蓝鱼o_0 发表于 2012-4-17 00:27

2012SHEA新闻:抗生素管理需要感染预防专家和医院流行病学家的亲密合作

本帖最后由 蓝鱼o_0 于 2012-4-17 00:28 编辑

Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Healthcare EpidemiologistsJulia Moody MSSM(ASCP), , ,1 Sara E. Cosgrove MDMS, , ,2 Russell Olmsted MPHCIC, , ,3 Edward Septimus MDFACPFIDSAFSHEA, , , , ,4 Kathy Aureden MSMT (ASCP)SICIC, , , ,5 Shannon Oriola BSNRNCICCOHN, , , , ,6 Gita Wasan Patel RPhPharmDBCPS, , , ,7 and Kavita K. Trivedi MD, 8    1. Workgroup Chair; HCA, Inc., Nashville, Tennessee2. SHEA Advisor; Johns Hopkins Medical Institutions, Baltimore, Maryland3. 2011 APIC President; Trinity Health, Ann Arbor, Michigan4. SHEA Advisor; HCA, Inc., Nashville, Tennessee5. Sherman Hospital, Elgin, Illinois6. Sharp Metropolitan Medical Center, San Diego, California7. HCA Supply Chain Services, Dallas, Texas8. Center for Health Care Quality, California Department of Public Health
Address correspondence to Julia Moody, MS, SM(ASCP), Clinical Director, Infection Prevention, Workgroup Chair, Clinical Services Group, HCA, Inc., Nashville, TN 37203 (julia.moody@hcahealthcare.com). Received January 23, 2012; accepted January 23, 2012; electronically published March 15, 2012Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the world’s most pressing public health problems.1 Not only does such inappropriate use diminish the therapeutic benefit of essential medications, it also facilitates the development and spread of multidrug-resistant organisms (MDROs).2 Antimicrobial resistance and the rise in MDROs globally are associated with increased morbidity and mortality, cross-transmission within and between healthcare settings, and increased consumption of limited patient-care resources. Despite elevated awareness, publication of guidelines on antimicrobial stewardship,3 and several initiatives, the proportion of resistant strains causing both health care– and community-associated infections continues to increase and the number of new antimicrobials continues to decline.4,5In response to this growing problem, the Centers for Disease Control and Prevention (CDC) launched the Get Smart for Healthcare initiative6,7 in 2004, which includes a national campaign to promote collaboration across healthcare settings and mobilize national and local health officials in educating patients, consumers, and healthcare practitioners about appropriate use of antibiotics. The importance of antimicrobial resistance was recently highlighted by the World Health Organization (WHO), which dedicated World Health Day 20118 to halting the spread of antimicrobial resistance. The CDC and WHO are leading voices working toward an international solution with a three-pronged focus: (1) optimizing use of existing antimicrobial agents, (2) preventing transmission of MDROs, and (3) pursuing new therapeutic tools to treat emerging pathogens.Antimicrobial Stewardship (AS) is an interprofessional effort and involves optimal, prudent antimicrobial use for patients across the continuum of care: acute, inpatient, and long-term care and outpatient settings.9This position paper highlights the critical importance of healthcare epidemiologists (HEs) and infection preventionists (IPs) in effective antimicrobial stewardship programs (ASPs). The skills and knowledge each of these highly skilled professionals brings to a facility’s ASP, when combined with other disciplines, can accelerate progress toward preventing emergence and cross-transmission of MDROs (Table 1). The Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology (SHEA) are the professional organizations with historical focus, expertise, and credibility in articulating and implementing best practices in antimicrobial stewardship and infection prevention and control.
Table 1.  Examples of Healthcare Epidemiologist (HE) and Infection Preventionist (IP) Strategies to Improve Stewardship Open New Window



