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BSC – SEM 3 – UNIT 7 – INFECTION CONTROL & SAFETY

Antibiotic stewardship

Antibiotic Stewardship:

Introduction

Antibiotic Stewardship refers to coordinated efforts to optimize the use of antibiotics to improve patient outcomes, reduce antibiotic resistance, and prevent infections caused by multidrug-resistant organisms (MDROs).

With the rise of antibiotic resistance, the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) emphasize proper antibiotic use to combat antimicrobial resistance (AMR) and ensure effective treatment of infections.

1. Definition of Antibiotic Stewardship

Antibiotic stewardship is a set of interventions designed to promote the appropriate selection, dosage, route, and duration of antibiotic therapy to achieve the best clinical outcomes while minimizing toxicity, adverse effects, and resistance development.

Antibiotic misuse includes:

  • Overuse – Prescribing antibiotics for viral infections (e.g., colds, flu).
  • Underuse – Stopping antibiotics early or skipping doses.
  • Misuse – Using broad-spectrum antibiotics when narrow-spectrum drugs are sufficient.

Goals of Antibiotic Stewardship:

  1. Optimize patient safety and clinical outcomes.
  2. Reduce the emergence and spread of antibiotic-resistant bacteria.
  3. Minimize adverse effects of antibiotic use (e.g., Clostridium difficile infections).
  4. Improve cost-effectiveness and resource utilization in healthcare.
  5. Promote education and awareness about appropriate antibiotic use.

2. The Need for Antibiotic Stewardship

A. Rising Antibiotic Resistance

  • Overuse of antibiotics has led to the emergence of drug-resistant bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), and Carbapenem-resistant Enterobacteriaceae (CRE).
  • WHO predicts that by 2050, drug-resistant infections could cause 10 million deaths annually if no action is taken.

B. Misuse of Antibiotics in Healthcare and Agriculture

  • 80% of antibiotic use occurs in agriculture, contributing to resistance.
  • 50% of antibiotics in hospitals are unnecessary or inappropriately prescribed.

C. Lack of New Antibiotics

  • The development of new antibiotics has slowed down, making it crucial to preserve existing antibiotics.

D. Consequences of Poor Antibiotic Stewardship

  • Increased hospital stays, treatment failure, and higher mortality rates.
  • Spread of resistant bacteria in healthcare and the community.
  • Economic burden due to costly treatments and prolonged hospitalizations.

3. Core Elements of an Antibiotic Stewardship Program (ASP)

A. Leadership Commitment

  • Institutional support and accountability for stewardship programs.
  • Allocation of resources (funding, staff, IT support).

B. Accountability & Governance

  • A dedicated Antibiotic Stewardship team led by a physician, pharmacist, or infectious disease specialist.
  • Multidisciplinary collaboration involving microbiologists, infection control teams, and nurses.

C. Action Plan for Antibiotic Optimization

  • Antibiotic restrictions: Limiting the use of certain high-risk antibiotics.
  • Prospective audit and feedback: Reviewing antibiotic prescriptions and providing real-time guidance.
  • Preauthorization for certain antibiotics: Restricting use unless approved by stewardship teams.

D. Tracking & Surveillance

  • Regular monitoring of antibiotic usage patterns in hospitals.
  • Tracking resistance trends and patient outcomes.
  • Using antibiograms to guide empirical therapy.

E. Education and Awareness

  • Training healthcare professionals on appropriate antibiotic use.
  • Public awareness campaigns to discourage self-medication.

F. Implementation of Policies & Guidelines

  • Use of clinical guidelines (WHO, IDSA, CDC) for antibiotic prescriptions.
  • Hospital antibiotic prescribing policies based on local resistance patterns.

G. Infection Prevention & Control (IPC)

  • Hand hygiene, vaccination, isolation of infected patients, and outbreak control.
  • Surveillance of healthcare-associated infections (HAIs) and antibiotic resistance patterns.

4. Strategies for Effective Antibiotic Stewardship

A. Appropriate Use of Antibiotics

  • Prescribe antibiotics only when necessary (avoid using for viral infections).
  • Select the right antibiotic, dose, and duration based on guidelines.
  • Use narrow-spectrum antibiotics whenever possible instead of broad-spectrum drugs.

