antimicrobial stewardship, and meeting quality improvement regulations. These hospitals simply don’t have sufficient resources or expertise to know what to do and, as importantly, how to do it.
Network models are one strategy to assist hospitals improve the quality of care provided. The Duke Infection Control Outreach Network (DICON) provides these services for 45 small, rural hospitals in the southeastern US. Core strategies of the “DICON model” include regular site visits, data analysis with feedback and benchmarking, educational activities, quality improvement initiatives, information dissemination, and subject matter expertise. Hospitals that participate in DICON decrease healthcare-associated infections by 50% during the first 5 years of participation in the network. In fact, based on the success of DICON, we recently developed a parallel, sister network to support antimicrobial stewardship activities in these hospitals, the Duke Antimicrobial Stewardship Outreach Network (DASON).
Though based on the “DICON model,” DASON provided the opportunity to improve our network model, particularly related to data gathering, analysis, and feedback. Collectively, DICON and DASON are unique, evidence-based strategies to improve infection prevention and antimicrobial stewardship activities in low resource settings.