A high performing antimicrobial stewardship program (ASP) harnesses the efforts of many departments and specialists within a hospital.
Infection preventionists (IPs) are among the most crucial of these partners as their work directly impacts the success of the ASP, according to the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA).1
Infection preventionists play a key role in performing surveillance for patients with healthcare-associated infections (HAIs) and promptly implementing isolation precautions, if applicable, and managing outbreaks. In addition, the monitoring of fundamental infection prevention and control practices, such as compliance with standard and contact precautions, hand hygiene, and implementation of best practice bundles naturally complement an antimicrobial stewardship program.
The surveillance techniques and technology used by IPs support the ASP by identifying and monitoring multidrug-resistant organisms (MDROs) among patients and trending incidence rates over time. IPs may be the first members of the ASP team to recognize adverse trends of MDROs. An antibiogram is a tool used to guide antibiotic usage by clinicians; IPs can assist with the dissemination and educational efforts of this data. Electronic surveillance software applications used by IPs can assist with designing clinical algorithms and other decision support tools used to determine the appropriate treatment for specific infections.
Infection preventionists have a key role in educating clinicians and patients. Through engagement with physicians, nurses, and patients, they can communicate the need for antimicrobial stewardship and the importance of appropriate use of antibiotics. For example, training sessions on best practice bundles designed to reduce urinary tract infections could include components that discuss the need to reevaluate antibiotic therapy after 48 hours in light of lab reports and other information.
IPs can also support pharmacy-led ASP interventions such as switching from IV to oral medication administration during unit visits, education programs, and one-on-one training. In addition, their access to disparate data feeds enables them to assist pharmacy operations in the identification of bug-drug mismatches and excessive use of broad-spectrum antibiotics that may contribute to the development of increasingly resistant organisms.
As IPs typically have responsibility for analyzing and reporting surveillance information, they are well-positioned to support the hospital's antimicrobial stewardship program with real-time data on HAIs and MDROs and adverse trends. They often have experience translating data into actionable knowledge for clinicians and administration, which can help maintain support for the ASP and significantly contribute to patient safety initiatives targeted at infection reduction.
1 Moody J, Cosgrove SE, Olmsted R, Septimus E, Aureden K, Oriola S, Patel GW,Trivedi KK. Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists. Am J Infect Control. 2012 Mar;40(2):94-5.