INFECTION CONTROL


cultures are sent to the laboratory at 6.00 pm on a Friday evening, which means they are not loaded into the incubator until 9.00 am on Monday morning. However, there is also a need to


reduce contamination with blood cultures. Devices, such as the Kurin Lock, which have been implemented at Guy’s and St. Thomas’, have been found to result in a 66% reduction in blood culture contamination.


He pointed out that simple solutions such as these could help to reduce unwarranted prescribing of antibiotics, as well as improving the “culture around cultures” within healthcare organisations. He highlighted the need for an “integrated ecosystem of devices, empowerment and communication” – whereby technology is safely and rapidly incorporated into clinical practice, to inform decision-making at the frontline. He concluded by raising awareness


of a recently launched White Paper, by the Infection Management Coalition (IMC), which calls for a transformational change in the way infection is detected, monitored, prevented and managed across all facets of the NHS, healthcare systems and broader society, by adopting a whole system approach.


The IMC was convened in January 2021 to drive change in support of holistic management and pandemic preparedness in response to the devastating impact the COVID-19 pandemic has had on societies and economies globally. The White Paper, which was


developed by a coalition of partners, calls for the creation of a healthcare system that is resilient and mature regarding: outbreak and pandemic preparedness; infection prevention; rapid treatment of time-critical viral and bacterial infection; with which to, ultimately, deliver effective antimicrobial stewardship. Among its recommendations, the White Paper highlights how vital it is to support healthcare providers in prescribing antimicrobials effectively – from rapid point-of-care diagnostics to determine if antimicrobials are appropriate, through to public health and vaccination programmes to avoid reliance on antimicrobials.


Call for a cohesive policy As a next step, the IMC is calling for the development of cohesive policy to support action. This includes working collectively to publish holistic infection management plans that include AMR; resourcing all areas equally, ensuring valued consideration of the antimicrobial and diagnostics pipeline; and delivering systems integration of infection


26


A recently launched White Paper by the Infection Management Coalition calls for a transformational change in the way infection is detected, monitored, prevented and managed across all facets of the NHS


management to support both immediate and long-term change for the better. Commenting on the White Paper, Dr. Daniels, said: “The COVID-19 pandemic has shone a light on the devastating global health and societal implications an infection can have when there are no available preventative interventions or treatment options. It concerns me greatly that the next pandemic may very well be a drug-resistant infection that the UK and its international partners are currently ill-equipped to tackle, despite the huge advances made recently in this space. We must act now to avoid this.” The White Paper can be read in full online (https://theimc.org/whitepaper.pdf).


References 1 GBD 2019 Diseases and Injuries


Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396 (10258): 1204–22. doi: 10.1016/S0140-6736(20)30925-9. Erratum in: Lancet 2020; 396 (10262): 1562.


2 US study suggests COVID-19 pandemic may be accelerating antimicrobial resistance. Oral presentation at the European Congress of Clinical Microbiology and Infectious Diseases (www.eurekalert.org/news- releases/950576).


3 Academy of Medical Royal Colleges. Statement on the initial antimicrobial treatment of sepsis. London: AOMRC, May 2022 (www.aomrc.org.uk/wp-content/ uploads/2022/05/Statement_on_the_ initial_antimicrobial_treatment_of_ sepsis_0522.pdf).


4 O’Neill J. Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: Final Report and Recommendations 19 May 2016 (https:// amr-review.org).


5 Nutbeam T, Daniels R; on behalf of the UK Sepsis Trust. Screening and action tools (https://sepsistrust.org/professional- resources/clinical-tools/).


6 Evans L, Rhodes A, Alhazzani W et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47 (11): 1181–247. doi:


10.1007/s00134-021-06506-y.


7 Seventh Patient Report of the National Emergency Laparotomy Audit, December 2019–November 2020 (www.nela.org. uk/downloads/NELA%20Year%207%20 Report%20-%20Full%20Report.pdf).


8 De Waele JJ, Schouten J, Beovic B, Tabah A, Leone M. Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions-a viewpoint of experts. Intensive Care Med 2020; 46 (2): 236–44. doi: 10.1007/s00134-019-05871-z.


9 Liu P, Ohl C, Johnson J, Williamson J, Beardsley J, Luther V. Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infect Dis 2016; 16 (1): 751. doi: 10.1186/s12879- 016-2080-3.


10 National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing COVID-19 [NG191]. London: NICE, 2021 (www.nice.org.uk/guidance/ ng191).


11 Abu-Rub LI, Abdelrahman HA, Johar AA, Alhussain HA, Hadi HA, Eltai NO. Antibiotics prescribing in intensive care settings during the COVID-19 era: A systematic review. Antibiotics (Basel) 2021; 10 (8) 935. doi: 10.3390/ antibiotics10080935.


Dr Ron Daniels BEM is a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust. He is a Fellow of the Royal College of Physicians of Edinburgh, Royal College of Anaesthetists, and The Faculty of Intensive Care Medicine. Ron sits on the Executive Committee of the Global Sepsis Alliance, having been instrumental in bringing World Sepsis Day and the World Sepsis Declaration to fruition. In May 2017, following unanimous approval of the Executive Board of the World Health Organization, he was part of a Task Force successful in securing the adoption of a Resolution on sepsis by the 70th World Health Assembly. He is also chief executive of the United Kingdom Sepsis Trust (https://sepsistrust.org).


This article first appeared in The Clinical Services Journal (Targeting global threats of sepsis and AMR. CSJ 2022 Aug; 21 [7]: 35–9) and is reproduced here in edited form by kind permission.


SEPTEMBER 2022 WWW.PATHOLOGYINPRACTICE.COM


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64