Infection Prevention & Control Programs—A Vital Component to Antimicrobial Stewardship

SHEA and APIC have declared infection control programs as critical components of antimicrobial stewardship programs—are you including them at your institution?

Antimicrobial resistance is a difficult biological threat and one that despite our best efforts, continues to challenge health care practitioners. The overuse of antibiotics in agriculture and the overprescribing habits of health care professionals have contributed to this growing problem. Recent reports have revealed that one-third of hospitalized children are getting antibiotics they don’t need, while other reports have shown that physicians continually succumb to the pressure to provide antibiotics to avoid patient complaints.

Furthermore, a recent study published in the Proceedings of the National Academies of Sciences found that over the course of 16 years (from 2000 to 2015) there has been a 65% increase in antibiotic consumption across 76 countries. Part of this increase was driven by “low- and middle-income countries where rising consumption was correlated with gross domestic product per capita (GDPPC).” Economic growth as a fuel for antimicrobial consumption should be a good thing, as antibiotics will become accessible to those individuals who need them. Except when stewardship is so poor.

A problem with a $2 billion-a-year price tag requires prioritization, but where can we start?

In 2012, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA), released a joint position paper regarding the collaborative partnership between infection preventionists (IPs) and health care epidemiologists (HEs) for antimicrobial stewardship. The 2 organizations emphasized the role IPs and HEs have in antimicrobial stewardship efforts through their unique skills and ability to provide guidance on surveillance, intervention implementation, and more.

Building on these recommendations, SHEA and APIC just released an update, which calls infection prevention and control programs “essential to antibiotic stewardship efforts.” While the 2012 paper highlighted the partnership, this recent edition focuses on infection prevention and control (IPC) programs, which tend to include IPs and HEs.

Ultimately, the authors of the new joint position paper underscore the inherent link between antimicrobial use and the transmission of multidrug-resistant organisms (MDROs). IPC programs include a multitude of aspects that impact antimicrobial stewardship and curbing the spread of MDROs, including surveillance, increasing awareness of antimicrobial resistance, ensuring isolation and standard precautions are followed, and ensuring prompt detection of MDROs, and more. Indeed, these are just a handful of ways IPC programs work to reduce the burden of antimicrobial resistance.

In terms of stewardship, the utilization of IPC skills and subject matter expertise can make a difference. The SHEA and APIC authors call on antimicrobial stewardship programs to “harness the talents of all members of the health care team” and utilize the IPC program strategies of best care bundles and education efforts to help strengthen health care practices.

IPC program strategies to reduce health care-associated infections trickle into cutting down on the presence and transmission of MDROs, which is why these programs are so critical for antimicrobial stewardship initiatives. IPC programs harness the knowledge of subject matter experts who are already fighting against behavioral and institutional barriers that result in health care-associated infections and poor practices (ie, hand hygiene, personal protective equipment compliance, etc). This makes them a strong tool in the stewardship arsenal. Ultimately, antimicrobial stewardship initiatives require hospital administration support; however, ensuring these groups are inclusive of members that will truly help lead the fight against antimicrobial resistance is critical. Including and empowering IPC programs within antimicrobial stewardship efforts can only serve to help these initiatives succeed—so what are we waiting for?