Pharmacy OneSource Blog

Clinical Corner: Infection Prevention and Antimicrobial Stewardship – A Natural Fit

Posted on 04/02/14

Infection_Prevention_and_Antimicrobial_Stewardship_–_A_Natural_Fit

In my 23 years of practicing infection prevention, it has been interesting to observe paradigm shifts in our collective efforts to improve healthcare-associated infection (HAI) prevention, patient safety, patient outcomes, and institutional financial stability. Remember when nosocomial infection rates were "confidential"? Now we have HospitalCompare.gov, mandated public reporting of HAIs, and CMS-driven pay-for-performance related to HAIs.

A more recent paradigm shift involves greater infection preventionist engagement in antimicrobial stewardship. Implementing an antimicrobial stewardship program in a hospital is proven to increase positive patient outcomes, decrease antibiotic resistance, decrease C.diff infections, and decrease costs.  Infection preventionists certainly bring additional expertise to these efforts.

Regardless of where your facility is in its antimicrobial stewardship efforts, an extremely helpful resource is in the March 2014 edition of CDC Vital Signs. The CDC also includes two documents that I find very helpful: a facility-assessment checklist and a review of the core elements of antimicrobial stewardship.

The CDC recommends that all hospitals implement antimicrobial stewardship programs that include seven core elements [1]:

  • Leadership commitment: Dedicating necessary human, financial, and information technology resources.
  • Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs has shown that a physician leader is effective.
  • Drug expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use.
  • Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e., "antibiotic time out" after 48 hours).
  • Tracking: Monitoring antibiotic prescribing and resistance patterns.
  • Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff members.
  • Education: Educating clinicians about resistance and optimal prescribing.

A recent webinar presentation by Linda Greene, RN, MPS, CIC [2] reviewed the role of infection prevention in antimicrobial stewardship. More than 300 infection preventionists were asked in an online survey to describe antimicrobial stewardship efforts at their facility.

The responses were as follows:

  • No antimicrobial stewardship (AS) program at the facility – 12%
  • An AS program exists but infection preventionists are not involved – 11%
  • An AS program is just getting started – 28%
  • Infection prevention is represented on the Pharmacy & Therapeutics Committee or a related antibiotic subcommittee – 37%

Whatever your responses would be to these questions, challenge yourself professionally to be a strong clinical participant in antimicrobial stewardship at your facility. If you are new at it, take advantage of the referenced websites and other literature. If you are more advanced in your personal and institutional AS efforts, share your accomplishments at your local APIC chapter or through blogging or publishing. We all have more to learn and teach!

References
1. CDC. Core elements of hospital antibiotic stewardship programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available athttp://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html.

2. Wolters Kluwer Health Sentri7. 2014. Antibiotic Stewardship: the Role of Infection Prevention [Webinar]. Retrieved from http://forums.pharmacyonesource.com/t5/Webinar-Blog/Antimicrobial-Stewardship-Infection-Prevention-s...

Understand Infection Prevention's Role in Antimicrobial Stewardship

Topics: Infection Prevention, Antimicrobial Stewardship

About the Author

Tom Jordan, RN, BS, CIC is an Infection Prevention Clinical Program Manager for Sentri7. Tom previously served as the Director of Infection Prevention for a hospital that was one of the initial customers utilizing Sentri7 Infection Prevention. He brings this rich and practical experience along with his extensive infection prevention knowledge to customers adopting the Sentri7 software. Mr. Jordan has more than 29 years of experience as a registered nurse during which time he provided clinical services in pediatric intensive care, trauma nursing and employee health. Tom served as Director of Infection Prevention for 21 years in acute care and long term acute care settings. His experience includes working in a large, multihospital system (100+ sites). Tom is a long standing member of the Association for Professionals in Infection Control and Epidemiology (APIC) member, an active SHEA member, has contributed articles to the publications Advance for Nurses and Nursing Spectrum, and has presented at national and regional conferences on a variety of infection prevention topics. Tom holds a Bachelor of Science Degree in Social Work from the Loyola University and a Nursing Degree from Illinois Masonic Medical Center School of Nursing.