Healthcare associated infections
February 2006
Strategies for improvement: role of the healthcare professional
Optimal use of antimicrobials
Antimicrobial resistance and multi-resistant micro-organisms complicate prevention and control of HCAIs and exacerbate the associated problems of infection. It is widely acknowledged that complacency, poor prescribing practice and misuse of antimicrobials are major factors in the emergence of drug resistant infections. The unsystematic and inappropriate prescribing of antimicrobials to treat infection within the healthcare setting promotes the emergence of antimicrobial resistance and multi-resistant micro-organisms. [Go to note 40] In June 2000, the DH published the UK Antimicrobial Resistance Strategy and Action Plan that outlines key actions required by many organisations to tackle the growing problem of antimicrobial resistance. [Go to note 41] One key area identified in this report that has responsibilities for healthcare professionals was prudent use of antimicrobials in humans, and in particular, promotion of optimal antimicrobial prescribing in clinical practice through professional education, tailored information, guidelines and prescribing support, and organisational support. In 2003, new funding was provided by the DH for the development of a hospital pharmacy initiative for promoting prudent use of antimicrobials in hospitals in England. [Go to note 42] The funding was designed to facilitate the development of clinical pharmacy services and provide a focus on antimicrobials management in key areas such as antimicrobials use in surgical prophylaxis, antimicrobials use in children, and infection control. The initiative has led to the appointment of ‘antibiotic pharmacists’ by NHS trusts who play a key role in developing appropriate antimicrobials policies.
Healthcare professionals have a responsibility to reduce the development of antimicrobial resistance by ensuring optimal use of antimicrobials (see box 12). This includes preventing the unnecessary prescribing of antimicrobials, tailoring antimicrobial treatment to the specific infection and encouraging patients to complete the course of antimicrobials correctly. This should be complemented by strict adherence to infection control measures including hygiene protocols. The vast majority of antimicrobial prescribing occurs in primary care (80%) and approximately half of these antimicrobials are prescribed for respiratory tract infections, a high proportion of which are caused by viral pathogens or self-limiting bacterial infections. [Go to note 43] Prescribing antimicrobials as a result of diagnostic uncertainty can be counterproductive as they are a potentially inappropriate treatment for the infection, and can reinforce patient beliefs that antimicrobials are universally beneficial and encourage future consultations. Antimicrobial prescribing is heavily influenced by patient pressure. Healthcare professionals have a responsibility to assist in educating patients and the public about the limitations of antimicrobials and the harmful effects of over-prescribing, so that they are less demanding for antibiotic prescriptions.
Box 12: Action areas and guidelines for the prudent use of antimicrobials
- Antimicrobials will normally be used only after a treatable infection has been recognised or there is a high degree of suspicion of infection.
- Choice of antimicrobial will normally be governed by local information about trends in antimicrobial resistance or a known sensitivity of the organism.
- Antimicrobials will only be taken by patients over the prescribed period at the correct dose.
- Prescription of antimicrobials for children will be carefully considered; they are often unnecessarily prescribed for common viral infections and the child is subsequently more likely to develop a resistant infection.
- Support for prudent antimicrobial prescribing in hospitals will be provided by the clinical pharmacists, medical microbiologists and infectious diseases physicians on the staff.
- Antimicrobials will be used for prevention of infection only where benefit has been proven.
- Narrow spectrum antimicrobials will be preferred to the broad spectrum groups.
Source: Winning ways – working together to reduce healthcare associated infection in England (DH, 2003)
Further information
- The HPA is responsible, through the Antibiotic Resistance Monitoring and Reference Laboratory (ARMRL) and the Laboratory of Healthcare Associated Infection (LHCAIs), for the detection and investigation of antimicrobial resistance. The HPA has developed evidence-based guidance on the use of antimicrobials and the management of common infections in primary care, outlining treatment options including first and second-line antimicrobial choices, if appropriate. This guidance is available on the HPA website here at www.hpa.org.uk/infections/topics_az/antimicrobial_resistance/guidance.htm
- Guidance on managing common infections is available from the computerised decision support system, PRODIGY that can be accessed here at www.prodigy.nhs.uk
- Information from the DH on antimicrobial resistance can be found on its website here at www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/AntimicrobialResistance/fs/en
- Further information on antimicrobial resistance can be found in Winning ways: working together to reduce healthcare associated infection in England (Department of Health, 2003) UK antimicrobial resistance strategy and action plan (Department of Health, 2000) and The path of least resistance: summary and recommendations (Standing Medical Advisory Committee Sub-group on Antimicrobial Resistance, 1998).