Antimicrobial resistance
dose. With advancements in technology, infusion pumps were implemented, which provided additional safety features. As the technology evolved, so did practice – resulting in many of us no longer administering a post medication flush to rinse the line,” she commented. “Underdosing has been created
unintentionally. It is an issue that is overlooked by many, with an immeasurable impact on our patients, antibiotic stewardship and the environment. While we are unable to turn back time, and amend what has been missed in the past, we now have an opportunity to make things right,” she continued. Certain specialties have retained line flushing with the use of ‘piggyback’ systems. This is especially common in oncology, where the delivery of full doses of chemotherapy is crucial. However, it is arguably essential for all patients, Ruth asserted. “Ensuring patients receive the full amount of the drug therapy that they are prescribed is a fundamental part of healthcare and it is widely understood to be a key priority for all staff charged with administering intravenous drugs. Ethically, it is wrong to deny patients the full dose of their treatment and, as clinicians, we are accountable for our actions,” she commented. “AMR is now one of the biggest threats to global health, food security and development, today. Antibiotic resistance occurs naturally, but misuse of antibiotics is accelerating the process. “Underdelivering antibiotics reduces the
likelihood of delivering the expected therapeutic dose/effect. In addition, administering antibiotics at subtherapeutic levels, may be a
significant contributor to the development of resistant strains,” she continued. “With no new classes of antibiotics discovered since the 1980s, the AMR challenge appears to be a daunting one. We have a responsibility to address the overuse and misuse of antibiotics in human medicine – reducing the suboptimal dosing that takes place. The environmental spread of AMR through pollution is also essential in combating the problem.” She acknowledged that there is a need for
further research to compare patient outcomes and the level of under-dosing, and suggested measuring the extent of under-dosing by collecting used administration sets and establishing the volume of drug remaining at
the point of being discarded. She pointed out that AMR is particularly
devastating for oncology - infections are the second leading cause of death among cancer patients. Cancer therapies weaken the immune system making patients more susceptible to infections and infections are becoming increasingly drug-resistant. Ruth warned that the accumulative effect of under-delivering IV antibiotics could: l Delay the switch to oral antibiotics l Increase the patient’s length of stay l Increase spend on medication l Increase consumable waste l Require a switch to a different antibiotic to fight the infection
She went on to highlight the fact that drug resistant infections cost the NHS £1 billion annually. In June 2023, all UK hospitals received a Freedom of Information request from the House of Lords to understand how NHS organisations use and dispose of antimicrobials when given as an intravenous, intermittent infusion. She highlighted the subsequent findings, which were published in November 2023, in a report on antibiotic underdelivery.3
These included:
l 70% of organisations do not have a line flushing policy.
l Of the 30% that do, only 12% are compliant with their policy.
l 24% detach the drip chamber from the line containing residual volume of antibiotic which is disposed of into waste streams – including watercourse, sharps bins or bags.
The report called for concerted UK-wide action on antibiotic line flushing, with
November 2024 I
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