An antimicrobial stewardship programme drives appropriate use of antibiotics

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According to the World Health Organisation (WHO), antibiotic resistance is exacerbated by poor infection prevention and control practices, which compromises the ability to treat infections.

The WHO World Antibiotic Awareness Week (14-20 November) aims to increase awareness of antibiotic resistance and to encourage best practices amongst the general public, all health workers and policy makers to avoid the further emergence and spread of antibiotic resistance, with the theme: Handle Antibiotics With Care. Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.

Fighting microbial resistance in a hospital setting

“There are multiple drivers of antimicrobial resistance which have a major impact in a hospital setting. A doctor led, multidisciplinary approach in each hospital is key to the success of an AMS (antimicrobial stewardship) programme to ensure that dynamic and wide-spread practices are in place to minimise pathogen resistance while providing quality patient care,” says Shirley Leadbeater, national pharmacy practice manager for the Life Healthcare Group.

The group has placed a strong focus on tackling this threat in their hospitals. In 2011 Life Healthcare implemented an antimicrobial stewardship (AMS) programme to ensure its hospitals act responsibly with regard to the use of antibiotic medicines. The approach is aligned to the national department of health’s AMR National Strategy Framework 2014 – 2024 in response to the World Health Assembly’s endorsement of a global action plan to tackle antimicrobial resistance (AMR).

A multifunctional approach

Although antimicrobial resistance is a global issue, it must be tackled at a local level. It takes focused effort at an individual hospital to alter antimicrobial utilisation and impact on pathogen resistance. Multifunctional review of antimicrobial utilisation as well as robust infection prevention practices effectively manage the issue.

“Pharmacists are the primary custodians of medicines and as part of the multidisciplinary healthcare team, focus on evaluating patient medication treatment to assist in achieving the best possible clinical outcomes and championing stewardship. The value of their in-depth knowledge of pharmacology and pharmacotherapy has globally proven to be valuable in the hospital environment,” she says.

The core elements to a successful AMS programme are:

• Leadership commitment;

• Comprehensive infection prevention and control;

• An effective multifunctional stewardship approach. AMS committees at hospital level with AMS doctor champions; and

• Effective communication, and timely and regular reporting.

Hygiene measures are an all-important, yet often undervalued aspect to infection prevention as well. The easiest and most important method to prevent the transfer of bacteria that everyone can apply in healthcare settings is appropriate hand hygiene. This should be practised conscientiously by all healthcare workers, patients and hospital visitors alike. “Infection prevention is taken extremely seriously and is a high priority for all hospitals, as one failure can transfer bacteria and increase the spread of hard to manage infections,” she explains.

Finally, patient education and provision of information and counselling are important in keeping antibiotic resistance in check. “All parties - the patient, the doctor and the entire multifunctional team should be aware of how their behaviour impacts this growing threat and how we can work together to prevent antibiotic resistance from spiralling out of control,” she concludes.