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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Page 14 of 40

14 ICT October 2018 facilities aren't practicing good infection control and stewardship, the whole system breaks down. I think we are beginning to recognize that all healthcare facilities must perform that work well, and they must communicate with each other — particularly if a patient is in isolation precautions at the hospital. If the acute-care facility maintains those precautions well but that patient is transferred to a nursing home that does not continue those precautions, that's a dangerous gap in the system." The costs of AR are signifcant. As the CDC (2013) explains, "Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics. The total economic cost of antibiotic resistance to the U.S. economy has been diffcult to calculate. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars). As the CDC (2013) observes, "Bacteria will inevitably fnd ways of resisting the antibiotics we develop, which is why aggressive action is needed now to keep new resistance from developing and to prevent the resistance that already exists from spreading." Even as the world stares down the threat of AR, it is a hollow sense of bravado, as enormous gaps in knowledge persist. The Centers for Disease Control and Prevention (CDC) observes that these gaps can be classifed into the following challenges and opportunities: ✦ There is limited federal, national and state capacity to detect and respond to urgent and emerging antibiotic resistance-related threats. As the CDC (2013) notes, "Even for critical pathogens of concern like carbap- enem-resistant Enterobacteriaceae (CRE) and Neisseria gonorrhoeae, we do not have a complete picture of the domestic incidence, prevalence, mortality, and cost of resistance." ✦ There is no systematic international surveillance of antibiotic resistance threats. As the CDC (2013) notes, "Today, the international identifcation of antibiotic resistance threats occurs through domestic importation of novel antibiotic resistance threats or through identifcation of overseas outbreaks." ✦ Data on antibiotic use in human healthcare and in agriculture are not systematically collected. As the CDC (2013) notes, "Routine systems of repor ting and benchmarking antibiotic use wherever it occurs need to be piloted and scaled nationwide." ✦ P ro grams to improve antibi otic prescribing are not widely used in the U.S. As the CDC (2013) observes, "These inpatient and outpatient programs hold great promise for reducing antibiotic resistance threats, improving patient outcomes, and saving healthcare dollars. The CDC (2013) says there are four core actions that will help fght resistant organisms and the infections they cause: 1. Preventing infections and preventing the spread of resistance: Avoiding infections in the frst place reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop during therapy. There are many ways that drug - re sis t ant infe c ti ons c an b e prevented: immunization, safe food preparation, handwashing, and using antibiotics as directed and only when necessar y. In addition, preventing infections also prevents the spread of resistant bacteria. 2. Tracking resistant bac teria: CDC gathers data on antibiotic-resistant infections, causes of infections and whether there are particular reasons (risk factors) that caused some people to get a resistant infection. With that information, exper t s can develop specifc strategies to prevent those infections and prevent the resistant bacteria from spreading. 3. Improving the use of today's antibiotics: Perhaps the single most important action needed to greatly slow down the development and spread of antibi- otic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe. Stopping even some of the inappropriate and unnecessary use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria. This commitment to always use antibiotics appropriately and safely—only when they are needed to treat disease, and to choose the right antibiotics and to administer them in the right way in every case—is known as antibiotic stewardship. 4. Promoting the development of new a nt i b i o t i c s a n d d e v e l o p i n g n e w diagnostic tests for resistant bacteria: Because antibiotic resistance occurs as part of a natural process in which bac teria evolve, it can be slowed but not stopped. Therefore, we will always need new antibiotics to keep up with resistant bacteria as well as new diagnostic tests to track the development of resistance. Let's examine these issues more closely. From a clinical perspective, healthcare providers can fght back against AR in many ways, including: ✦ Knowing what types of drug-resistant infections are present in their facility and patients ✦ Requesting immediate alerts when the lab identifes drug-resistant infections in your patients. ✦ Alerting a receiving facility when you transfer a patient with a drug-resistant infection. ✦ Protecting patients from drug-resistant infections. ✦ Following relevant guidelines and precautions at every patient encounter. ✦ Prescribing antibiotics wisely. ✦ Removing temporary medical devices such as catheters and ventilators as soon as they are no longer needed. From an administrative perspective, healthcare facility leaders can join the fght by: ✦ Requiring and strictly enforcing CDC guidance for infection detection, prevention, tracking, and reporting. ✦ Ensuring the facility's lab can accurately identify infections and alert clinical and infection prevention staff when these bacteria are present. ✦ Knowing infection and resistance trends in your facility and in the facilities around you. ✦ When transferring a patient, require staff to notify the other facility about all infections. ✦ Joining or starting regional infection prevention efforts. ✦ Promoting wise antibiotic use. 2 3 1 4

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