Antimicrobial resistance (AMR) is an increasing threat facing healthcare systems and society more broadly. According to the ‘Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis’ the global burden associated with drug-resistant infections estimated at 4·95 million deaths, of which 1·27 million deaths were directly attributable to drug resistance. Resistance to fluoroquinolones and β-lactam antibiotics (carbapenems, cephalosporins, and penicillins, etc) accounted for more than 70% of deaths attributable to AMR.
Whilst it’s well recognised the AMR problem is complex, requiring co-ordinated global action, healthcare entities, especially acute care facilities, have an important role to play. Antimicrobial stewardship (AMS) goes hand in hand with infection prevention and control (IPAC); it’s everyone’s responsibility. Just like IPAC, leaders of AMS programs suffer from staff at all levels not having access to actionable data which can inhibit broader ‘buy in’ from the healthcare workforce. A lack of buy in can make life difficult complying with regulatory standards and compliance requirements. Secondary to this, akin to hospitals’ recent experience with COVID, co-ordinated activity is needed across the acute and community healthcare spectrum because the burden largely occurs in the community. Of course, this does not mean that the acute care system cannot lead the way in confronting with this issue.
The obvious benefit of an advanced AMS program in the acute care setting, designed to go beyond compliance with local regulatory standards, is a reduction in per patient expenditure. This reduction comes from a variety of sources
- Minimising length of stay
- Reducing the intensity of care
- Limiting/eliminating inappropriate prescribing
- Identifying opportunities for switching to lower cost therapies and/or generics
Of course, the above can be linked to quality indicators, healthcare acquired complications/risk reduction efforts, and, over the longer term, may improve the hospital’s reputational standing; not to mention what impact such positive news can have on staff morale.
Intangible benefits of deploying a purpose-built clinical surveillance solution could be that clinical pharmacists have more time to spend with patients educating them about their prescribed pharmaceuticals, ensuring they have the drugs and the instructions needed to be discharged safely. This can place the facility as a leader in the space and become a positive impact on staff morale.
On a macro scale, the existence of a collated, facility specific datasets obtained through surveillance can provide a ‘helicopter view’ to drive a hospital’s fight against antimicrobial resistance. The data is pivotal in forming localised, evidence based prescribing policy, which is the bedrock of a successful and highly visible AMS program that can be owned and refined, over time, by the hospital community. We shouldn’t underestimate the value of these sorts of feedback loops when trying to change the prescribing culture within a hospital community. Advanced AMS programs can be even more powerful when dovetailed with the efforts of the IPAC team, as, reducing the frequency of infection (in this case healthcare acquired infections) removes the opportunity for resistance to occur. With correct prescribing policy in place, the judicious use of antimicrobials reduces the local evolutionary pressure on resistance to emerge, and, in turn, reduces the potential for multi-resistant organisms (MROs) to establish themselves in the local environment.
Continuing this cycle; socialising the results of AMS and IPAC programs down to the unit mangers and floor staff can be motivational in and of itself, amplifying desire for whole of hospital goals like hand hygiene rates, etc.
So, how do you get there?
Specialist clinical surveillance software, complimentary to Electronic Hospital/Medical Records, can be the backbone of AMS, IPAC and infectious diseases teams work providing the hospital’s single source of truth on infection and resistance data. It can also align them to local regulation/standards providing the platform to do amazing things, beyond those requirements. Any such system must be able to collate a facility specific dataset to drive local evidence-based policies and make it easy for data to be distributed to all stakeholders from executive down, so that success is shared and owned by the entire hospital workforce, from CEO to the cleaning staff.