Thursday, April 28, 2011

Infection Prevention + Optimal Antibiotic Use = Zero Infections

Julia Moody, MS SM (ASCP), Clinical Director, Infection Prevention, Clinical Services Group, HCA, Inc, APIC Antimicrobial Stewardship Task Force

Antibiotics are the second most common medication prescribed in the US. Although the discovery of antibiotics advanced the treatment of infections, excessive use frequently occurs. Bacteria easily adapt to become resistant, often at an alarming rate, posing a threat to public health safety, because new, more powerful antibiotic development is limited. This threat to public health safety was recognized on World Health Day, April 7, 2011, and endorsed by Centers for Disease Control and Prevention (CDC) and healthcare professional organizations in the U.S. To address the threat, antimicrobial stewardship programs are instituted to optimize antibiotic use and improve patient outcomes, while decreasing the development of resistance.

Antibiotic exposure is the single most important risk factor in C. difficile infection, a cause of severe diarrhea, serious intestinal complications and death. In some parts of the U.S., C. difficile is more common than MRSA. New cases of C. difficile infection occurring during a hospital stay are an indicator of adverse drug events as there is growing evidence that the risk for infection drops with antimicrobial stewardship.

What is the science of infection prevention and the value for hospitalized patients? Hospitals are where the most vulnerable patients in intensive care units, those with chronic health conditions and whose immune systems are unable to fight infection, rely totally on antibiotics to treat life-threatening infections. Resistant bacteria can leave these patients without an effective antibiotic for their infections.

How does the role of infection preventionists decrease the risk of infections and slow the pace of antibiotic resistance in healthcare settings? Infection prevention uses scientifically proven concepts to (1) identify trends and occurrences of drug resistant bacteria [MDROs], like MRSA, and new, emerging resistance in gram negative bacteria; (2) apply practices to prevent transmission of these MDROs to other patients, using bundles of hand hygiene before and after patient contact, isolation precautions placing patients in private rooms, where caregivers wear gowns and gloves, and environmental cleaning to ensure that surfaces and equipment are completely cleaned to reduce the presence of bacteria in the environment; (3) implement care bundles – like checklists – that when consistently performed, reduce the risk of getting an infection from use of catheters or after undergoing a surgical procedure; and (4) share findings of MDRO-related infections with the antimicrobial stewardship team members to identify successes and improvement opportunities.

What have been the outcomes? In the past 10 years, healthcare epidemiologists and infection preventionists – in collaboration with their direct care co-workers – have documented dramatic reductions in the frequency of infections, especially among patients in ICUs, as reported into the CDC’s National Healthcare Safety Network (NHSN) database.

What can you do today to prevent infections and save antibiotics for their intended use? Practice good hand hygiene with alcohol based hand rubs or soap and water, know what common infections do not respond to antibiotics, like the common cold, viral sore throats and influenza, take the full dose of antibiotics when prescribed for true infections, and keep current on vaccinations.