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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16 ICT October 2018 www.infectioncontroltoday.com Stewardship is an important component of AR prevention. It has been more than a decade since SHEA issued its guidance on creating and sustaining hospital-based antimicrobial stewardship programs, when it urged, "Effective antimicrobial stewardship programs can be fnancially self-supporting and improve patient care. Comprehensive programs have consistently demonstrated a decrease in antimicrobial use, with annual savings of $200,000 to $900,000 in both larger academic hospitals and smaller community hospitals. Thus, healthcare facilities are encouraged to implement antimicrobial stewardship programs." "There is much more awareness and interest from hospitals regarding antimi- crobial stewardship," confrms Keith Kaye, MD, MPH, president of the Society for H ealthcare Epidemiology of A merica (SHEA) and professor of internal medicine and infectious diseases at the University of Michigan. "As recently as two to three years ago I think there were many unknowns and misconceptions about what stewardship was that have been cleared up. My impression from talking to hospital leaders and clinicians around the country is that there is greater understanding of what a stewardship program does, and a greater appreciation for what these programs accomplish. They realize how the stewardship role is critical and complimentary to that of infection prevention regarding fghting antimicrobial resistance and I think this has led to a greater acceptance and progress regarding implementation and promotion of stewardship. I think a lot of pushback a few years ago often had to do with misinformation in terms of viewing stewardship as the 'antibiotic police' or as clinicians losing control of patient care. Now with the quality movement really taking hold, and as stewardship is gaining a foothold with the Joint Commission embracing stewardship programs, we are defnitely moving toward more broad acceptance of stewardship by leadership and clinicians alike." Kaye continues, "We are now starting to see a co-management of patients by pharmacists and physicians that may not have been as accepted in the past. Regarding patient safety, pharmacists can identify adverse effects of medication, duration, dosing, and can improve the care of patients while and making clinicians' jobs much easier. I think there is greater understanding and acceptance of what an infectious disease pharmacist brings to the table. I also think we are seeing greater adoption and integration of interventions like extended infusion of antibiotics for carbapenems and therapeutic drug monitoring, and these types of therapeutic modalities don't occur without a very invested joint effort by physicians and pharmacists, which comes most commonly through stewardship efforts. These treatment modalities are becoming the rule instead of the exception, and that's an exciting, signifcant shift in the last three to fve years. I don't think that happens without a systematic, intentional effort by stewardship personnel." Earlier this year, professional societies updated a joint position paper underscoring the synergy of infection prevention programs and antibiotic stewardship programs. "The issues surrounding the prevention and control of infections are intrinsically linked with the issues associated with the use of antimicrobial agents and the prolif- eration and spread of multidrug-resistant organisms," says Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC, lead author of the paper published concurrently in the American Journal of Infection Control and Infection Control and Hospital Epidemiology. "The vital work of IPC and AS programs cannot be performed independently. They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infec tion and ensuring that effective antibiotic therapy is available for future generations." The joint position paper, endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP), updates a 2012 paper that affrmed the key roles of infection preventionists (IPs) and healthcare epidemiologists (HEs) in promoting effective use of antimicrobials in collaboration with other healthcare professionals. The new paper highlights the synergy of IPC and AS programs, including the importance of a well-functioning IPC program as a central component to a successful AS strategy. The authors acknowledge that successful AS programs require a signifcant investment on the part of the healthcare facility. As Manning, et al. (2018) explain, " AS programs have been shown to improve patient outcomes, reduce antimicrobial agent- related adverse events, and decrease AMR. To date, primary strategies include prescriber preauthorization and prospective audit and feedback, with supplemental strategies such as guidelines and clinical pathway development, intravenous-to-oral conversion protocols, limiting inappropriate culturing, and provider education. Changing practices and prescribing pat terns and learned behaviors of physicians, nurses, pharmacists, and other healthcare providers will take time and investment, but is critical to affecting a long-term solution to the rise of AMR and CDI infections. It is equally important that all clinicians depend on evidence-based IPC interventions to reduce demand for antimicrobial agents by preventing infections from occurring in the frst place and making every effort to prevent transmission when they do. IP and HE leaders are credible IPC subject-matter experts with additional social and behavioral skills to effectively engage the different professional disciplines to promote, implement, support, sustain, and evaluate IPC strategies across practice settings—many of the same skills needed by those leading AS programs." The authors urge healthcare leaders to prioritize IPC and AS as part of wider patient safety initiatives and recommend that IPC and AS leaders collaborate in communications to the C-suite. "Given the synergy between AS and IPC programs, IPC and AS program leaders should seize every opportunity to beneft from each other's expertise and organizational infuence and partner when making the case for program support and necessary resource allocation to clinical and administrative leadership. Key antimicrobial stewardship techniques, including limiting formularies and formal restrictions of certain classes of antimi- crobials, the cycling of antibiotics; and Ò Te issues surrounding the prevention and control of infections are intrinsically linked with the issues associated with the use of antimicrobial agents and the proliferation and spread of multidrug-resistant organisms.

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