Infection preventionists, healthcare epidemiologists play key roles in promoting antimicrobial stewardship

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."