Hospital Infection Prevention and Control (IPC) and Antimicrobial Stewardship (AMS): Dual Strategies to Reduce Antibiotic Resistance (ABR) in Hospitals

Abstract

In this chapter we review the development of hospital infection prevention and control (IPC) since the nineteenth century and its increasingly important role in reducing the spread of antibiotic resistance (ABR). Excessive rates of hospital-acquired infection (HAI) fell dramatically, towards the end of the nineteenth century, because of improved hygiene and surgical antisepsis, but treatment remained rudimentary until effective antibiotics became widely available in the mid-twentieth century. While antibiotics had profound clinical benefits, their widespread appropriate and inappropriate use in humans and animals inevitably led to the emergence of antibiotic resistance (ABR). Within 50 years, this could no longer be offset by a reliable supply of new drugs, which slowed to a trickle in the 1980s. In hospitals, particularly, high rates of (often unnecessary) antibiotic use and ABR are exacerbated by person-to-person transmission of multi-drug resistant organisms (MDRO), which have, so far, largely resisted the introduction of antimicrobial stewardship (AMS) programs and repeated campaigns to improve infection prevention and control (IPC). Despite clear evidence of efficacy in research settings, both AMS and IPC programs are often ineffective, in practice, because of, inter alia, insufficient resourcing, poor implementation, lack of ongoing evaluation and failure to consult frontline staff. In this chapter we review reasons for the relatively low priority given to preventive programs despite the ethical obligation of healthcare organisations to protect current and future patients from preventable harm. The imminent threat of untreatable infections may provide an impetus for a shared organisational and professional commitment to promoting the cultural and behavioural changes needed to successfully reduce the burdens of ABR and drug-resistant HAIs.

Health Science Students’ Perceptions of Hand Hygiene Education and Practice in a South African University: Introducing the University Hand Hygiene Improvement Model

“…Moreover, continuous monitoring and feedback have been found to be effective strategies to enhance hand hygiene adherence [ 40 ]. In past research in our laboratory [ 19 , 21 ], we have found that while training and intervention improved student participant knowledge and attitudes about hand hygiene, their actual practices, as evidenced by microbial data from their hands, did not align with their knowledge and attitudes. We deduced that the presence of bacteria on the hands could be a result of inadequate hand hygiene practice rather than a lack of hand hygiene frequency.…”

“…Furthermore, the frequency of each reason does not necessarily reflect its significance or impact on overall hand hygiene practices. Several factors have been reported to negatively impact adherence to recommended practices among HCWs [ 20 , 21 , 22 , 23 , 52 ]. These factors include limited knowledge and awareness, handwashing agents causing discomfort and dryness, inconveniently positioned sinks, a lack of soap and paper towels, time limits, severe workload owing to understaffing, unfamiliarity with rules and practices, and occasional forgetfulness [ 10 , 18 , 20 , 22 , 44 , 52 , 53 , 54 , 55 ].…”

“…The hands of healthcare workers (HCW) are the most common vehicles for the spread of healthcare-acquired infections (HAI), as pathogenic microorganisms have been shown to be present on the hands of healthcare workers for 2-60 min following contamination [15][16][17]. Although HH is a simple and effective infection control strategy and an important barrier in the defence against HAI, a non-compliance rate of 40-70% has been reported in healthcare workers [17][18][19][20][21]. In South Africa, it has been reported that at least one in seven patients visiting South African hospitals are at risk of acquiring an HAI due to poor IPC measures, such as improper waste management and poor handwashing techniques [22,23] Limited information exists on the impact of hand hygiene education and awareness interventions in South Africa, particularly on changing hand hygiene behaviors among health science students [11][12][13][22][23][24].…”

The New Precision Stewards?

“…Among the many challenges of AM stewardship, one possible framing is in terms of intergenerational justice: how to appropriately balance the wellbeing of current and future patients [ 128 ]. Variably termed appropriate, prudential, or rational use of AMs, stewardship is also often understood as a classic challenge of implementation science; evidenced-based standards of AM use are established, but integrating this knowledge into practice is no simple matter [ 129 ]. Behavior change is notoriously challenging for humans, including experts.…”

Nurses’ knowledge on nosocomial infections preventive measures and its associated factors in Ghana: a cross-sectional study

“…Reducing person-to-person transmission involves implementing various measures to minimize the spread of infections between patients, healthcare workers, and visitors. This includes promoting proper hand hygiene practices (i.e., handwashing or using hand sanitizers), and practicing safe injection practices [ 11 ]. On the other hand, preventing transmission from the environment involves maintaining a clean and hygienic healthcare setting.…”