Q&A: How community hospitals can fight antimicrobial resistance
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NATIONAL HARBOR, Maryland — Although nearly every health care facility has felt the effects of the COVID-19 pandemic, smaller, nonacademic medical centers are facing these problems with fewer resources to fall back on.
During a presentation at the World Anti-Microbial Congress, Elizabeth S. Dodds Ashley, PharmD, BCPS, Infectious Disease News Editorial Board Member and professor of medicine at Duke University School of Medicine, highlighted some of these challenges.
“We wanted to highlight what some of the challenges are in the smaller community hospitals, really trying to build on the fact that if we put all these efforts into developing new testing capabilities and new drugs to give to patients, it doesn't really help if we can't get them to the patients where we need to improve care,” Dodds Ashley told Healio. “These conversations can help inform some of the new policies and decisions that are made regarding ways to combat antimicrobial resistance (AMR).”
Healio spoke with Dodds Ashley following her presentation to discuss problems faced by community hospitals and what strategies could improve them.
Healio: What differentiates a community hospital from other hospitals?
Dodds Ashley: I am the one who uses the term community hospital, and I actually applied it probably in an error because technically, according to the HA, we all say community hospitals, but the technical definition of a community hospital is a non-federally funded facility. I think that when we use it colloquially, we consider it hospitals that are not academic medical centers, but probably the better thing to call them are rural hospitals. About 35% of community hospitals are in the rural setting based on those federal definitions. You can also call them smaller community hospitals because academic medical centers all have more than 500 beds, and that's really what we're talking about — smaller community hospitals.
Healio: What challenges do community hospitals face in terms of antimicrobial stewardship?
Dodds Ashley: Well, there are some similarities in terms of availability of staff. So, as an example, and picking up on one of the themes of the World AMR Congress meeting, in our network, a third of our hospitals don't have an infectious diseases physician. So, imagine trying to do all this without an infectious disease physician. Many of them also have very limited pharmacy staffs, so they certainly don't have pharmacists who are experts or are dedicated to infectious diseases. At best, they have a little bit of time for a pharmacist to work on infectious diseases, which makes it a real challenge. So, the workforce issues are definitely concerning in community hospitals.
They have limited local resources. For example, some of them may not have a microbiology laboratory on site, which increases the time to getting test results back. If you're waiting to stop antibiotics because you're waiting to see if a culture is negative, it's a send out that with the transit time makes it 5 to 7 days. That's added antibiotic exposure. These smaller community hospitals also have trouble getting resources for laboratory equipment for laboratory personnel.
They also have trouble recruiting just like everybody's been talking about at World AMR Congress. There just isn't a workforce. In my network, we've had three long-term microbiologists retire in the last 6 months. That is an amazing amount of expertise to walk out the door, and there aren't trained people to take over. The hospital is having to train new people in their place. The same is true for infection preventionists, along with many pharmacists.
Healio: What sort of strategies can community hospitals use to overcome these challenges?
Dodds Ashley: There are some things that are now actually endorsed. If the smaller community hospitals are part of a network, they can tap into network resources to help with antimicrobial stewardship. That’s one model that's worked. You just need to be aware that stewardship is not one size fits all. So, if you have a program that works for a big academic medical center, it might need to be pared down for the smaller community hospitals.
Other strategies could include telesupport — we've learned so much about telemedicine recently. There's actually telestewardship, there's tele-ID, you can seek outside consultants, or you can work on training your own staff for it.
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Healio interview.
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