Infection prevention groups outline steps needed to preserve antibiotics

Washington, March 19, 2012 – Infection preventionists and healthcare epidemiologists play key roles in promoting effective antimicrobial stewardship in collaboration with other health professionals, according to a joint position paper published today by the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) in their respective peer-review journals, the American Journal of Infection Control and Infection Control and Hospital Epidemiology.

Antimicrobial agents, which include antibiotics and similar drugs, are effective, but the intended target -- microorganisms that cause infections -- can quickly develop resistance by a variety of mechanisms. The World Health Organization considers misuse and overuse of antimicrobials one of the top three threats to human health. These issues can lead to the emergence of multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA). MDROs cause a significant proportion of serious healthcare-associated infections (HAIs) and are more difficult to treat because there are fewer and, in some cases, no antibiotics that will cure the infection.

Antimicrobial stewardship programs (ASPs) encourage optimal, prudent antimicrobial use across healthcare settings. The APIC-SHEA paper highlights the importance of infection prevention professionals known as infection preventionists and healthcare epidemiologists in effective ASPs. This position paper comes at a crucial time as the pipeline of new antibiotics has dwindled with very few new antibiotics in development. Therefore, prevention of infection and antimicrobial stewardship are critical tools -- especially to help prevent C. difficile infections as highlighted recently in the Centers for Disease Control and Prevention's Vital Signs report.

"The skills and knowledge each of these highly skilled professionals bring to a facility's antimicrobial stewardship programs, when combined with other disciplines, can accelerate progress toward preventing emergence and cross transmission of MDROs," state the authors. "Antimicrobial stewardship programs must harness the talents of all members of the healthcare team."

Antimicrobial stewardship programs and interventions help healthcare professionals know when antibiotics are needed and what the best treatment choices are for a particular patient. These programs help preserve the efficacy of antibiotics while improving quality patient care by effectively treating the underlying infection.

Antimicrobial stewardship programs effectively identify the organism, prescribe the most appropriate empiric antibiotic that will destroy it, institute precautions to prevent its spread to others, and once susceptibility is known, narrow the treatment to a more precise choice.

"Infection preventionists and healthcare epidemiologists play a pivotal role in this approach by assisting with prompt detection of MDROs and promoting compliance with standard and transmission-based precautions," said workgroup chair Julia Moody, MS, SM(ASCP), of HCA, Inc. "Infection preventionists and healthcare epidemiologists also facilitate use of other infection prevention strategies such as care bundle practices aimed at preventing bloodstream, urinary, and respiratory tract infections; hand hygiene; and education on prevention for staff, patients, and visitors. Effective prevention strategies minimize HAIs, decrease the use of additional antibiotics, and reduce MDROs."

"Antimicrobial stewardship: A collaborative partnership between infection preventionists and healthcare epidemiologists," by Julia Moody, Sara E. Cosgrove, Russell Olmsted, Edward Septimus, Kathy Aureden, Shannon Oriola, Gita Wasan Patel, and Kavita Trivedi, appears in the American Journal of Infection Control, Volume 40, Issue 2 (March 2012), and Infection Control and Hospital Epidemiology, Volume 33, Issue 4 (April 2012).

For more information, visit APIC's dedicated page on antimicrobial stewardship and SHEA's dedicated page on AS.

Authors:

Julia Moody, MS, SM(ASCP), (Corresponding Author)
Workgroup chair, HCA, Inc., Nashville, Tenn.

Sara E. Cosgrove, MD, MS
Johns Hopkins Medical Institutions, Baltimore, Md., SHEA advisor

Russell Olmsted, MPH, CIC
Trinity Health, Ann Arbor, Mich., 2011 APIC president

Edward Septimus, MD, FACP, FIDSA, FSHEA
HCA, Inc., Nashville, Tenn., SHEA advisor

Kathy Aureden, MS, MT (ASCP)SI, CIC
Sherman Hospital, Elgin, Ill.

Shannon Oriola, BSN, RN, CIC, COHN
Sharp Metropolitan Medical Center, San Diego, Ca.

Gita Wasan Patel, RPh, PharmD, BCPS
HCA Supply Chain Services, Dallas, Texas

Kavita K. Trivedi, MD
Center for Health Care Quality, California Department of Public Health

American Journal of Infection Control (www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

APIC's mission is to create a safer world through prevention of infection. The association's more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Follow APIC on Twitter: http://twitter.com/apic.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at www.shea-online.org.