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Position paper: Infection prevention, antibiotic stewardship go hand in hand
Infection prevention and control programs are essential to antibiotic stewardship efforts in all clinical settings, according to a position paper published by three infectious disease societies.
Members of the Association for Professionals in Infection Control (APIC), the Society for Healthcare Epidemiology of America (SHEA) and the Society of Infectious Disease Pharmacists (SIDP) wrote the paper, which was published in the American Journal of Infection Control and Infection Control & Hospital Epidemiology. In it, they also reinforced the roles of infection preventionists (IPs) and health care epidemiologists (HEs) in stewardship efforts.
“The 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 [MDROs],” lead author Mary Lou Manning, PhD, RN, an assistant professor of medical oncology at the Thomas Jefferson University College of Nursing in Philadelphia, said in a news release. “The vital work of infection prevention and control [IPC] and antimicrobial stewardship [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 infection and ensuring that effective antibiotic therapy is available for future generations.”
Recent studies have illustrated the vital importance of antimicrobial stewardship, the authors noted. Among other data, the CDC in 2013 conservatively estimated antibiotic-resistant organisms cause more than 2 million infections and 23,000 deaths each year in the United States. In a 2014 report commissioned by the United Kingdom and the Wellcome Trust, researchers suggested that, in the absence of global action, 10 million people will die from antimicrobial-resistant infections worldwide by 2050.
The authors singled out, among other threats, MDROs as particularly difficult to treat, further indicating the importance of AS programs. They cited studies showing the benefits, including a meta-analysis in which AS programs reduced infections and colonization with a range of pathogens.
“Furthermore, AS programs, when implemented alongside IPC measures — especially hand-hygiene interventions — were more effective than implementation of AS alone, verifying that a well-functioning IPC program is fundamental to a successful organizational AS strategy,” the authors wrote. “Similar data have shown that the addition of AS interventions can enhance results of robust IPC measures, particularly when addressing an outbreak.”
Leaders in the effort to improve AS must work to change behaviors like inappropriate prescribing or overprescribing of antibiotics, which have helped to spur and aggravate antimicrobial resistance and threats like Clostridium difficile infection, they continued. By preventing infection in the first place, IPC initiatives can reduce the demand for antimicrobials from the start. IPs and HEs can lend their valuable expertise to that effort, the authors wrote.
“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,” they said. – by Joe Green
Disclosures: The authors report no relevant financial disclosures.