What is Antimicrobial Stewardship?
November 18, 2022
What is Antimicrobial Stewardship?
The World Health Organization(WHO) declared antimicrobial resistance (AMR) as one of the top 3 threats to human health with an estimated mortality amounting to 10 million deaths annually by 2050. Causing more deaths than cancer.
This is alarming, but do nurses understand the positive impact we can have in reducing antimicrobial resistance?
In the last century, antibiotics have revolutionised medicine and reduced mortality and morbidity from almost all serious infections.
Antibiotics have dramatically reduced the risks associated with many medical and surgical procedures. Treatment for leukaemia, organ transplants, joint replacements, and more. Without antibiotics, many of these procedures would have unacceptably high failure or death rates.
Overuse of antibiotics contributes to the development of resistant bacteria, like MRSA, VRE, CRE, and Clostridium difficile.
Antimicrobial resistance occurs when some of the germs (bacteria, virus, or fungus) that cause infections become resistant to the effects of the medicines used to treat them.
This may lead to the inability to treat the cause of the infection.
There are a few reasons for the dramatic increase in AMR, including a shortage of new antimicrobials, widespread use of antimicrobials in agriculture and inappropriate or overuse.
Our Residential Aged Care Facilities have frail older residents who need help with daily living, antibiotics, and invasive devices like catheters. With group activities, shared living spaces, objects, and bathroom facilities, and a lack of infection prevention and control, residential aged care has a challenge managing infection.
Infections become increasingly difficult to diagnose and treat as antimicrobial resistance grows. In nursing homes, this is one of the biggest causes of mortality and morbidity. Lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), skin and soft tissue infections, and gastroenteritis are our most common infections.
According to reports, 1 in 10 residents in Residential Aged Care are taking an antimicrobial.
It is widely reported that half of the antibiotics used in residential care facilities are inappropriate or unnecessary. Inappropriate use can include the wrong choice of antibiotic, the wrong dose or prolonged use of antibiotics.
These reports are hardly surprising when you consider the decision on prescribing antibiotics is made off-site by telephone, with limited laboratory and clinical information. An overworked and under-resourced GP surgery can be adversely influenced by staff members concerned about their residents.
AMS programs reduce inappropriate antimicrobial use, improve resident outcomes, and reduce the consequences of antimicrobial use (like antimicrobial resistance, toxicity, and unnecessary costs).
In response to this widespread over and inappropriate use of antibiotics, countries are now implementing quality initiatives in how we detect and diagnose infection
Along with infection prevention, hand hygiene, and surveillance, AMS programs prevent antibiotic resistance and decrease preventable infections.
But what is Antimicrobial Stewardship? The term Antimicrobial Stewardship (AMS) first appeared in the scientific literature in 1996 (McGowan & Gerding, 1996) and refers to an approach to using antimicrobials responsibly to maintain their future effectiveness.
There’s a broad range of understanding of the term ‘AMS’. Nurses are often asked “what is AMS?” Or “what can we do when our doctor prescribes antibiotics?”
Despite the huge amount of research and promotion, the term remains unclear. Aged care nurses need to know that they play a pivotal and significant role in antimicrobial stewardship. In an environment where infection prevention education is often underfunded, it’s crucial to acknowledge and fully support this.
Aged Care Facilities can be largely managed by Healthcare Workers, we need to address that roles in AMS can often be limited by scope of practice. Additionally, nurses may feel limited in their ability to contribute to AMS due to their limited role in prescribing. This disparity is due to the distinction that exists between the GP’s role in prescribing and the nurse’s role in administering medication.
Doctors and pharmacists have traditionally been responsible for Antimicrobial Stewardship.
Despite studies showing that stewardship requires a multidisciplinary approach, the role of nurses is seldom acknowledged.
Nursing plays a unique role in resident care by being present at every stage of a resident’s journey. Nurses and Healthcare Workers are, therefore, ideally placed to contribute to AMS.
It is, therefore, vital to know how nurses perceive their own role in AMS, so that AMS programmes can be adapted to maximise nurses’ contributions.
The most effective AMS programs require a multidisciplinary approach that includes improving clinical practice, educating healthcare workers and residents, monitoring antimicrobial use, and implementing government policies. Antimicrobial resistance can be minimised with AMS, leading to fewer infections, reduced resident mortality and, in the long run, lower healthcare costs.
Nurses, when aware of their role, take part in Antimicrobial Stewardship and are eager to contribute. Nurses are also keen to work together in partnership to achieve this. To get such participation, nurses must feel confident about raising concerns. As a nurse, speaking up is an essential part of keeping residents safe.
It’s common for nurses and healthcare workers to be hesitant to speak out of fear they won’t be taken seriously. In addition, they may want to be part of the team and not be labelled a troublemaker. Nurses are hesitant to ask antibiotic prescribers questions because challenging prescribing practices will often not be well received, and challenging prescribing decisions is not a consideration.
Practices such as nurses not being included on GP rounds, or their opinions not being proactively sought, validate the perception of nurses’ contribution to antibiotic management practices having no value.
Nurses’ reluctance to raise concerns about AMS may be due to this culture, and research shows that some nurses are hesitant to cross what they view as a clear boundary between the nursing and medical roles.
How can we improve the role of nurses in aged care and decisions affecting residents, especially in AMS?
Nurses and Healthcare Workers who are empowered through education will be able to contribute to Antimicrobial Stewardship by educating both residents and the community. Nurses and healthcare workers need to be educated about the importance of safe and appropriate antibiotic use, including the risks and when antibiotics are not appropriate.
In nursing, we are aware of the need to tailor information to our audience’s knowledge, literacy, and language. The focus of infection prevention education has too long been on the immediate setting, but there are many advantages to including all service members, including residents and visitors. Collaboration is essential for infection prevention and AMS.
As a service, we need to improve knowledge of AMS and infection prevention by prioritising training, protecting teaching time, and ensuring members are supported.