APIC and SHEA believe the following:
• MDROs cause a significant proportion of serious healthcare-associated infections (HAIs) and pose significant risk to patient safety across all points of health care delivery.
• Regulatory and accreditation organizations, along with legislative bodies, must continue to make HAIs, including those caused by MDROs, a greater priority in health care.10,11
• Integrated, multidisciplinary ASPs led by a physician and a pharmacist with training in antimicrobial stewardship are crucial to promoting the prudent use of antimicrobials and in combating the development of MDROs in all health care settings.
• ASPs can benefit infection prevention and control (IPC) programs by identifying reported trends and outbreaks of epidemiologically significant organisms and educating about infection prevention policies in the course of interaction with providers.
• IPs and HEs benefit ASPs by providing support and guidance in approaches to surveillance for syndromes of interest, implementing interventions to guide the delivery of evidence-based practices, and translating data and infection rates to healthcare workers, nursing units, and administrators.12-14
SummaryJump To Section... It is clear that the widespread and injudicious use of antimicrobials has greatly increased the presence of MDROs that threaten the health of all. There is worldwide acknowledgment that this threat is growing and that prudent use of antimicrobials combined with infection prevention can prevent harm and improve patient safety. ASPs must harness the talents of all members of the healthcare team to effectively identify the organism, determine its susceptibility, institute any precautions required, and prescribe the narrowest-acting antibiotic that will destroy it. IPs/HEs play a pivotal role in this approach by assisting with early organism and infected-patient identification, by promoting compliance with standard and transmission-based precautions and other infection prevention strategies such as care bundle practices, hand hygiene, and by educating staff, patients, and visitors.
AcknowledgmentsJump To Section... We acknowledge Arjun Srinivasan, MD, FSHEA, for his insightful review and commentary.Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.



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6. Centers for Disease Control and Prevention. Get Smart: Know When Antibiotics Work. Get Smart Web site. http://www.cdc.gov/getsmart/http://www.jstor.org/templates/jsp/_jstor/images/externalLink.png. Accessed November 23, 2011. First citation in article
7. Centers for Disease Control and Prevention. Get Smart for Healthcare. Get Smart Web site. http://www.cdc.gov/getsmart/healthcare/?s_cid=dhqp_002http://www.jstor.org/templates/jsp/_jstor/images/externalLink.png. Accessed November 23, 2011. First citation in article
8. World Health Organization (WHO). World Health Day: 7 April 2011. Antimicrobial Resistance: No Action Today, No Cure Tomorrow. World Health Organization Web site. http://www.who.int/world-health-day/2011/en/index.htmlhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png. Accessed November 23, 2011. First citation in article
9. Fishman N. Antimicrobial stewardship. Am J Infect Control 2006;34(suppl):S55–S63. First citation in article, CrossRefhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png
10. The Joint Commission (TJC). Assets for Acute Care Hospital Accreditation 2011: Comprehensive Accreditation Manual for Hospitals.http://www.jointcommission.org/assets/1/6/2011_NPSGs_HAP.pdfhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png. Accessed May 7, 2011. First citation in article
11. California State Senate Bill 739. http://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents/SB739.pdfhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png. Accessed January 19, 2012. First citation in article
12. Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011;52:1232–1240. First citation in article, CrossRefhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png
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[*]14. Septimus EJ, Owens RJ Jr. Need and potential of antimicrobial stewardship in community hospitals. Clin Infect Dis 2011;53(suppl 1):S8–S14. First citation in article, CrossRefhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png



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[*]National Quality Forum Surgical Care Improvement Project. Related and Competing Measures. http://www.qualityforum.org/Projects/s-z/Surgery/Surgery_Related_and_Competing_Measures.aspxhttp://www.jstor.org/templates/jsp/_jstor/images/externalLink.png.




[*]This article is being jointly published by American Journal of Infection Control and Infection Control and Hospital Epidemiology.

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© 2012 by The Society for Healthcare Epidemiology of America and The Association for Professionals in Infection Control and Epidemiology. All rights reserved.

蓝鱼o_0 发表于 2012-4-17 00:40

IPS和HES在ASP中发挥重要作用,体现在早起病原微生物和感染患者的确定,促进标准预防的依从性提高,优化其他的感控策略,如手卫生,护理BUNDLE,通过教育职工,患者和探视者。

天涯丽人 发表于 2012-4-17 08:08

到沙发。光看题目,不是很明白“医院流行病学家”在国外医院的设置,所起作用,需要什么样资质的等等。国内对我们院感专职人员一直要求要掌握流行病学、微生物学、统计学等等相关知识,是不是我们比较“多功能”些?

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