This week we hosted a webinar on antimicrobial stewardship and infection control.

Here we will cover some background information on antimicrobial stewardship as well as key discussion points from the event.

 

What are antimicrobials? 

Antimicrobial medicines are used to fight microbial infections.

They do this by killing or slowing the growth of microorganisms. 

Antimicrobial medicines include antifungals, antivirals, antiparasitic agents and the commonly known antibiotics.

Antibiotics have saved millions of lives since they were discovered in 1928.

However, no new antibiotic discoveries have been made since the 1980’s.

A lack of new drug discoveries combined with antimicrobial overuse has led to the risk of antimicrobial resistance.

 

Antimicrobial resistance

Antimicrobials are effective as long as they work against the organism causing the infection.

Antimicrobial resistance occurs when a drug is over prescribed or prescribed inappropriately (without clinical indication or a confirmed diagnosis).

Over time, the infection becomes resistant to the medication making it less effective. 

Resistance also impacts the efficacy of preventing infections associated with cancer treatments and organ transplants. 

Antimicrobial resistance already causes 700,000 deaths a year around the globe. 

This figure is predicted to rise to 10 million by 2050 if action is not taken.

 

Antimicrobial stewardship

The World Health Organisation refers to antimicrobial resistance as a public health threat.

Taking preventative action is critical to ensuring that antimicrobials can continue to be used well into the future.

Antimicrobial stewardship is essentially improving clinical outcomes where antimicrobials are required and reducing adverse events.

This will involve: 

  • Infection prevention
    • An infection prevented is a course of antibiotics avoided 
  • Effective treatment of infections
    • Ensuring people take their full dose of antibiotics when prescribed 
  • Reducing inappropriate use and overuse of antimicrobials
    • Prescribing antibiotics only when necessary 
    • Prescribing alternative treatments wherever possible

 

Antimicrobial stewardship in aged care

Aged care providers ought to have a policy in place regarding antimicrobial stewardship.

This policy should promote the following: 

Clear documentation

When an antimicrobial is prescribed documentation should clearly outline:

  • Medication
  • Dose
  • Frequency
  • Route
  • Indication or rationale and site
  • Duration (start and end date)
  • Planned number of treatment days

Clinical review

A clinical review of antimicrobial therapies should be conducted at 48 and 72 hours. 

Long term antimicrobial medications should be reviewed at least monthly.

Evidence based guidelines 

Ensure these are used to develop clinical pathways for the management of conditions and symptoms such as UTIs and IAD with suspected infection. 

 

The role of prescribing errors in antimicrobial resistance

Prescribing the incorrect antibiotic, the incorrect dose or the incorrect duration of treatment are among the most common prescribing errors.

Errors in prescribing not only lead to antimicrobial resistance but are also associated with harmful side effects and potential allergic reactions. 

Within aged care there is an increased risk of infection outbreak and residents are often frail.

Due to these factors antibiotic use can sometimes outweigh the risk of side effects and antibiotic resistance.

 


Next week: infection control policy and procedure for aged care providers.