Joint Commission looks at antibiotic resistance

Raised awareness, but no specific standard

Reflecting a growing concern about antibiotic resistance, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, is advising its surveyors to ask more "targeted questions," based on a recent report that challenges hospital leadership to address the problem.

"The microbes are mutating faster than we can keep up with them, and there aren't that many new antibiotics in the pipeline -- it's a real crisis," says Carole Patterson, RN, MN, Joint Commission associate director of standards development, who participated in a workshop that led to the recently published article.1 The Centers for Disease Control and Prevention in Atlanta sponsored the effort, but the findings were issued as a consensus position with other participating organizations rather than as CDC guidelines.

In issuing "a challenge to hospital leadership" that includes administrative and medical staff, the authors emphasized the need to begin monitoring and providing feedback regarding antibiotic resistance. Underscoring the need for both better antibiotic controls and infection control measures, the report advises hospitals to target a list of problem pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant and high-level penicillin-resistant enterococci, and gram-negative bacilli resistant to third-generation cephalosporins and aminoglycosides. (See recommendations, below.)

"We feel that clinicians acting on their own in a complex medical system aren't likely to be able to affect all of the components of the system which are required to reduce antibiotic resistance," says lead author Donald A. Goldmann, MD, hospital epidemiologist at Children's Hospital in Boston. "[Hospital] leadership needs to make it a priority for the institution to mobilize people in various disciplines to get together and work on the system's problems as a group."

Though the Joint Commission has not adopted a specific standard addressing antibiotic resistance, the article is being distributed to surveyors to encourage questions about antibiotic-resistant pathogens and infection control efforts in accredited hospitals.

"They could consult with the medical staff in the hospital and ask, 'Do you know what your resistant trends are? Have you studied how to improve antibiotic use in your hospital?'" Patterson says.

Joint Commission surveyors may be aware of regional trends for a particular resistant pathogen and then assess control efforts at individual hospitals, she says. Though failure to address such issues may not be cited under a specific standard, the commission's effort may put some impetus behind the recommendations and raise awareness of the issue.

"The [challenge] is to all hospital leaders, not just the administrative side -- the leaders of the medical staff, the leaders of nursing, the CEO and his or her staff, as well as the governing body," Patterson says. "All of our surveyors are trained to ask questions about infection control as they go through the survey process."

Too many hospitals have not made the control of antibiotic resistance a high priority, typically delegating efforts to the infection control department, says William J. Martone, MD, co-author of the article and director of the National Foundation for Infectious Diseases in Bethesda, MD.

"Responsibility to this point has mainly been with infection control," Martone says. "They really can't do it alone. They need support of a multifaceted group within the hospital. It's got to cross departmental levels -- nursing, medicine, surgery, central supply, pharmacy. The whole issue of control of antimicrobial resistance is a total hospital problem. It isn't just infection control's [problem]. And the hospital administration has to make that a strategic hospital priority, which I don't think they have in the past."


1. Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: A challenge to hospital leadership. JAMA 1996; 275:234-240. *