Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

Abstract

PurposeThe global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today.MethodsA review of the literature.ResultsThe classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures.ConclusionsIn summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.

Enterococci, from Harmless Bacteria to a Pathogen

“…Given the ease of acquisition of resistance genes by the enterococci, the prudent use of antibiotics as therapeutic agents is an important tool in the management of the antibiotic resistance problem [ 5 ]. Antibiotic stewardship programs, especially those that involve prospective auditing and feedback, have been shown to have an important impact on the resistance rates in individual institutions [ 52 , 53 ]. They reduced the overall usage of these drugs, thereby decreasing the selective pressure on the hospital microbiota, and increased the heterogeneity of the prescribed antimicrobial agents [ 52 , 54 ].…”

Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments – evaluation of national screening guidelines

“…In spite of the fact that the number of new communityacquired MRSA cases has risen approximately 350% over the past 10 years (3579 cases in 2017), and despite the low screening sensitivity shown in this study, the number of hospital-acquired cases has remained low and almost constant (approximately 50 cases/year) [18]. A high general infection control standard is supported by other studies which favour a prevention approach, focusing on body washes with antiseptics, hand hygiene compliance and antibiotic stewardship, compared with a pathogenic-specific approach, based on screening, isolation and eradication [19].…”

Use of “Social Media”—an Option for Spreading Awareness in Infection Prevention

“…Implementation of antibiotic stewardship (ABS) programmes and infection control practices with increased hand hygiene compliance, antiseptic body washes, continuing education and the use of new tools (e.g. electronic wearables and Wi-Fi-equipped dispensers) reduced transmission of MDROs causing the majority of nosocomial infections than screening and isolation measures [ 6 ]. Effective implementation of IPC interventions can prevent further infections and AMR spread [ 7 ].…”