_______________________________________________________________ Healthcare-Associated Infections
EDUCATION FOR HEALTHCARE PROFESSIONALS
• Streamlining or de-escalation of therapy • Dose optimization • Systematic plan for parental-to-oral conversion The goal of phase four of the CDC national HAI Action Plan is to “slow the emergence of resistant bacteria and prevent the spread of resistant infection” ( Table 20 ) [2]. As previously stated, the HHS is working to update the plan with new indi- cator targets and data, new research and intervention efforts, and a review of the impact of the COVID-19 public health emergency on HAIs [2]. The CDC is coordinating stewardship activities among federal agencies, public health, and healthcare systems [2]: • Establishment of antibiotic stewardship programs in all acute care hospitals and improved stewardship across all healthcare settings • Reduction of inappropriate antibiotic use by 50% in outpatient settings and by 20% in inpatient settings • Establishment of Antibiotic Resistance Prevention Programs in all 50 states The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use engaged in establishing or improving antimicrobial stewardship programs in 389 ambulatory care practices throughout the United States [319]. This program involves webinars, audio presentations, educational tools, and office hours to engage stewardship leaders and clinical staff to address attitudes and cultures that challenge judicious antibiotic prescribing and incorporate best practices for the management of common infections. Over the period of one year (December 2019 through November 2020), antibiotic prescribing at participating clinics was cut overall by nearly 48%, while prescribing for acute respiratory infections was reduced by 37% [319].
Education on best practices is a crucial aspect of preventing HAIs and is a recommendation in all infection control guide- lines. Education should highlight the effect of prevention measures on the rates of HAIs, enhance knowledge about cur- rently available guidelines, and provide instruction on carrying out guideline recommendations. Research has also suggested that education about prevention strategies may be more effec- tive if patterns of care and levels of risk are incorporated into recommendations [320]. Numerous studies have shown that knowledge and practices related to HAIs and guidelines are improved after educational programs. The combination of a self-study module (with pretest and post-test), inservice lectures, posters, and fact sheets on the prevention of intravascular device-related bloodstream infections and appropriate prac- tices led to substantial reductions in the prevalence of such infections [268; 321; 322]. A small study showed that ICU nurses’ knowledge and practices were enhanced by education on the prevention of ventilator-associated pneumonia [200]. A Canadian study demonstrated that rates of nosocomial MRSA infection significantly decreased after a mandatory infection control education program on MRSA that included discussion of hospital-specific MRSA data and case-based practice [323]. Because increasing knowledge is not sufficient for effecting behavior change, theoretical models for behavior change should be considered when designing improvement initiatives [300; 324]. Among effective model-related strategies are the following [300; 324]: • Education and discussion of barriers to adherence (cognitive model) • External reinforcements, incentives, and reminders (behavioral model)
CDC’S CORE ELEMENTS FOR ANTIBIOTIC STEWARDSHIP PROGRAMS IN HOSPITALS, NURSING HOMES AND OUTPATIENT FACILITIES
Core Element
Definition
Leadership commitment
Dedicating necessary human, financial and information technology resources
Accountability
Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective Appointing a single pharmacist leader responsible for working to improve antibiotic use Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e., “antibiotic time out” after 48 hours)
Drug expertise
Action
Tracking
Monitoring antibiotic prescribing and resistance patterns
Reporting
Regular reporting of information on antibiotic use and resistance to doctors, nurses and other relevant staff
Education Source: [2]
Educating clinicians about resistance and optimal prescribing
Table 20
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