Off the top, I have to make the disclaimer, I am not a
pharmacist and while I took several pharmacology courses as part of my Bachelor
of Science, the only thing that I can state with certainty is that you should
not take Acetaminophen to cure a hangover headache. If you didn’t know, mixing Acetaminophen and alcohol can cause acute liver failure.
Our most recent blogs have been focusing on the
importance and need for environmental cleaning.
As we know, infection prevention and control is not as simple as
implementing one strategy. It takes the
implementation of a number of strategies (e.g. a bundle) and together these
strategies can work together to provide the desired outcome. In many Outbreak management strategies,
environmental cleaning and either increasing the frequency of cleaning or
improving the efficacy of cleaning is a cornerstone. Cleaner surfaces mean less chance for hand
contamination and of course, reducing hand contamination can help reduce
transmission of infection.
However, hand hygiene and cleaning compliance is not
always the end all and be all. In fact,
I do know of a facility that implemented more stringent cleaning and hand
hygiene policies but still have issues with a persistent outbreak of a
particular antibiotic resistant organism. This facility lacked an Antibiotic Stewardship Program and upon review
did come to the realization that in part, the lack of such a program lead to
the prescription of unnecessary and / or inappropriate antibiotics.
It’s because of this that I found an article by Siaman et
al (ICHE 2012;34:274-283) in the March edition of ICHE to be so
interesting. The research team
investigated the knowledge and use of antimicrobial susceptibility testing for
multi-drug resistant gram-negative bacilli (MDR-GNB). As expected, the study uncovered knowledge
gaps and educational needs that could lead to improved use of both
susceptibility testing and antibiotic usage. I’ll let you read the full study to learn about the results around
knowledge of antimicrobial agents, susceptibility testing, prescribing
resources and confidence in interpreting susceptibility results.
I want to hone in on the findings regarding “Agreement
with potential strategies to reduce MDR-GNB” as the findings (at least to me)
are a bit scary. While it’s good to know
that 96% of the healthcare providers agreed that limiting the use of
antibiotics could decrease resistance development only 74% of the ICU
healthcare professionals surveyed agreed that implementing contact precautions
for colonized or infected patients could decrease resistance. Further, only 56% of ICU healthcare
professionals knew and/or were aware of the definition used to implement
contact isolation in their facility.
This definition has been in place since 2006 so is certainly not
something new!
Talk about an eye opener!
We have been slamming environmental service staff for poor cleaning
compliance and placing a significant portion of the blame for transmission of
these organisms as a result of unclean (or improperly cleaned) surfaces. While I still believe, we need to clean
better and clean with more frequency, perhaps the bigger issue has to do with a
lack of knowledge surrounding when patients need to be put onto isolation
precautions! MDR-GNBs are pesky, colonized
or infected patients shed these into the environment and these bugs have the
ability to survive and stick around for long periods of times. A properly isolated patient will heighten
the infection prevention and control measures and is certainly one of the keep
links in the chain to breaking transmission!
Bugging Off!
Nicole
