infection prevention
By Sue Barnes, RN, CIC, FAPIC
The Role of Infection Preventionists in Antibiotic
Stewardship Programs
S
ince their introduction in the 1940s, antibiotics have
greatly reduced illness and death from all types of
infections caused by bacteria. However, overuse has led
to development of bacterial resistance, making the drugs
less effective and creating bacteria that is more difficult
to treat. Each year in the United States, at least 2 million
people become infected with bacteria that are resistant to
antibiotics, and 23,000 people die as a direct result of these
infections. 1 To promote the appropriate use of antibiotics,
antibiotic/antimicrobial stewardship programs (ASP) have
been implemented in hospitals nationwide, and are required
by the Joint Commission and the Centers for Medicare and
Medicaid. 2 These programs are making progress in reducing
resistance, and the incidence of infections caused by multi-
drug-resistant organisms. In addition, the appropriate use of
antibiotics also serves to reduce the incidence of Clostridium
difficile infections (C. diff), caused in part by the disruption
of helpful intestinal bacteria. 1
Various perspectives have been offered regarding the
role of the infection preventionist (IP) in ASP. A 2019 paper
published in AJIC on the subject suggests that “the absence
of a clear role definition for IPs in ASPs is likely hindering IPs
from contributing in consistent, meaningful ways.” 3 This was
written subsequent to publication of two key Association for
Professionals in Infection Control and Epidemiology (APIC)
documents, suggesting that there is still work to do to clarify
the role of the IP in ASP. The updated APIC-Society for
Healthcare Epidemiology of America (SHEA) position paper
on the role of the IP in ASP, published in 2018, proposes the
following ASP related functions for IPs: 4
➊ Leadership commitment: Infection prevention
and control (IPC) and antimicrobial stewardship (AS)
program leaders must work together to align their pro-
grams, promoting communication and collaboration,
and reducing the likelihood of redundant initiatives.
➋ Action: IPs can leverage strong collegial relation-
ships to influence and facilitate nursing’s supporting
role in initiating antibiotic timeouts, performing
antibiotic reconciliation during patient transitions of
care, and educating patients and families.
➌ Tracking: IPC programs perform surveillance for
difficile/CDI) and audit data (e.g., hand hygiene
adherence) to clinicians and other stakeholders. CDI
prevention is a high priority for IPC and AS programs,
so sharing and disseminating antibiotic use and CDI
infection rates is essential to prevention efforts.
➎ Education: Some specific examples include
providing education to frontline healthcare workers
regarding the appropriate collection of urine cultures,
cultures from endotracheal tubes, and indications for
testing for CDI infections.
➏ Diagnosis: It is essential for IPs, HEs, and the AS
team to understand the scope of rapid diagnostic tests
and work together to assist clinicians in interpreting
and responding appropriately to results.
The second APIC paper published in 2019 was
“Advancing the profession: An updated future-oriented
competency model for professional development in
infection prevention and control,” proposed the following
actions for the IP role in ASP: 5
➊ providing consultative expertise
➋ being a leader and advocate
➌ identifying and detecting multidrug-resistant
organisms
➍ reporting surveillance trends over time
➎ using surveillance data (e.g., treating asymptomatic
bacteriuria, collecting contaminated specimens)
➏ analyzing antibiograms and antibiotic use
➐ assisting with early organism and infected patient
identification
➑ promoting compliance with standard and transmis-
sion-based precautions and other infection prevention
strategies, such as care bundle practices and hand
hygiene
emerging pathogens and resistance patterns, as well
as rapid response to every possible transmission. ➒ developing and providing educational programs for
➍ Reporting: IPC programs are responsible for HAI Other experts have recommended additional activities
which arguably would cross the boundary into the com-
petencies of other departments. For instance, participating
surveillance and providing feedback of infection rates
(e.g., multidrug-resistant organisms and Clostridioides
www.healthcarehygienemagazine.com • april 2020
staff, patients, and visitors
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