Staff nurses as antimicrobial stewards

An integrative literature review | American Journal of Infection Control

Background: Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

Methods: An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

Results: Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

Discussion: Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

Full reference: Monsees, E. et al. (2017) Staff nurses as antimicrobial stewards: An integrative literature review. American Journal of Infection Control. Vol. 45 (no. 8) pp. 917–922

Antibiotics Don’t Work for 1/4 of Adults with Pneumonia

Approximately 1 in 4 (22.1 percent) adults prescribed an antibiotic in an outpatient setting for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference | Infection Control Today

B0007348 Streptococcus pneumoniae

Image source: Debbie Marshall – Wellcome Images // CC BY 4.0

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae, the species of bacterium that is the commonest cause of pneumonia.

McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.

The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia.  The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.  The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.  After adjusting for patient characteristics, the failure rates by class of antibiotic were:  beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).

Measles: Don’t let your child catch it

This poster highlights the current new campaign to encourage parents to get their child vaccinated | PHE

measles

Image source: PHE

This poster has been revised and updated as part of the measles elimination strategy. The number of young people catching measles is rising. To be protected they need to be immunised with the MMR vaccine. It’s never too late to be vaccinated. It’s time to make measles a disease of the past.

An A3 size downloadable poster is available here

Can vitamin D really stop you getting cold and flu?

New study claims that Vitamin D can reduce the risk of colds and influenza. A new study, published in the British Medical Journal found that daily pills of the vitamin reduced infections by 12%

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Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.

Design Systematic review and meta-analysis of individual participant data (IPD) from randomised controlled trials.

Results 25 eligible randomised controlled trials (total 11 321 participants, aged 0 to 95 years) were identified. Vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants.  In subgroup analysis, protective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses but not in those receiving one or more bolus doses.  Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event. The body of evidence contributing to these analyses was assessed as being of high quality.

Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.

Full reference: Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data  | Published 15 February 2017 | BMJ 2017;356:i6583

See also: BBC News: Vitamin D pills ‘could stop colds or flu’

NICE guideline update – Surgical site infections: prevention and treatment

Surveillance report 2017 – Surgical site infections: prevention and treatment (2008) | NICE guideline CG74

nice-guidance

Surveillance decision: We will plan an update of the guideline on prevention and treatment of surgical site infections. The update will focus on:

  • nasal decontamination of Staphylococcus aureus
  • choice of preoperative skin antiseptics
  • application of intraoperative topical antiseptics/antimicrobials before wound closure
  • type of suture.

We will consider intraoperative perfusion and hydration, and intraoperative blood glucose control in a new guideline on perioperative care. Recommendations in the surgical site infection guideline will be withdrawn on publication of new recommendations in the perioperative care guideline.

Read the full update here

Promoting better hygiene with children and young people

NICE and Public Health England recommend children and young people are taught the importance of hand washing to tackle antimicrobial resistance.

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The guidance recommends children in nurseries and young people at university be taught when and how to wash and dry their hands, for example after going to the toilet and before preparing food, in order to prevent the spread of infections. Public Health England’s (PHE) educational resources, e-Bug and Germ Defence, are listed as two ways to promote better hygiene.

The guidance by NICE and PHE, is aimed at NHS organisations, local authorities and health and social care professionals so they can provide information to people in their care.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework

Iwami M. et al. (2017) BMJ Open. 7:e012520

NHS Framework Documant 2008

Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice.

 

Results: National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.

Conclusions: For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.

Read the full article here