Infection Control Today

MAY 2019

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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" We need to combat antibiotic resistance before the situation gets worse. — Stephanie Uses, PharmD, MJ, JD " Patients need to feel like they are being taken care of, even without a prescription for an antibiotic. — Sharon Bradley, RN, CIC 11 May 2019 ICT IPs Can Play Key Role in Addressing Patient-Safety Threats and educating patients and families. Partner with the epidemiologist, and the infectious disease physician to provide information from surveillance data, culture reviews, outbreak investigation, and resistance trends to the stewardship team." Marella continues, "In our Top 10 Patient Safety Concerns for 2019, we talked about extending antibiotic stewardship to ambulatory settings--physician practices and aging services. An IP working in a health system might start to look at antibiotic use in these settings, and for aging services, pharmacists are required to review patients' charts. Some of the problems we see in these settings that an IP could help prevent are treating infections empirically and not modifying treatment based on culture results, and continuing antibiotics for too long. In any setting, it's important to help patients understand when antibiotics aren't appropriate and what they can do instead to help them feel better." "Patients need to feel like they are being taken care of, even without a prescription for an antibiotic," explains Sharon Bradley, RN, CIC, senior infection prevention and patient safety analyst/consultant, ECRI Institute. "Instead, give them a prescription for what to do, what to watch for. Follow up with them. Everyone needs to know their role: the physician needs to know what to do, and the patient needs to know what to do." Organizations need to be able to implement and support antimicrobial stewardship programs. Bradley recommends that the provider ask four questions to determine an antibiotic's appropriateness for the patient being treated: 1. Does this patient have an infection that will respond to antibiotics? 2. If so, is the patient on the right antibiotic(s), dose, and route of administration? 3. Can a more targeted antibiotic be used to treat the infection (de-escalate)? 4. How long should the patient receive the antibiotic(s)? "Antibiotic stewardship does not mean withholding necessary treatment," Bradley adds. "But we have casually and cavalierly handed around the candy dish of antibiotics without a second thought as to how we may be harming our patients." By Kelly M. Pyrek T his year's list of top patient safety concerns issued by the ECRI Institute provides healthcare professionals with the opportunity to evaluate the performance of their institutions relating to patient outcomes and establishing priorities for improvement. Let's examine in more detail a number of these issues. Antimicrobial Stewardship in Physician Practices and Aging Services "We need to combat antibiotic resistance before the situation gets worse," says Stephanie Uses, PharmD, MJ, JD, patient safety analyst/consultant with ECRI Institute's Patient Safety Organization (PSO), noting that not many newly approved drugs are antibiotics. As antibiotic resistance increases, "your treatment options can be limited," she explains. Perhaps the most significant challenge facing antibiotic stewardship is managing patient expectations. Patients "expect an antibiotic to help them get better," Uses says. Moreover, unnecessary antibiotic admin- istration puts patients at unnecessary risk of adverse drug reaction. And the broadest concern, she notes, is that overprescribing leads to antimicrobial resistance. William M. Marella, MBA, MMI, executive director of PSO operations and analytics at ECRI Institute, offers some advice for how infection preventionists (IPs) at all levels of experience can become more involved with their facility's antimicrobial stewardship program. "For a novice IP in the hospital, the important things to focus on are: who to know, what to know, and what to do," says Marella. "For who to know: become friendly not only with hospital epidemiologists and the infectious disease physicians but also nursing, pharmacy, and prescribers. For what to know: antibiotic stewardship is all about using those medications at the right time, using the right one based on the infection and the organism, and using them for the right duration of treatment. Learn what pathogens are prevalent in your organization and how antibiograms are communicated to physicians and whether they are infuencing prescribing. For what to do: A novice IP should use the CDC core elements checklist, the CMS infection control assessment tools and the Joint Commission standards to guide risk assessment, gap identifcation, goals, measuring and monitoring, feature

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