Lack of knowledge hinders ICimplementation
Bolster administrative support, HCW compliance
While much attention has been focused on reducing antibiotic use to stave off a rise in resistant pathogens, it is becoming increasingly clear that infection control measures are an equally important measure, said Ava D. "Deanie" Lancaster, RN, BSN, CIC, director of infection control at St. Thomas Hospital in Nashville.
Lancaster spoke at a recent CDC public health training network satellite broadcast for physicians, nurses, infection control professionals, and others interested in curbing the rise of resistant pathogens.
But one of the initial obstacles ICPs often face in trying to implement infection control measures is a lack of knowledge among other health care personnel and patients about the importance of controlling pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, she noted.
"Lack of knowledge can only be fought with education on all levels," she said. "This includes administrators, physician leaders, health care workers, and certainly health care consumers. Each of these groups can contribute to the problems and solutions of widespread antimicrobial resistance. Education [of] health care administrators is very important because they directly impact the quality of care. Improper treatment of the resistance problem can lead to prolonged hospital stays or at-home health care, and this will directly influence the financial well-being of your institution or the entire health care system."
In that regard, it is important to have a hospital administrator on the infection control committee or other groups that are responsible for infection control practices in the facility or health care system.
"This administrator should be a leader who is truly interested in infection control issues and who can effectively educate their peers," Lancaster said.
Antimicrobial use and resistance patterns should be a standing agenda item for discussion at all infection control and pharmacy and therapeutics committee meetings, she said, adding that it is important to record discussions and distribute them to all appropriate administrative and physician groups.
"It is also very important to include any financial data associated with antimicrobial resistance in any educational session because we know that the bottom line can impact many decisions in a health care setting," Lancaster said.
Such data related to antibiotic-resistant infections may include the direct cost of extra hospital days (cumulatively and per patient); the cost of follow-up care and additional physician visits; and the cost of additional antimicrobials used to treat infected patients.
"If you can prove to your administration that you will save money by controlling antimicrobial use, they will listen," she said.
With care delivery taking place across an ever-expanding continuum, it is important to share knowledge about antibiotic resistance and infected or colonized patients among all facilities.
"If you receive patients with antimicrobial-resistant organisms from an outlying facility, be sure and make them aware of the patient's condition," Lancaster said. "Also, when you transfer patients with these organisms to another facility, include some written information about the organisms. This can be particularly helpful to smaller facilities, where such educational materials aren't readily available."
Lancaster recommended forming a multidisciplinary task force to evaluate current infection control practices and address the gamut of issues involved with antibiotic resistance. The group should not only include some members of the infection control committee and the pharmacy and therapeutics committee, but bedside caregivers, managers, and other interested physicians, she said. Use such meetings to clarify current isolation practices and ask for any ideas on improving health care worker compliance with recommended practices, she noted.
"Remember, the responsibility for enforcing infection control practices doesn't rest solely with infection control or epidemiology departments," she said. "Hospital management at different levels should decide how employees will be monitored. A decision on the responsibility of preventing and controlling infection could also be considered as a core competency and probably should be included in performance appraisals. Peer review groups can also be a valuable tool for dealing with infection control compliance issues."
While educating staff is critical, ICPs are increasingly emphasizing patient and public education efforts to address the broad scope of the resistance problem.
"Health care consumers are not adequately informed about the problem surrounding antimicrobial-resistant organisms," she said. "Many need to understand why it's important to take their medications exactly as prescribed, and they also need to know that antimicrobials don't prevent or cure viral infections."
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