B. De-escalation Strategy

  • Start with broad-spectrum antibiotics for severe infections, then switch to targeted antibiotics based on culture results.
  • Helps reduce resistance, toxicity, and cost.

C. Dose Optimization

  • Adjust dosing based on patient weight, kidney function, and infection site.
  • Use therapeutic drug monitoring (TDM) for drugs like vancomycin and aminoglycosides.

D. IV-to-Oral Conversion

  • Switch from intravenous (IV) to oral antibiotics when a patient is stable.
  • Reduces hospital stay, costs, and complications.

E. Use of Biomarkers (e.g., Procalcitonin) for Antibiotic Decisions

  • Helps distinguish between bacterial and viral infections.
  • Guides decisions on stopping antibiotics early when infection is resolved.

5. Implementation of Antibiotic Stewardship in Healthcare Settings

A. Hospital-Based Stewardship Programs

  1. Restricting high-risk antibiotics (e.g., carbapenems, colistin, vancomycin).
  2. Developing hospital-specific antibiograms to guide empirical therapy.
  3. Regular audits and feedback to clinicians on antibiotic prescriptions.

B. Community-Based Stewardship Programs

  1. Encouraging rational antibiotic use in outpatient settings.
  2. Educating patients on completing prescribed antibiotic courses.
  3. Preventing over-the-counter antibiotic sales without prescriptions.

C. Veterinary & Agricultural Antibiotic Stewardship

  1. Reducing antibiotic use in livestock and poultry.
  2. Banning antibiotics as growth promoters in animal feed.
  3. Promoting vaccinations to reduce the need for antibiotics.

6. Challenges in Implementing Antibiotic Stewardship

  • Lack of awareness and training among healthcare providers.
  • Limited microbiology lab support for rapid diagnostics.
  • Patient demands for antibiotics, even for viral infections.
  • Over-the-counter availability of antibiotics in some countries.
  • Inadequate government policies and enforcement of regulations.

Solutions:

  • Strengthening hospital antibiotic stewardship teams.
  • Educating physicians, pharmacists, and the public.
  • Implementing antibiotic use guidelines at national and hospital levels.
  • Investing in rapid diagnostic tests to guide therapy.
  • Promoting vaccination programs to reduce infections requiring antibiotics.

7. Global Initiatives for Antibiotic Stewardship

  • WHO’s Global Action Plan on Antimicrobial Resistance (2015).
  • CDC’s Antibiotic Resistance Threats Report and stewardship programs.
  • IDSA’s Antimicrobial Stewardship Guidelines.
  • European Union’s “One Health” approach to antibiotic stewardship.

Importance of Antibiotic Stewardship

Introduction

Antibiotic Stewardship is a critical global health initiative aimed at ensuring the responsible use of antibiotics to prevent antimicrobial resistance (AMR), improve patient outcomes, and reduce healthcare costs. The World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) emphasize the urgent need for effective antibiotic management in hospitals, clinics, and community settings.

Without proper antibiotic stewardship, antibiotic resistance will lead to treatment failures, longer hospital stays, increased mortality, and the rise of untreatable infections.

1. Prevents Antibiotic Resistance

A. Growing Threat of Antimicrobial Resistance (AMR)

  • Antibiotic resistance occurs when bacteria evolve to withstand antibiotics, making infections harder to treat.
  • Overuse and misuse of antibiotics have led to the emergence of Multidrug-Resistant Organisms (MDROs) such as:
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • Carbapenem-resistant Enterobacteriaceae (CRE)
    • Vancomycin-resistant Enterococci (VRE)
    • Extensively Drug-Resistant Tuberculosis (XDR-TB)

B. Global Health Crisis

  • WHO predicts that by 2050, drug-resistant infections could cause 10 million deaths annually.
  • Common infections like pneumonia, tuberculosis, gonorrhea, and foodborne illnesses are becoming increasingly resistant to treatment.
  • Without urgent action, we may return to a pre-antibiotic era where minor infections are deadly.

Antibiotic Stewardship slows down the development of resistance by ensuring antibiotics are only used when absolutely necessary and that the right drug, dose, and duration are prescribed.

2. Improves Patient Safety & Clinical Outcomes

A. Reduces Treatment Failures

  • Inappropriate antibiotic use leads to ineffective treatment and prolonged infections.
  • Stewardship ensures that patients receive the correct antibiotic at the right time, leading to faster recovery and fewer complications.

