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Select Month: November 2013

Sometimes the Safest Prescription is “Wait and See”

Categories: Antibiotic use, Antimicrobial Resistance

Adam L. Hersh, MD, PhD

Adam L. Hersh, MD, PhD

Guest Author – Adam L. Hersh, MD, PhD
Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Utah

Get Smart About Antibiotics Week is a great opportunity to call attention to a priority that we all share: preserving the effectiveness of antibiotics for the future. Doctors and other practitioners on the front-lines of ambulatory care may become frustrated when they hear the way they practice medicine is partly to blame for the urgent threat of antibiotic resistance.

For those of us working in ambulatory care settings, it is a really busy and demanding job, and for many patients with upper respiratory tract infections (URIs), it’s hard to know who has a bacterial infection and who doesn’t. This year, Get Smart About Antibiotics Week is featuring the publication of Principles of Judicious Antibiotic Prescribing for Pediatric Upper Respiratory Tract Infections in the journal Pediatrics. It discusses the importance of diagnostic certainty and reviews the clinical criteria practitioners should use when determining the likelihood of a bacterial infection.

There are established and stringent clinical criteria that should be applied to justify an antibiotic prescription for the key URIs in pediatrics that are potentially caused by bacteria. Many bacterial URIs will resolve on their own without antibiotic treatment. And the serious and justifiably feared complications of URIs (such as mastoiditis as a complication of otitis media) usually cannot be prevented by early antibiotic therapy anyway. All of this is important to consider as our understanding continues to grow about the harms antibiotics can cause.

Antibiotic overuse not only contributes to increased resistance but also avoidable adverse drug events including serious allergic reactions, cardiovascular problems and chronic conditions such as eczema, asthma, inflammatory bowel disease and obesity. Doctors want to do what is safe and in their patients’ best interests. When there is a considerable degree of uncertainty regarding the diagnosis for patients with URIs, sometimes the safest thing to do is to “wait and see.”

Good Infection Prevention Habits Don’t Just Happen

Categories: Hand Hygiene, Healthcare-associated infections

Elaine Larson, RN, PhD, CIC, FAAN

Elaine Larson, RN, PhD, CIC, FAAN

Guest Author – Elaine Larson, RN, PhD, CIC, FAAN
Associate Dean for Research and Anna C. Maxwell Professor of Nursing Research
Columbia University School of Nursing
Editor, American Journal of Infection Control

Over the past few decades, especially since the ‘antibiotic era’ and the advent of increasingly technologic and sophisticated interventions, there has been less and less attention paid to simple hygiene measures in the curriculum of healthcare professionals.  In fact, I recall in the 1980s reading that the age of infections was coming to an end because we had conquered germs.  Confident that the ‘battle against germs’ was won, hand hygiene, isolation practices, and personal protective equipment took a back seat to fancier therapies.  Educators of physicians and nurses seemed to assume either that everybody knows how to wash their hands (or perhaps that it wasn’t really that important?).  Hence, because many effective barrier practices are also rather simple, they have received little, if any, attention in healthcare curricula.

In the September issue of The American Journal of Infection Control, Gould and Drey reported on student nurses’ experiences with infection prevention and control during their clinical placement.  Almost 500 students from England, Wales, Scotland, and Northern Ireland responded to a survey placed on the website of The Royal College of Nursing.  More than three-fourths reported that they had seen clinicians failing to perform hand hygiene before patient contact, and more than half reported deficiencies in other infection prevention practices such as ‘sharps’ disposal, changing personal protective equipment between patients, or failure to apply isolation precautions.

Even though the study was biased by a low response rate and by the fact that nursing students who respond to such surveys may have characteristics and attitudes different than those who do not respond, the findings are very consistent with what others have reported from both nursing and medical students.  That is, when students observe infection prevention practices, they can and do identify frequent breeches in themselves and others. 

So what do these findings mean for educators and for clinicians working with ‘newbies’?  Clearly, the problem does not seem to be lack of knowledge, since students can identify deficiencies.  But we know that infection prevention practices and habits don’t just happen, even when people know what to do!  Having students be observant of practice increases their mindfulness and can help translate the ‘book learning’ into actual practice.  Such ‘mindfulness’ ultimately is what will be required of all staff members to build the kind of safety and patient-oriented culture for which we are striving.  So, we need to support students and staff to increase their mindfulness and take ownership of their own infection prevention practices.

 
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