Strengthening Defenses: Integrating Infection Control With Antimicrobial Stewardship

Overprescribing antibiotics leads to resistant bacteria.

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Infection control and antimicrobial stewardship (AMS) are critical components of modern health care, particularly in the context of increasing antimicrobial resistance (AMR). This article explores the interconnectedness of these 2 fields, emphasizing the necessity of a unified approach to enhance patient safety and improve health outcomes.

The Importance of Infection Control
Infection control encompasses practices to prevent and manage infections in health care settings. Effective infection control measures reduce the incidence of healthcare-associated infections (HAIs), which can lead to significant morbidity, mortality, and increased healthcare costs. According to the CDC, HAIs affect one in 31 hospital patients daily, underscoring the need for robust infection control protocols.¹
Key infection control strategies
1. Hand hygiene: Regular and proper handwashing is one of the most effective ways to prevent the spread of infections. The World Health Organization (WHO) recommends a five-moment approach to hand hygiene, emphasizing critical times when healthcare workers should wash their hands.²
2. Use of personal protective equipment (PPE): PPE such as gloves, masks, gowns, and face shields are essential in protecting health care workers and patients from infection transmission, especially in high-risk settings.
3. Environmental cleaning and disinfection: Regular cleaning and disinfection of surfaces and medical equipment can significantly reduce the risk of pathogen transmission.
4. Surveillance: Monitoring infection rates and identifying outbreaks are crucial for timely interventions and resource allocation.
Understanding AMS
AMS refers to a coordinated effort to improve the use of antimicrobials, ensuring their effectiveness for future generations. AMR poses a severe threat to global health, with the World Health Organization warning that it could lead to 10 million deaths annually by 2050 if left unaddressed.⁴

Key components of AMS
1. Appropriate prescribing: Ensuring that antimicrobials are prescribed only when necessary and appropriate, tailored to the specific infection and patient’s needs.
2. Education and training: Health care professionals should be educated on the principles of AMS, including the risks of overprescribing and the importance of adhering to guidelines.
3. Monitoring and feedback: Regular review of prescribing practices and providing feedback to health care providers can promote responsible antimicrobial use.
4. Interdisciplinary collaboration: Engaging a team of health care professionals, including pharmacists, microbiologists, and infection control practitioners, fosters a comprehensive approach to AMS.

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The synergy between infection control and antimicrobial stewardship is evident in their shared goals of reducing infections and improving patient outcomes. By implementing infection control measures, healthcare facilities can lower the incidence of infections, subsequently reducing the need for antimicrobials. Conversely, effective antimicrobial stewardship can prevent the emergence and spread of resistant organisms, thereby supporting infection control efforts.

Case Studies Demonstrating the Link
1. Reducing catheter-associated urinary tract infections (CAUTIs): A study showed that implementing a comprehensive infection control program, including proper catheter insertion techniques and timely removal, significantly decreased CAUTI rates. This reduction in infection rates led to less reliance on antibiotics, demonstrating the impact of infection control on AMS.⁵
2. Surgical site infections (SSIs): Research indicates that enhanced infection control practices, such as preoperative screening and antibiotic prophylaxis, reduce the incidence of SSIs. This, in turn, diminishes the need for postoperative antimicrobial treatment, reinforcing the importance of both infection control and AMS.³

Implementing a Unified Approach
Health care facilities must adopt a unified approach integrating infection control and antimicrobial stewardship to optimize outcomes. Here are several strategies to achieve this:
1. Leadership engagement: Hospital leadership should prioritize infection control and AMS as organizational goals, allocating resources and fostering a culture of safety.
2. Training and education: Regular training for healthcare staff on both infection control practices and antimicrobial stewardship principles is essential. This education should be tailored to specific roles and responsibilities within the organization.
3. Data sharing and collaboration: Establishing a system for sharing data on both infection rates and antimicrobial use can facilitate collaboration between infection control and AMS teams.
4. Policy development: Developing and enforcing policies that promote best infection control and antimicrobial stewardship practices can create a cohesive framework for action.
5. Continuous quality improvement: Implementing continuous quality improvement initiatives that focus on both infection control and AMS can help identify areas for improvement and monitor the effectiveness of interventions.

Challenges and Barriers
While the integration of infection control and AMS offers many benefits, several challenges must be addressed:
1. Resource limitations: Many health care facilities, especially in resource-limited settings, may lack the necessary personnel and funding to implement comprehensive infection control and AMS programs.
2. Cultural resistance: Changing established practices and fostering collaboration between different departments can encounter resistance from staff accustomed to traditional workflows.
3. Data silos: In some organizations, infection control and AMS data may be managed separately, hindering effective collaboration and decision-making.

Conclusion
The unified approach to infection control and AMS is essential for promoting safer health care environments and combatting the growing threat of antimicrobial resistance. By integrating these 2 fields, health care facilities can improve patient outcomes, enhance the effectiveness of antimicrobials, and ultimately safeguard public health. Collaboration, education, and a commitment to best practices are vital for realizing the full potential of this integrated strategy.

References
1. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791.
2. Healthcare-associated infections (HAIs). CDC. 2021. Accessed October 8, 2024. https://www.cdc.gov.
3. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. WHO. 2019. Accessed [Date]. https://www.who.int.
4. WHO Guidelines on Hand Hygiene in Health Care. WHO. 2021. Accessed October 8, 2024. https://www.who.int.
5. Zimlichman E, Henderson D, Tamir O, et al. Healthcare-associated infections: A meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med. 2013;173(22):2039-2046.