The U.S. Centers for Disease Control and Prevention recommends that all hospitals adopt an antimicrobial stewardship program to address the growing antimicrobial resistance (AMR) threat.
Antimicrobial stewardship usually describes a coordinated strategy to educate physicians about AMR and the proper use of antibiotics, to improve patient outcomes and reduce unnecessary costs. The CDC promotes strategies that increase accountability and analyze and track antibiotic prescribing procedures.
As of July 2019, 175 U.S. organizations had made a commitment to curbing the spread of AMR, according to the CDC’s AMR Challenge website, established in September 2018.
The Society for Healthcare Epidemiology of America (SHEA) also offers guidelines, suggestions, and procedural recommendations for mitigating the spread of AMR in hospitals and outpatient clinics. The organization’s policy statement on antimicrobial stewardship encourages programs and strategies to remain focused on optimal antimicrobial use, to limit increased resistance among bacteria. Proper antibiotic use and subsequent fewer infections will also reduce treatment costs, according to the statement.
Since all antibiotic use contributes to the spread of AMR, every possible measure must be taken to prevent infection in the first place, according to the Association for Professionals in Infection Control and Epidemiology (APIC).
In a APIC 2012 position paper, co-published with SHEA, the role of infection preventionists in antimicrobial stewardship is described as “assisting with early organism and infected patient identification, by promoting compliance with standard and transmission-based precautions and other infection prevention strategies such as care bundle practices, hand hygiene, and by educating staff, patients, and visitors.”
One of the authors of the APIC and SHEA paper, Julie Moody, also published an article in the 2012 summer issue of Prevention strategist. In it, she further explored the need for antimicrobial stewardship strategies to include infection prevention professionals.
“[Infection preventionists] and healthcare epidemiologists play a pivotal role in stewardship by assisting with prompt detection of MDROs and promoting compliance with standard and transmission-based precautions,” Moody concluded. “The infection prevention/antimicrobial stewardship partnership is bidirectional. Where there is no transmission of infection, there is no need for antimicrobial treatment, thus reducing the development of resistance.”
But are these arguments incomplete? After all, as antimicrobial resistance continues to spread around the globe, hospital-acquired infections caused by contaminated medical devices pose a greater risk to patients. It’s more difficult and expensive to cure infections caused by antimicrobial-resistant organisms than ever before – and more infections have been traced back to flexible endoscopes than any other medical device.
CDC recommendations for curbing the spread of AMRs do go slightly beyond responsible antibiotic use. They include proper handwashing regimens and removing temporary medical devices, such as catheters and ventilators, as soon as they are no longer needed.
When it comes to medical devices, other than the temporary instruments mentioned by the CDC, the importance of cleaning and disinfecting those devices to limit the spread of disease usually falls solely under the umbrella of infection prevention in hospital systems and does not get included in the antimicrobial stewardship discussion. Why? We’ll explore this and other questions around antimicrobial stewardship strategies as we talk to experts in the coming weeks about:
- The role of infection prevention: Should it play a greater role in antimicrobial stewardship?
- Challenges and innovations: Reprocessing a flexible endoscope is a long and arduous process, prone to errors. There are, however, some innovations that help curb contamination risk.
- Leadership: Typically, physicians who prescribe antibiotics spearhead antimicrobial stewardship efforts, but bedside nurses are just as important to the strategy, especially in the OR and ICU.
- Conclusions: Effective antimicrobial stewardship should address all levels of infection prevention and control, including the proper handling of bronchoscopes.