Infection prevention and control programs are essential to antibiotic stewardship efforts
Arlington, Va., March 26, 2018 — Infection prevention and control (IPC) and antibiotic stewardship (AS) programs are inextricably linked, according to a joint position paper published today by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP) in APIC and SHEA's peer-review journals, the American Journal of Infection Control and Infection Control and Hospital Epidemiology.
This paper is an important update to a 2012 paper that affirmed the key roles of infection preventionists (IPs) and healthcare epidemiologists (HEs) in promoting effective use of antimicrobials in collaboration with other healthcare professionals. The new paper highlights the synergy of IPC and AS programs, including the importance of a well-functioning IPC program as a central component to a successful AS strategy.
"The issues surrounding the prevention and control of infections are intrinsically linked with the issues associated with the use of antimicrobial agents and the proliferation and spread of multidrug-resistant organisms," said Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC, lead author of the new paper. "The vital work of IPC and AS programs cannot be performed independently. They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infection and ensuring that effective antibiotic therapy is available for future generations."
Antimicrobial stewardship programs encourage the appropriate use of antimicrobials (including antibiotics) to minimize overuse, improve patient outcomes, reduce microbial resistance, decrease the spread of infections and preserve the efficacy of antibiotics. Multidrug-resistant organisms cause a significant proportion of serious healthcare-associated infections (HAIs) and are more difficult to treat because there are fewer and, in some cases, no antibiotics that will cure the infection. The Centers for Disease Control and Prevention (CDC) states that each year in the United States at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a result.
According to the paper, when AS programs are implemented alongside IPC programs, they are more effective than AS measures alone, verifying that a well-functioning IPC program is fundamental to the success of an AS strategy.
"It is important that all clinicians depend on evidence-based IPC interventions to reduce demand for antimicrobial agents by preventing infections from occurring in the first place, and making every effort to prevent transmission when they do," said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC . "IPC and AS programs are intrinsically linked, making effective collaboration essential to ensure patient safety."
The three societies present their position against a backdrop of increased awareness of antimicrobial resistance among healthcare providers, policy makers, and the public, and national action plans and forums designed to address the issue, which emphasize the important role of IPC programs in advancing successful AS interventions across the continuum of patient care.
"IP and HE leaders are IPC subject matter experts who are also trained with social and behavioral skills that allow them to effectively engage with different professional disciplines within healthcare to promote, implement, evaluate, support and sustain IPC strategies across practice settings. These are similar skills as those exhibited by leaders of successful AS programs," said Keith Kaye, MD, MPH, FSHEA, president of SHEA.
APIC, SHEA, and SIDP support the CDC Core Elements of AS framework and identify the synergy of IPC and AS within each element of the CDC recommendations. In addition, the three societies believe that microbiology laboratory staff members and clinical microbiologists play an essential role in successful IPC and AS programs.
"IPs and HEs engage a diverse range of clinical disciplines across practice settings in HAI prevention. The work of physician and pharmacist AS program leaders is greatly enhanced by the support of other key groups, including IPC programs," said Elizabeth Dodds Ashley, PharmD, MHS, BCPS, Duke University Department of Medicine and president of SIDP.
The authors acknowledge that successful AS programs require a significant investment on the part of the healthcare facility. "Changing practices and prescribing patterns and learned behaviors of physicians, nurses, pharmacists, and other healthcare providers will take time and investment, but it is critical to affect a long-term solution to the rise of AMR and CDI infections," they state in the paper.
The authors urge healthcare leaders to prioritize IPC and AS as part of wider patient safety initiatives and recommend that IPC and AS leaders collaborate in communications to the C-suite. "Given the synergy between AS and IPC programs, IPC and AS program leaders should seize every opportunity to benefit from each other's expertise and organizational influence and partner when making the case for program support and necessary resource allocation to clinical and administrative leadership."
NOTES FOR EDITORS
"APIC/SHEA/SIDP Antimicrobial Stewardship Position Paper: Antimicrobial stewardship and infection prevention – leveraging the synergy: A position paper update," by Mary Lou Manning, Edward J. Septimus, Elizabeth S. Dodds Ashley, Sara E. Cosgrove, Mohamad C. Fakih, Steve J. Schweon, Frank E. Myers, and Julia A. Moody, appears in the American Journal of Infection Control, Volume 46, Issue 4 (April 2018), and Infection Control and Hospital Epidemiology, Volume 39, Issue 4 (April 2018).
Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC (Corresponding Author)
College of Nursing, Thomas Jefferson University, Philadelphia, PA
Edward J. Septimus, MD, FIDSA, FACP, FSHEA
Clinical Services Group, Hospital Corporation of America, Inc., Houston, TX
Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS
Department of Medicine, Duke University, Durham, NC
Sara E. Cosgrove, MD, MS, FSHEA
Department of Antimicrobial Stewardship, Johns Hopkins University, Baltimore, MD
Mohamad C. Fakih, MD, MPH, FIDSA, FSHEA
Center of Excellence for Antimicrobial Stewardship and Infection Prevention, Ascension Health, St. Louis, MO
Steven J. Schweon, MPH, MSN, RN, CIC, HEM, FSHEA, FAPIC
Steven J. Schweon, LLC, Saylorsburg, PA
Frank E. Myers, MA, CIC, FAPIC
Infection Prevention and Clinical Epidemiology, University of California, San Diego Healthcare Systems, San Diego, CA
Julia A. Moody, SM-ASCP
Clinical Services Group, Hospital Corporation of America, Inc., Nashville, TN
ABOUT AJIC: AMERICAN JOURNAL OF INFECTION CONTROL
The American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 19th out of 83 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
APIC's mission is to create a safer world through prevention of infection. The association's more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at http://www.apic.org. Follow APIC on Twitter: http://www.twitter.com/apic and Facebook: http://www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC's Infection Prevention and You website at http://www.apic.org/infectionpreventionandyou.
The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society's work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.
The Society of Infectious Diseases Pharmacists (SIDP) is an association of more than 1,200 pharmacists and allied healthcare professionals engaged in patient care, research, teaching, the pharmaceutical industry, and government. SIDPs mission is to advance infectious diseases pharmacy and lead antimicrobial stewardship in order to optimize the care of patients. The society is committed to guiding optimal use of antimicrobial agents and supporting practice, teaching and research in infectious diseases therapy. SIDP also collaborates with like-minded healthcare organizations to further our educational and advocacy goals and promote our vision of safe and effective antimicrobials for now and the future. Visit SIDP online at http://www.sidp.org.