Education abounds for physicians, nurse practitioners and physician assistants regarding the over use of antibiotics, when to order when not to order. The CDC has even created a Stewardship Program to help reduce the improper use of antibiotics. Yet here we are in a global situation where antibiotics are no longer "curing" infections.
What is the nurse's part? What are we ethically required to do? We are required by the American Nurses Association (ANA) Code of Ethics to keep our education current and relevant. Part of the Code, is the principals of Fidelity and Nonmaleficence. Within the principal of Fidelity is advocacy, and the principal of nonmaleficence is to do no harm.
We as nurses are the front line defense against MDRO's on multiple levels. We are to advocate for our patients and prevent harm in the following ways:
◾Hand Hygiene
◾Hold others accountable to good hand hygiene
◾Using proper PPE and isolation processes
◾Providing PPE, isolation processes, and continuing education to SRNA and other ancillary staff
◾Following standards of practice regarding invasive procedures like IV catheter insertions and all sterile procedures
◾Patient education regarding antibiotic use and completion
◾Strong assessment skills to identify and distinguish between viral and bacterial infections of all bodily systems
Numerous times in my short career as a nurse I have seen nurses calling a physician to report the patient has a non-productive cough, slight chest congestion, with clear nasal drainage and vital signs within normal limits. The physician immediately orders a chest x-ray. The x-ray results negatively and yet the physician orders antibiotics. The patient then is on a course of antibiotic for seven to ten days, and sometimes antibiotic associated diarrhea occurs. This ultimately places the patient at risk for skin break down, and the dreaded possibility of c-diff.
Yet more than likely the patient was experiencing a viral infection and did not need antibiotics at all. So who failed here? The nurse? The physician? The answer is both.
Despite the extensive evidence regarding antibiotic stewardship available out there the physician ordered the antibiotic based on the nurses assessment. Is this a chicken and egg situation? No the nurses assessment came first.
Our part as nurses is to reduce the spread of MDRO's and to ensure continued education to enable us to have excellent assessment skills.
Dr. Linda Petter in her article, "Virus or Bacteria: How to Tell The Difference" distinguishes the differences between viral and bacterial infections well.
◾Viral - widespread symptoms
◾Bacterial - localized symptoms
◾Phlegm bacterial - green, yellow, bloody, brown, or brown tinged
◾Phlegm viral - clear, cloudy or absent
◾Viral duration - 2 to 10 days
◾Bacterial duration - typically longer than 10 days
◾Febrile viral - may or may not be febrile
◾Febrile bacterial - typically febrile the majority of the time
Knowing the difference between viral and bacterial infections is our ethical duty as nurses to one, cause no harm and two to advocate for the patient to ensure the highest quality of care is provided at all times.
With the increase in comorbidities infections are going to happen and have the potential to be more severe, and cause more harm due to the risks associated with antibiotic use such as, interference with anticoagulants, birth control medications, skin break down and diabetic medications. Not to mention secondary infections that can be life threatening like c-diff.
Knowing the difference between viral and bacterial infections is only one part of this problem, with the prevalence of CRE and other impossible to treat UTI's/CAUTI's it is imperative that nurses educate themselves in the prevention of MDRO's and how they are spread and prevented.
Veronica Cheney, RN, BSNS
Washing your hands
is the number way to prevent the spread of MDRO's
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What can nurses do to reduce MDRO's?