Last September, the White House introduced its National Strategy for Combatting Antibiotic-Resistant Bacteria, which included a goal of reducing C. difficile infections by 50 percent by 2020. The CDC has also named C. difficile as a threat to public health, along with other forms of antibiotic resistant infections.
Hospitalized patients are most at risk for developing a C. diff infection, either as a result of taking antibiotics that disrupt their microbiota, or by ingesting spores that have been spread through environmental contamination. Some of these patients will suffer serious complications. Yet despite the costs and risks posed by C. diff, a recent survey has found that hospitals are not doing everything possible to prevent these serious infections.
The study was published in Infection Control & Hospital Epidemiology. Researchers found that nearly all the hospitals surveyed had programs in place to monitor for C. diff infections, and had protocols in place for preventing the spread of infection – including specific cleaning techniques, isolation precautions, and the use of personal protective equipment. Yet the study also found that nearly half the hospitals lacked one key prevention practice: an antimicrobial stewardship program. Despite strong evidence that such programs work, there seems to be a disconnect in putting it into practice. Research shows that up to 50 percent of the antibiotics administered to hospitalized patients are used inappropriately. A CDC advisory report estimates that reducing antibiotic use by 30 percent could cut the number of new C. diff infections by 26 percent.
Antimicrobial stewardship programs have two goals: to optimize the treatment of infections and to reduce adverse events associated with antibiotic use, including C. diff infection. In 2014, the CDC recommended that all acute care hospitals implement such a program. Stewardship teams ideally are multi-disciplinary, and the work of stewardship program leaders should be supported by other key stakeholders within the hospital. These include:
- Physicians. As the prescribers of antibiotics, they must be supportive of efforts to improve antibiotic use in hospitals.
- Infection preventionists. They can not only assist with monitoring infections, but can help to educate physicians, nurses, and patients on best practices.
- Quality improvement staff. This is a key patient safety issue.
- Laboratory managers. They can offer input on testing and interpreting results.
- Informatics specialists. They can help to integrate stewardship protocols into clinical workflows (for example, by creating prompts in the EMR when antibiotic use may not be appropriate).
- Nurses. As frontline caregivers, they can help to ensure protocols are being followed (for example, by making sure cultures are performed in conjunction with antibiotic use, and reviewing medications on a daily basis).
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