Pharmacy OneSource Blog

Making the Case for Public Health-Led Coordinated Prevention Programs to Reduce Antibiotic-Resistant Healthcare Infections

Posted on 08/16/15

antibioticresistantbacteria

Antibiotic-resistant bacteria account for an estimated 2 million infections and approximately 23,000 deaths annually in the U.S. In a recent Morbidity and Mortality Infection Report (MMWR)1, Slayton and colleagues note that despite the success of independent facility-initiated reduction programs focused on C.difficile (CD) and other antibiotic-resistant bacteria, inter-facility transmission of these pathogens continues. The problem: lack of a coordinated approach, which includes the community facilities that also care for these patients.

Using mathematical simulation models, the authors estimated the impact of national interventions combining infection control and antimicrobial stewardship on four problematic HAIs caused by carbapenemase-resistant Enterobacteriaceae (CRE), multi-drug resistant Pseudomonas aeruginosa, invasive MRSA, and CD. The estimated percentage of HAIs to occur over the next 5 years due to P. aeruginosa and CRE were generated from device-associated and procedure-associated HAIs reported to NHSN from 2009-2013. Projections for MRSA and CD were derived from the Emerging Infections Program national surveillance from 2005-2012 for MRSA and 2011 for CD.

Based on current trends, it was estimated that in 5 years, the number of infections due to these pathogens would increase to 340,000 – a 10% increase from 2011 data. With immediate implementation of evidence-based infection prevention strategies to reduce transmission and improved inpatient antibiotic prescribing practices,an estimated 619,000 HAIs and 37,000 deaths could be avoided

(Figure 1).   

Based on current trends, it was estimated that in 5 years, the number of infections due to these pathogens would increase to 340,000 – a 10% increase from 2011 data. With immediate implementation of evidence-based infection prevention strategies to reduce transmission and improved inpatient antibiotic prescribing practices,an estimated 619,000 HAIs and 37,000 deaths could be avoided (Figure 1).   

The authors state that public health departments are uniquely positioned to facilitate a coordinated approach to reducing the transmission of these infections. Key steps that need to be taken include:

  1. Leaders in healthcare facilities need to assure accurate and timely detection and reporting of these infections and promote the use of evidence-based infection control practices.

  2. Independent healthcare facilities need to ensure that infection control practices are communicated and implemented when transferring patients with antibiotic-resistant infections.

  3. Data sharing between facilities and public health regarding the incidence and prevalence of these infections needs to be defined.

The public health model of surveillance was adopted by hospital infection control programs many years ago. It is now time for these programs to embrace the public health endorsement for a coordinated response to preventing antibiotic-resistant infections.  

References

1Slayton RB, Toth D, Lee BY, Tanner W, Bartsch SM, et al. Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Healthcare Facilities, United States. MMWR, August 4, 2015.

Topics: Infection Prevention

About the Author

Joan N. Hebden, RN, MS, CIC served as the Director of Infection Prevention and Control for 28 years at the University of Maryland Medical Center, Baltimore, MD. Her clinical background includes general medicine, oncology, and cardiothoracic intensive care. She has presented at national epidemiology conferences, participated in research regarding the transmission of multi-drug resistant bacteria, contributed chapters on infection control to nursing resource textbooks, and published in medical and infection control journals. Joan received her Bachelor of Science degree in nursing and a Master of Science degree in nursing education and trauma/critical care from the University of Maryland School of Nursing. She is certified in Infection Control & Epidemiology (CIC). Joan is an active member of SHEA and APIC and is currently on the Editorial Board of the American Journal of Infection Control (AJIC).