Safe Healthcare

The Society for Healthcare Epidemiology of America (SHEA)

Author - Sara Cosgrove, MD, MS,
Johns Hopkins University School of Medicine

Medical and scientific advances change the way we look at the world. Before penicillin was introduced in 1942, any infection could be a death sentence. Since then, we have been in awe of and dependent on the use of antibiotics as one of the most valuable tools in our medical toolbox. But society as a whole has taken these drugs for granted with use that has allowed the issue of drug resistant infections to creep up on us and grow to be a serious public health threat. Correcting this misuse of antibiotics in our healthcare facilities is necessary to help preserve these drugs; the cost of inaction is too great to be ignored.

One strategy to preserve the use of the antibiotics currently available and reign in resistance is antimicrobial stewardship. These programs and interventions help prescribers know the right drug, at the right time, in the right dose, for the right duration. These programs help to improve the use of antibiotics.

Antimicrobial resistance is becoming an increasing issue in healthcare facilities and communities throughout the country, as evidenced by outbreaks of MRSA and carbapenem-resistant Enterobacteriaceae (CRE). These resistant bugs are associated with increased patient morbidity, mortality and higher healthcare costs spent on useless use of antibiotics and longer, more intense hospital stays.

Carlos Don, victim of an antibiotic-resistant infection, methicillin-resistant Staphylococcus aureus, which took his life days before his 13th birthday

Author – David A. Relman, MD, FIDSA
IDSA President

Carlos Don was a healthy, active, and spirited sixth grader who loved playing football and never let anything slow him down. In 2007, an antibiotic-resistant infection, methicillin-resistant Staphylococcus aureus, took his life just days before his 13th birthday.

Sadly, this is just one of many tragedies caused by the alarming rise in drug-resistant infections and the lack of new antibiotics in the development pipeline. Using antibiotics appropriately—at home, in the doctor’s office, at the pharmacy, in the hospital, and on the farm—is a crucial part of addressing this public health crisis. Antibiotics can save lives when used wisely, but misusing them can do more harm than good, from serious allergic reactions to hastening the development of resistance.

This week, as we mark “Get Smart About Antibiotics Week,” the Infectious Diseases Society of America (IDSA) is joining with the Centers for Disease Control and Prevention and other national health organizations to commit to principles, including antibiotic stewardship, to both conserve and replenish our antibiotic resources. It’s part of IDSA’s ongoing effort to find solutions to this crisis, which requires a multipronged approach.

Another key element of this effort is to provide incentives that encourage research and development of new antibiotics, such as new approval pathways to streamline the development of antibiotics needed to treat the most serious bacterial infections. In addition, doctors and their patients sorely need more advanced rapid diagnostic tools to unmask infections more quickly and accurately. Finally, stronger public health measures, including surveillance, data collection, and immunization, and related research are also in order.

It will take all of us working together to ensure a future where the lives of patients like Carlos are not cut short by antibiotic-resistant infections and we have the antibiotics and diagnostics we need to prevent such tragedies. Getting smarter about antibiotic use is a critical step on this path.

Visit www.AntibioticsNow.org to learn more about Carlos, others who have been affected by antibiotic-resistant infections, and IDSA’s efforts.

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Authors:  Diane Jacobsen MPH, CPHQ, Director, Institute for Healthcare Improvement
Don Goldmann MD, Vice President, Institute for Healthcare Improvement

Did you ever wonder why a practical change idea can be more than a simple challenge?   For example, how do you get the right antibiotic to the right patient for the right amount of time?

In 2009, The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) invited experts to create a set of key changes for appropriate and timely antibiotic use for patients cared for in the hospital.  We created a Driver Diagram as a way of organizing our theories of what it would take to bring about change.  We also organized the change ideas in an easy to use guide called a change package and developed a measurement framework. Drivers and changes were chosen to reflect the causal pathway towards appropriate antibiotic utilization and reduction of adverse drug events, antibiotic-associated colitis, cost of care, and antibiotic resistance. We wanted to make it practical and easy for hospitals to test and deploy at the front line.