Antimicrobial Stewardship Programs: Are They Pulling ID Physicians Away from Infection Prevention Programs?
Are we investing in infection prevention programs like we should or are competing interests pulling resources?
The prevention, identification, and reporting of health care-associated infections is critical for patient care and staff safety, and also because of the introduction of the US Centers for Medicare and Medicaid (CMS) non-payment rules. These regulatory requirements place a spotlight on infection prevention and control (IPC) programs, partly because they also play a large role in reducing the transmission of antibiotic-resistant infections. As such, they are also frequently cited as a pivotal component to the success of antimicrobial stewardship programs. Therefore, investigators on a new study sought to address the impact of antibiotic stewardship programs on IPC programs.
According to a 2013 report from the US Centers for Disease Control and Prevention (CDC), in the United States alone, 2 million people contract an antibiotic-resistance infection and at least 23,000 people die each year. Antibiotic stewardship is paramount in reducing these infections and both CMS and the Joint Commission (TJC) have included rules about antimicrobial stewardship programs and the role of an infectious disease-trained physician in leading such initiatives.
Although there is no regulatory requirement for an infectious disease physician to have a role within IPC programs, most IPC programs have this support, particularly because of the expectation and support from major industry groups like the CDC, Association for Professional in Infection Prevention and Control (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Infectious Disease Society of America (IDSA).
ASPs, on the other hand, do have regulatory directives by CMS and TJC that require physician leadership, and this can stress the time such physicians have for IPC programs. These competing priorities can be challenging, as infectious disease physicians are already juggling their clinical practice and consults.
This article draws attention to the considerable difference in directives and accreditation requirements between IPC programs and ASP. As an infection preventionist, I can wholly attest to the critical role that these physicians have in our programs. Whether it is backing us up on the tough call of identifying a health care-associated infection, having 1:1 talks with providers who just will not wear their personal protective equipment, or a number of other things that, frankly, require bringing in the big guns (ie, physicians) to support IPC efforts.
What is particularly concerning about the juxtaposition between regulatory requirements for ASPs versus IPC programs is that studies have supported the roles of infectious disease physicians in IPC programs since the 1970s. Ultimately, there continues to be a need for more infectious disease physicians, but when we require ASPs to have physician leadership, too, it often pulls them away from the IPC program, which does a disservice to the infection preventionists and the staff and patients. The authors of this study note that “the inclusion of infection preventionists (IPs) with ASP legislative advocacy for time allocation and compensation models should be encouraged by all associated professional and regulatory organizations including IDSA, SHEA, APIC, TJC, and CMS to help build the infectious disease physician workforce with the goal of improving patient care.”
As this study emphasized, there needs to be more of a push from the top down (both regulatory and administrative) to ensure IPC programs are supported by infectious disease physician sponsors. Moreover, it is critical that regulatory requirements don't just include surveillance and reporting efforts, but also emphasize the resources needed to make IPC programs work.