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- Title
Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication.
- Authors
Lemmen, S. W.; Lewalter, K.
- Abstract
Purpose: The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today.Methods: A review of the literature.Results: The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures.Conclusions: In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.
- Subjects
PREVENTION of infectious disease transmission; ANTI-infective agents; BACTERICIDES; COMMUNICABLE diseases; PREVENTION of communicable diseases; CONTINUING education; CROSS infection; DRUG utilization; ENTEROCOCCUS; HAND washing; ISOLATION (Hospital care); MEDICAL errors; MEDICAL protocols; MEDICAL screening; MULTIDRUG resistance; VANCOMYCIN resistance; POINT-of-care testing; HUMAN services programs; EVALUATION of human services programs; DISEASE eradication
- Publication
Infection, 2018, Vol 46, Issue 5, p581
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-018-1137-1