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Friday, February 15, 2013

I’ll take Drugs and Bugs for a $1000

Off the top, I have to make the disclaimer, I am not a pharmacist and while I took several pharmacology courses as part of my Bachelor of Science, the only thing that I can state with certainty is that you should not take Acetaminophen to cure a hangover headache.  If you didn’t know, mixing Acetaminophen and alcohol can cause acute liver failure.

Our most recent blogs have been focusing on the importance and need for environmental cleaning.  As we know, infection prevention and control is not as simple as implementing one strategy.  It takes the implementation of a number of strategies (e.g. a bundle) and together these strategies can work together to provide the desired outcome.  In many Outbreak management strategies, environmental cleaning and either increasing the frequency of cleaning or improving the efficacy of cleaning is a cornerstone.   Cleaner surfaces mean less chance for hand contamination and of course, reducing hand contamination can help reduce transmission of infection.

However, hand hygiene and cleaning compliance is not always the end all and be all.  In fact, I do know of a facility that implemented more stringent cleaning and hand hygiene policies but still have issues with a persistent outbreak of a particular antibiotic resistant organism. This facility lacked an Antibiotic Stewardship Program and upon review did come to the realization that in part, the lack of such a program lead to the prescription of unnecessary and / or inappropriate antibiotics.

It’s because of this that I found an article by Siaman et al (ICHE 2012;34:274-283) in the March edition of ICHE to be so interesting.  The research team investigated the knowledge and use of antimicrobial susceptibility testing for multi-drug resistant gram-negative bacilli (MDR-GNB).  As expected, the study uncovered knowledge gaps and educational needs that could lead to improved use of both susceptibility testing and antibiotic usage. I’ll let you read the full study to learn about the results around knowledge of antimicrobial agents, susceptibility testing, prescribing resources and confidence in interpreting susceptibility results.

I want to hone in on the findings regarding “Agreement with potential strategies to reduce MDR-GNB” as the findings (at least to me) are a bit scary.  While it’s good to know that 96% of the healthcare providers agreed that limiting the use of antibiotics could decrease resistance development only 74% of the ICU healthcare professionals surveyed agreed that implementing contact precautions for colonized or infected patients could decrease resistance.  Further, only 56% of ICU healthcare professionals knew and/or were aware of the definition used to implement contact isolation in their facility.  This definition has been in place since 2006 so is certainly not something new!

Talk about an eye opener!  We have been slamming environmental service staff for poor cleaning compliance and placing a significant portion of the blame for transmission of these organisms as a result of unclean (or improperly cleaned) surfaces. While I still believe, we need to clean better and clean with more frequency, perhaps the bigger issue has to do with a lack of knowledge surrounding when patients need to be put onto isolation precautions!   MDR-GNBs are pesky, colonized or infected patients shed these into the environment and these bugs have the ability to survive and stick around for long periods of times. A properly isolated patient will heighten the infection prevention and control measures and is certainly one of the keep links in the chain to breaking transmission!

Bugging Off!

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