B. Lowers Mortality Rates

  • Patients infected with antibiotic-resistant bacteria have a higher risk of death.
  • Stewardship improves survival rates by ensuring that antibiotics are prescribed based on evidence-based guidelines.

C. Reduces Adverse Drug Reactions (ADR)

  • Many antibiotics cause side effects such as allergic reactions, gastrointestinal disturbances, kidney damage, and liver toxicity.
  • Stewardship programs prevent unnecessary exposure to antibiotics, reducing the risk of side effects.

3. Decreases Healthcare-Associated Infections (HAIs)

A. Prevents Clostridium difficile Infections (CDI)

  • Overuse of antibiotics disrupts normal gut flora, increasing the risk of C. difficile infections.
  • Antibiotic stewardship reduces CDI cases by limiting unnecessary antibiotic exposure.

B. Reduces the Spread of Multidrug-Resistant Infections in Hospitals

  • Resistant bacteria spread easily in healthcare settings, causing outbreaks of difficult-to-treat infections.
  • Stewardship promotes infection control measures such as hand hygiene, isolation protocols, and proper antibiotic use.

C. Improves Surgical and ICU Outcomes

  • Appropriate antibiotic prophylaxis in surgeries prevents post-operative infections.
  • Stewardship ensures optimal antibiotic use in intensive care units (ICUs), where antibiotic resistance is a major concern.

4. Optimizes Antibiotic Use & Preserving Future Treatment Options

A. Ensures Rational Prescribing

  • Up to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate.
  • Stewardship programs help doctors choose the right antibiotic, dose, and duration based on clinical guidelines.

B. Reduces Overuse of Broad-Spectrum Antibiotics

  • Broad-spectrum antibiotics should be reserved for severe infections, but they are often overprescribed.
  • Stewardship promotes narrow-spectrum antibiotics whenever possible, preventing unnecessary resistance.

C. Encourages IV-to-Oral Antibiotic Conversion

  • Switching from intravenous (IV) to oral antibiotics reduces hospital stays and costs.
  • Stewardship ensures timely de-escalation of antibiotics based on patient recovery and lab results.

5. Lowers Healthcare Costs

A. Reduces Hospital Stay Duration

  • Antibiotic resistance leads to longer hospitalizations, requiring expensive treatments.
  • Appropriate antibiotic use shortens hospital stays and improves patient turnover.

B. Minimizes Unnecessary Lab and Treatment Costs

  • Stewardship prevents the unnecessary use of expensive antibiotics and diagnostic tests.
  • Hospitals save resources by avoiding overtreatment and redundant therapies.

C. Supports Cost-Effective Drug Use

  • Overprescribing high-cost antibiotics strains healthcare budgets.
  • Stewardship encourages the use of generic, effective antibiotics instead of costly alternatives.

6. Promotes Public Health & Community Awareness

A. Educates Healthcare Providers

  • Stewardship programs train doctors, nurses, and pharmacists on responsible antibiotic prescribing.
  • Continuous education ensures that new guidelines and resistance trends are integrated into practice.

B. Reduces Self-Medication & Over-the-Counter Antibiotic Use

  • Many people misuse antibiotics without prescriptions, leading to resistance.
  • Public awareness campaigns help educate patients about the dangers of unnecessary antibiotic use.

C. Supports Vaccination & Alternative Infection Prevention Methods

  • Vaccines reduce the need for antibiotics by preventing bacterial infections.
  • Stewardship encourages preventive measures like proper hand hygiene and sanitation.

7. Ensures Compliance with National & Global Guidelines

A. WHO Global Action Plan on Antimicrobial Resistance

  • Countries worldwide are required to implement stewardship programs to combat antibiotic resistance.

B. CDC & IDSA Antibiotic Stewardship Recommendations

  • Hospitals and clinics must follow standardized antibiotic prescribing practices.
  • Stewardship teams must track antibiotic use, resistance patterns, and patient outcomes.

C. Reduces Legal & Regulatory Risks for Healthcare Facilities

  • Hospitals not following stewardship policies may face penalties, increased costs, and reduced patient safety.
  • Compliance ensures accreditation and funding eligibility from healthcare agencies.

