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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Infection Preventionists and Antimicrobial Stewardship Programs, A Marriage in Progress

Antimicrobial resistance is a rapidly growing problem that involves everyone. Efforts to combat this problem span across health care, from pharmaceuticals to biomedical organizations, veterinary medicine, agriculture, and more. Health care-associated infections as a result of resistant organisms result in significant morbidity and mortality for the patients, not to mention the potential transmission that can occur. The cost of health care for patients with resistant infections is higher than care for those without such infections.

The practice of antimicrobial stewardship is one tool to combat antimicrobial resistance and the spread of these multidrug-resistant infections. Antimicrobial stewardship programs help reduce antimicrobial resistance by reducing unnecessary use and better prescribing habits.

These initiatives are a critical aspect of medical care as each year in the United States, 2 million people will battle antibiotic-resistant infections and 23,000 of these individuals will die.

In an effort to encourage antibiotic stewardship across institutions, beginning in 2017, regulatory agencies, like the Joint Commission, required hospitals and nursing centers to have antimicrobial stewardship programs. As such it’s no surprise that antimicrobial stewardship programs continue to take center stage at ID Week, held this year in San Francisco, California, and a study presented by Monika Pogorzelska-Maziarz and Mary Lou Manning of Jefferson College of Nursing sought to address the topic of antimicrobial stewardship programs through a different lens—the role of the infection preventionist in these programs. 

For the study, investigators surveyed infection preventionists affiliated with the Association of Professionals in Infection Control and Epidemiology. Of the 255 infection preventionists who responded, the majority (78%) reported that their health care facility had an established antimicrobial stewardship program, while 13% reported that they had some kind of antimicrobial stewardship activities, but no formal program. A total of 88% reported that an infection preventionist was a core member of the antimicrobial stewardship program but there were few who reported financial support (ie, budget) and specific time within the infection preventionists job description to work on the antimicrobial stewardship or associated activities.

Roughly half of the respondents noted that the role of the infection preventionists was well defined within the antimicrobial stewardship program and 59% noted that they had adequate knowledge of antimicrobial stewardship to participate in the program.

When asked what the roadblocks were for infection preventionists’ participation in the antimicrobial stewardship program, 41% cited time, 23% noted no allocated full-time employee, and 20% reported that there was not a defined infection preventionists role or responsibility within the antimicrobial stewardship program. The infection preventionists who responded also stated that within their antimicrobial stewardship program, most had a hospital antibiogram, a hospital-specific recommendation to assist with antibiotic selection, a review of Clostridium difficile rates within the antimicrobial stewardship program, and a pharmacist review of appropriateness for specific antibiotics. A total of 57% of respondents noted that there was physician or pharmacist pre-approval for specific antibiotics, while only 45% had an antimicrobial stewardship program with a review of the appropriateness of antibiotics during patient care transitions.

These findings shed light into the existing antimicrobial stewardship program structure within health care facilities, as well as the challenges of incorporating infection preventionists into these programs. Although the role of infection prevention is obvious within the antimicrobial stewardship program, infection preventionists lack a clear set of responsibilities. The integration of the infection preventionists into antimicrobial stewardship programs should be evaluated and strengthened to establish a more wholistic and responsive program. 
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Big advances in treatment can't make up for an inability to stop new infections, which number 5,000 per day worldwide.
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