Session report: Healthcare-associated infections and antimicrobial stewardship
Healthcare-associated infections (HAIs) are acquired by patients during their stay in any healthcare setting or immediately after the discharge. Although some of HAIs can be treated easily, others may more seriously affect a patient’s health with a considerable distress, increasing in-hospital stay and costs.
Current challenges for European nursing
More than 3.5 million cases of HAI are estimated to occur in the European Union (EU) each year, leading to more than 90 thousand deaths. Furthermore, HAIs constitute the 71% of infection cases with antibiotic-resistant microorganisms, including bacteria resistant to last-resort antibiotics, such as carbapenem-resistant enterobacterales.
The HAIs can affect respiratory tract, surgical site, urinary tract, bloodstream, and gastro-intestinal tract (delivered by clostridioides difficile). The prolonged use of invasive devices, the prolonged exposure to pathogens, patients with immunodepression or subjected to immunosuppression treatment, and critically ill patients represent the most important risk factors for HAIs.
The European Centre for Disease Prevention and Control (ECDC) collects many data from hospitals and health-care facilities in the EU by periodically performing prevalence surveys about the HAIs and antimicrobial use.
Up to 50% of HAIs are estimated to be preventable: the application of infection prevention and control measures in healthcare settings is essential for their prevention. Nevertheless, hands hygiene represents the most economical and simple measure to reduce HAIs risk.
The antimicrobial-resistance (AMR) represents a global threat to public health: although it is multifactorial, there is a strong correlation between the use of antibiotics and the development of resistant microorganisms. The emergence of AMR because of antibiotics’ inappropriate use increases mortality rates and has become a major public health challenge worldwide. To improve the appropriateness for antimicrobial use, it is important that prescribers document the reason to use an antimicrobial treatment in medical records. A comprehensive assessment of the global burden of AMR, based on estimates for 204 countries worldwide, projected 4.71 million deaths associated with bacterial AMR in 2021.
Given the significant challenge posed by bacterial AMR, it is imperative to identify effective methods to mitigate its impact. Moreover, a responsible utilisation of antimicrobials necessitates active participation from all health-care professionals.
The opportunities for antimicrobials liquid preparations to come into contact with the nurse, patient or environment during the manipulation process are numerous and have the potential to significantly impact AMR in the workplace. The preparation potentially exposes both the nurse and the environment to frequent small doses of these drugs; this exposure may lead to the development of contact allergies or respiratory problems. Therefore, it is recommended to wear gloves and keep infusion sets intact when disposing of them.
Antimicrobial Stewardship (AMS) is a systematic approach aimed to promote the rational and appropriate use of antimicrobials. The goal is to preserve the long-term effectiveness of these agents, prevent overuse, combat antimicrobial resistance (AMR), and reduce healthcare costs. AMS involves the implementation of coordinated interventions to improve and monitor the appropriate use of antimicrobials by offering the best possible prescription based on dose, duration and route of administration.
The role of nurses
The involvement of nurses in the AMS is widely recommended and it is essential, both in general and specific care settings; it could be increased with an appropriate training and support.
These are the main nursing tasks in AMS:
- Preventing HAIs (for less use of antimicrobials)
- Early removal of medical invasive devices
- De-escalation and timely transition from intravenous to oral antimicrobial therapy
- Monitoring of treatment efficacy and any adverse effects
- Patient and family information and education
- Monitoring of prescriptions and signs and symptoms of infections
- Respect standard and isolation precautions
- Correct disposal of intravenous antibiotics and reduction of contamination of hospital environments
- Collection and documentation of allergic history, distinguishing true antibiotic allergies from adverse events
- Appropriate collection of microbiological samples
- Appropriate administration of antimicrobial therapy (method: maintenance of asepsis, timing: e.g.: preoperative prophylaxis).
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Author: Mr. Mattia Boarin, RN, MScN, Milan (IT)