Infection Control Today

OCT 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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12 ICT October 2018 www.infectioncontroltoday.com By Kelly M. Pyrek As one of the mos t signific ant challenges in modern medicine, the fight agains t antibiotic / antimicrobial resistance (AR) is becoming the responsibility of clinicians at every level and is part of daily infection prevention work. As Frieden (2013) reminds us, "Antimicrobial resistance is one of our most serious health threats. Infections from resistant bacteria are now too common, and some pathogens have even become resistant to multiple types or classes of antibiotics. The loss of effective antibiotics will undermine our ability to fi ght infectious diseases and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery, especially organ transplantation, for which the ability to treat secondary infections is crucial. When fi rst-line and then second-line antibiotic treatment options are limited by resistance or are unavailable, healthcare providers are forced to use antibiotics that may be more toxic to the patient and frequently more expensive and less effective. Even when alternative treatments exist, research has shown that patients with resistant infections are often much more likely to die, and survivors have signifi cantly longer hospital stays, delayed recuperation, and long-term disability. Efforts to prevent such threats build on the foundation of proven public health strategies: immunization, infection control, protecting the food supply, antibiotic stewardship, and reducing person-to-person spread through screening, treatment and education." Antimicrobial Resistance: Stewardship and Strategies for Conquering a Global Threat The use of antibiotics is the single most impor tant factor leading to antibiotic resistance around the world, as antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to half of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed, experts say. The classic interventions associated with effective infection prevention and control that are non-pharmaceutical in nature remain the cornerstone of AR prevention and work in tandem with antimicrobial stewardship. There is no silver bullet," emphasizes Matthew Zahn, MD, a pediatric infectious disease physician with CHOC Children's Hospital in Orange County, California. "The simplest solutions — infection prevention and control practices such as handwashing and sur face cleaning, and the overall prevention of spread of MDROs — remain the best interventions. These good practices are the best way to prevent transmission of multidrug-resistant organisms (MDROs) and they are the most important work that we do. There is no end to that fi ght against MDROs, and we must maintain personal and institutional diligence." Zahn continues, "The development of antimicrobial resistance is an inevitability over time and so the infection control work that prevents the spread of these MDROs is tremendously important. It is essentially a delay tactic, as we know that over time AR is likely to develop in multiple organisms. It is up to us on a national level to identify and to develop new drugs to keep ahead of the organisms. In the meantime, preventing spread of AR-resistant organisms within hospitals, between hospitals, and between hospitals and nursing homes, is a major concern for all of us. Public health laboratories have developed signifi cant capacity for conducting testing of AR bacteria, so now we can identify new and variant strains more often and more quickly than we used to. What we are wrestling with from a public health perspective is how we best use these fi ndings, which requires a tremendous amount of work from all sides to identify, track and prevent spread of those organisms." Zahn points to Carbapenem-resistant Enterobacteriaceae (CRE) as an example. "CRE is a signifi cant concern, and many states have made CRE reportable. Whole genome sequencing testing for CRE is being conducted at local and state laboratories, and as we gain more insights about how it spreads, we must improve in our efforts to track this transmission between hospitals and nursing homes. I think long-term care is a particularly big concern for all of us because so many people who harbor antimicrobial-resistant bacteria live out the rest of their lives there, but nursing homes have fewer resources for infection control practices compared to hospitals." Zahn continues, "The next frontier we are approaching is effective antimicrobial stewardship in those facilities. If someone is colonized with MDROs in a hospital, there's a very good chance that person will be discharged to a nursing home and if those feature

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