Patti Kieffer, BSN, RN, CIC, FAPIC, infection prevention consultant at BJC HealthCare in St. Louis, had a much different talk in mind when she originally thought of addressing her IP colleagues on the antibiotic stewardship.
She didn’t say exactly what it was, but it is no secret some IPs have questioned how a profession that cannot prescribe antibiotics drew such a critical role in combatting drug resistance by clamping down on antibiotic overuse and misuse.
“I have to be honest with you,” she said recently in Portland at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). “I have sort of done a 180 from when I started talking about doing this presentation. It was actually last year at APIC that I had the idea. As I prepared this talk over the course of the last year, I have really changed my view about infection prevention and antibiotic stewardship.”
In the interim, she teamed with key colleagues in pharmacy and medicine to implement an antibiotic stewardship program at BJC and its affiliated hospitals.
“Some of the conclusions I have reached over the course of the last year in working with [my colleagues] is that our stewardship teams have a lot to learn by working with infection prevention and a lot to gain by partnering with infection prevention,” she said. “Another realization I have come to is that infection prevention has a lot to gain as well by partnering in stewardship. I also think we have a lot to lose if we choose not to partner. That is sort of the transition I have made in my own personal view of antibiotic stewardship.”
Face it — no IP wants another task added to his or her plate when many programs are underfunded and short-staffed.
“We have a lot of competing priorities and it is very hard, but I think that by partnering with our stewardship teams our patients have a lot to gain,” Kieffer said. “I think we can really work toward better outcomes for our patients. And if we really think about the definition of stewardship, that is really what we are trying to do: establish better outcomes for our patients while at the same time minimizing the effect of MDROs [multidrug-resistant organisms].”
Where Does IP Fit In?
“Quite honestly, I realize part of that is going to depend on the type of facility you’re at. Some of you may have been asked to be part of you stewardship team on the periphery and others have, perhaps, been asked to lead the team.”
Kieffer referenced a seminal 2012 paper by APIC and the Society for Healthcare Epidemiology of America, which advocated key roles for IPs in antibiotic stewardship programs, saying they can preserve antibiotic efficacy, reduce MDROs, and prevent Clostridium difficile infections.1
The paper recommended that, ideally, a clinical pharmacist and a physician champion should have primary responsibility for the day-to-day operations of a stewardship program.
“That makes sense,” she said, then referred to some of the duties IPs could assist with on a stewardship team.
“It’s really stuff we are already doing,” Kieffer told APIC attendees. “We are already identifying, monitoring, and reporting trends with MDROs. We have most of the oversight of compliance with our standard precautions, contact precautions, and hand hygiene programs. We use surveillance data to develop our risk assessments. It’s really just a matter of us doing the stuff that we are used to doing every day, but bringing in our stewardship partners to share some of that data with them and look at this issue together.”
Conceding there are some discomforting aspects, Kieffer noted the paper’s recommendations for IPs to implement antibiotic strategies aimed at prevention of infection and improve the therapeutic use of antimicrobials.
“Sometimes we get a little uncomfortable because we are not the prescribers,” she said. “Sometimes we get a little uncomfortable because we are asked to educate clinicians on the prudent and appropriate use of antibiotics, but I think we have the knowledge and skills to do that.”
With that as the rally cry, Kieffer went on to encourage and persuade IPs that they are uniquely positioned to be the linchpin of antibiotic stewardship programs.
“I believe we possess a special skill set as IPs,” she told APIC attendees. “We are great at developing partnerships. We partner with every single department in our hospitals. We are great at program development. Many of you have probably built your infection control program from the ground up. You have been involved in guideline development, pathway development, protocols, and bundles to try and prevent device infections. Education — that goes without saying. Every time you step out of your office and go onto the floor you are educating your staff, whether you know it or not. You mention something about isolating a patient, removing isolation, you are educating staff.”
On the contrary, stewardship partners like pharmacists may find this task daunting.
“Many of our pharmacists are used to staying within the pharmacy,” she said. “Asking them to come out and educate clinicians and healthcare workers is something they are not comfortable with. So, they can draw on the skill set that we have to do that. We’re really good at developing education modules and decreasing the risk of infections.”
Similarly, data collection critical to antibiotic stewardship metrics is another skill seasoned IPs have in their toolkit.
“Who does data better than an infection preventionists, right?” she said. “We collect, report, analyze, and present data. We do that within our institutions, state health departments, and nationally.”
Reminding IPs that they are part of a much bigger fight to stave off a post-antibiotic era — when common infections may no longer be preventable — Kieffer closed with this quote from the Alliance for the Prudent Use of Antibiotics: “Antibiotics are uniquely societal drugs because individual use affects others in the community and in the environment.”
- Moody J, Cosgrove SE, Olmsted R, et al. Antimicrobial stewardship: A collaborative partnership between infection preventionists and healthcare epidemiologists. AJIC 2012; 40: 94-95