Antimicrobial resistance
Antimicrobial resistance: a silent pandemic?
The future of antimicrobial resistance (AMR) depends on what we do today. Better diagnostics, infection prevention, and surveillance are vital factors in the fight against AMR, argues Greg Quinn.
Antimicrobial resistance (AMR) is a complicated and multi-sectorial problem which requires urgent action to address. Recently, there has been an outbreak of Group A streptococcus in the UK, showcasing the importance of education and stewardship in the face of AMR and sepsis to protect the lives of children. We’ve come a long way within Infection Prevention and Control (IPC) over the last 20 years, but we still have a long way to go to help protect continued delivery of care for generations to come. Looking ahead to the ‘silent’ pandemic of AMR, it’s important for all stakeholders, including healthcare leaders, industry, and governments to work together and act now to mitigate another global health crisis. Of equal importance is engagement with younger generations on which effective actions can help tackle AMR. As with climate change, public support and behaviour change is vital. The World Health Organization (WHO) cites AMR as one of the top 10 threats to global health.1
Already at least
700,000 people die annually from drug-resistant diseases - this is not silent and is not a problem of the future.2 It is estimated that 63.5% of cases of infections with antibiotic-resistant bacteria are healthcare associated.3
up to 50% of all antibiotics prescribed in European hospitals are deemed inappropriate or unnecessary.4
Resistant infections were
found to increase excess length of stay (LOS) by 4.9-9.3 days.5
Antimicrobial resistant infections
in hospitals can be exacerbated by insufficient or ineffective processes, tools, communication, and coordination. When infection prevention measures fail, then in an ideal world, life-threatening pathogens would be detected, identified, and accurately
tested for antibiotic susceptibility to enable the best treatment management decision. Yet, according to WHO, drug-resistance is spreading, leading to more difficult to treat infections and death as antibiotics become increasingly ineffective.1
With clear increasing challenges
due to AMR, it is more important than ever for healthcare providers in and outside the acute setting to accurately and rapidly diagnose and treat patients with blood stream and/or surgical site infections or patients with sepsis. By 2050 drug-resistant microbes will lead to
ten million deaths every year if the problem is not solved and no action is taken.2
Perhaps not surprisingly,
Where are we now? There has been an evolution from infection control towards infection prevention and control. Better monitoring, reporting, and attention has been placed on infection, all which have helped bring prevention to the fore. Societies such as the Infection Control Nurses Association have changed their name to the Infection Prevention Society, while job titles have changed to include prevention and control in nurse/doctor titles, showing a shift in language and approach. Mandated Directors of Infection Prevention and Control (DIPC) posts were created in all NHS Trusts and a Director of IPC network was created to offer guidance and
education. Yet, while there has been incredible progress, we still have a long way to go… Targeted efforts and programmes have
worked previously when the Government, NHS, industry, and front-line staff and patients are aligned. National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in NHS hospitals in England were originally commissioned by the Department of Health and developed during 1998–2000 by a nurse- led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001 (epic) and updated in 2007 (epic2), and more recently in 2013 (epic3).6
These guidelines
stress that clinically effective infection prevention and control practice is an essential feature of patient protection. These, alongside NICE guidelines, the NHS’s
Saving Lives programme of High Impact interventions,7,8
or bundles of care have helped
to drive changes in behaviour and practice. Novel products were assessed and, where appropriate, their adoption encouraged by the Government’s Health Protection Agency Rapid Review Panel.26
By incorporating guidelines into
routine daily clinical practice, patient safety can be enhanced and the risk of patients developing a preventable healthcare-associated infection in NHS hospitals in England can be minimised.6
April 2023 I
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