8. Encourages the Development of New Antibiotics

A. Slows Down the Need for New Antibiotics

  • If existing antibiotics are used wisely, the urgency to develop new drugs decreases.
  • Stewardship ensures long-term efficacy of current antibiotics.

B. Supports Research & Development in Alternative Therapies

  • Encourages investment in new antibiotics, vaccines, and antimicrobial peptides.
  • Promotes exploration of bacteriophage therapy and non-antibiotic treatments.

Antimicrobial Resistance (AMR):

Introduction

Antimicrobial Resistance (AMR) occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop resistance to antimicrobial drugs, making infections harder to treat. As a result, medications become ineffective, leading to prolonged illness, increased mortality, and higher healthcare costs.

The World Health Organization (WHO) has declared AMR as one of the top 10 global public health threats. Without urgent action, common infections may become untreatable, leading to a post-antibiotic era where minor injuries and infections could be fatal.

1. Definition of Antimicrobial Resistance (AMR)

AMR happens when microorganisms evolve mechanisms to survive the effects of antimicrobial agents that were originally effective against them.

Key Aspects of AMR:

  • Bacteria, fungi, viruses, and parasites can develop resistance to drugs.
  • Overuse and misuse of antibiotics accelerate resistance.
  • Resistant infections require stronger, more toxic, and expensive drugs.
  • AMR can spread between humans, animals, food, and the environment.

2. Causes of Antimicrobial Resistance

A. Overuse and Misuse of Antibiotics

  • Overprescribing antibiotics for viral infections like colds, flu, and sore throats.
  • Unnecessary use of broad-spectrum antibiotics when narrow-spectrum drugs could work.
  • Stopping antibiotics too early before the infection is fully eradicated.

B. Poor Infection Control in Healthcare Settings

  • Lack of hand hygiene and infection prevention measures in hospitals and clinics.
  • Failure to isolate patients with multidrug-resistant infections.

C. Use of Antibiotics in Agriculture & Livestock

  • 70-80% of antibiotics are used in animal farming to promote growth and prevent disease.
  • Antibiotic residues in meat and dairy products contribute to AMR in humans.

D. Lack of New Antibiotic Development

  • Pharmaceutical companies are not developing enough new antibiotics due to low profitability.
  • Most new antibiotics are modifications of existing drugs, not novel classes.

E. Poor Sanitation & Lack of Clean Water

  • Inadequate sewage disposal and unsafe drinking water spread resistant bacteria.
  • Limited access to proper hygiene in low-income countries increases AMR risk.

3. Types of Drug-Resistant Microorganisms

A. Multidrug-Resistant Bacteria (Superbugs)

  1. Methicillin-Resistant Staphylococcus aureus (MRSA) – Causes severe skin, bloodstream, and lung infections.
  2. Carbapenem-Resistant Enterobacteriaceae (CRE) – Resistant to last-resort antibiotics.
  3. Vancomycin-Resistant Enterococci (VRE) – Common in hospital-acquired infections.
  4. Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria – Resistant to penicillins and cephalosporins.

B. Drug-Resistant Tuberculosis (TB)

  • Multidrug-Resistant TB (MDR-TB) – Resistant to isoniazid and rifampin.
  • Extensively Drug-Resistant TB (XDR-TB) – Resistant to multiple TB drugs.

C. Antifungal Resistance

  • Candida auris – A deadly drug-resistant fungal infection found in hospitals.
  • Azole-Resistant Aspergillus – Causes lung infections in immunocompromised patients.

D. Antiviral Resistance

  • Drug-resistant HIV strains make antiretroviral therapy (ART) less effective.
  • Oseltamivir-resistant influenza (Tamiflu-resistant flu) limits flu treatment options.

4. Global Impact of Antimicrobial Resistance

A. Increased Mortality and Morbidity

  • Resistant infections kill nearly 5 million people each year worldwide.
  • By 2050, AMR could cause 10 million deaths annually, surpassing cancer deaths.

B. Economic Burden

  • AMR increases hospital costs due to prolonged treatments and ICU stays.
  • The World Bank estimates that AMR could reduce global GDP by 3.8% by 2050.

C. Threat to Medical Procedures

  • Without effective antibiotics, surgeries, chemotherapy, and organ transplants become high-risk.
  • Simple infections like urinary tract infections (UTIs) could become untreatable.

