12 steps to prevent antimicrobial resistance in hospitalized patients

12 steps to prevent antimicrobial resistance in hospitalized patients

Prolonging the usefulness of new and older antibiotics should be a goal of every health care provider. Many antibiotic resistance problems originate in hospitals and other health care facilities. The CDC offers the following 12 steps as a means of preventing the development of resistance in hospitalized patients. Most of these points have application in office practice, as well.

PREVENT INFECTION

Step 1: Vaccinate

• Give influenza and pneumococcal vaccines to at-risk patients before discharge.

• Get your own influenza vaccine every year.

Step 2: Get the catheters out

• Use catheters only when essential.

• Use the correct catheter.

• Use proper insertion and catheter-care protocols.

• Remove catheters when they are no longer essential.

DIAGNOSE AND TREAT INFECTION EFFECTIVELY

Step 3: Target the pathogen

• Culture the patient.

• Target empiric therapy to likely pathogens and local antibiogram.

• Target definitive therapy to known pathogens and antimicrobial susceptibility test results.

Step 4: Access the experts

• Consult infectious diseases experts for patients with serious infections.

USE ANTIMICROBIALS WISELY

Step 5: Practice antimicrobial control

• Engage in local antimicrobial control efforts.

Step 6: Use local data

• Know your antibiogram.

• Know your patient population.

Step 7: Treat infection, not contamination

• Use proper antisepsis for blood and other cultures.

• Culture the blood, not the skin or catheter hub.

• Use proper methods to obtain and process all cultures.

Step 8: Treat infection, not colonization

• Treat pneumonia, not the tracheal aspirate.

• Treat bacteremia, not the catheter tip or hub.

• Treat urinary tract infection, not the indwelling catheter.

Step 9: Know when to say No

• Treat infection, not contaminants or colonization.

• Fever in a patient with an intravenous catheter is not a routine indication for vancomycin.

Step 10: Stop antimicrobial treatment

• When infection is cured

• When cultures are negative and infection is unlikely

• When infection is not diagnosed.

PREVENT TRANSMISSION

Step 11: Isolate the pathogen

• Use standard infection control precautions.

• Contain infectious body fluids. (Follow airborne, droplet, and contact precautions.)

• When in doubt, consult infection-control experts.

Step 12: Break the chain of contagion

• Stay home when you are sick.

• Keep your hands clean.

• Set an example.

Source: CDC.