D. Environmental & Zoonotic Risks

  • Antibiotic-resistant bacteria spread through contaminated water and soil.
  • Resistant bacteria from animals can transfer to humans through food consumption.

5. Strategies to Combat Antimicrobial Resistance

A. Antibiotic Stewardship Programs (ASP)

  • Ensuring rational prescribing of antibiotics in hospitals and clinics.
  • Using culture tests to confirm bacterial infections before prescribing antibiotics.
  • De-escalating broad-spectrum antibiotics to targeted therapy.

B. Infection Prevention & Control (IPC)

  • Hand hygiene, sterilization of medical equipment, and isolation of infected patients.
  • Vaccination programs to prevent infections requiring antibiotic treatment.

C. Development of New Antibiotics & Alternative Therapies

  • Pharmaceutical companies need incentives to develop new antimicrobial drugs.
  • Research on bacteriophage therapy, antimicrobial peptides, and probiotics.

D. Regulation of Antibiotic Use in Agriculture

  • Reducing antibiotics in animal feed and promoting vaccines for livestock.
  • Banning non-therapeutic antibiotic use in food production.

E. Public Awareness & Education

  • Educating the public on responsible antibiotic use.
  • Encouraging people to complete full antibiotic courses and avoid self-medication.

F. Strengthening Surveillance & Global Action

  • National and international monitoring of antibiotic resistance trends.
  • Collaboration between WHO, CDC, and governments to enforce AMR policies.

6. Global Initiatives to Tackle AMR

A. WHO Global Action Plan on Antimicrobial Resistance (2015)

  • Encourages countries to develop National Action Plans (NAPs) against AMR.
  • Strengthens surveillance and research on antimicrobial resistance.

B. CDC Antibiotic Resistance Threats Report

  • Identifies urgent threats and promotes antimicrobial stewardship.
  • Provides funding for AMR research and prevention strategies.

C. One Health Approach

  • Recognizes that human, animal, and environmental health are interconnected.
  • Integrates policies for responsible antibiotic use in healthcare, agriculture, and industry.

D. UN Political Declaration on AMR (2016)

  • Calls for international cooperation to combat antibiotic resistance.
  • Supports research funding and stricter regulations on antibiotic use.

7. Challenges in Combating AMR

A. Lack of Awareness and Public Education

  • Many people misuse antibiotics due to lack of knowledge about AMR risks.

B. Limited Access to Diagnostics & Surveillance

  • Many countries lack laboratory facilities to test for resistance patterns.

C. Slow Development of New Antibiotics

  • Pharmaceutical companies have reduced investment in antibiotic R&D due to low profitability.

D. Over-the-Counter Sales of Antibiotics

  • In some countries, antibiotics are available without prescriptions, leading to misuse.

E. Cross-Border Spread of AMR

  • International travel and trade contribute to the global spread of resistant bacteria.

8. Future Outlook: Can We Control AMR?

A. Possible Solutions

  • Global coordination and stronger antibiotic regulations.
  • Investment in new antimicrobial drugs and alternative therapies.
  • Stricter infection control and vaccination programs.
  • Greater emphasis on One Health strategies linking human, animal, and environmental health.

B. Call to Action

  • Governments, healthcare professionals, farmers, and the public must collaborate to reduce antibiotic misuse.
  • Without urgent action, we risk entering a “post-antibiotic era” where common infections are fatal.

Prevention of MRSA and Multidrug-Resistant Organisms (MDROs) in Healthcare Settings

Introduction

Methicillin-Resistant Staphylococcus aureus (MRSA) and Multidrug-Resistant Organisms (MDROs) pose a significant threat to patient safety in healthcare settings. These pathogens are resistant to multiple antibiotics, making infections difficult to treat. Hospitals, long-term care facilities, and clinics must implement strict infection control measures to prevent the spread of MRSA and MDROs.

World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Infection Control Committees recommend strategies such as hand hygiene, environmental cleaning, antibiotic stewardship, and isolation protocols to minimize the transmission of these resistant bacteria.

1. Understanding MRSA and MDROs

A. What is MRSA?

  • MRSA (Methicillin-Resistant Staphylococcus aureus) is a strain of Staphylococcus aureus that is resistant to methicillin, penicillins, and cephalosporins.
  • It can cause skin infections, pneumonia, bloodstream infections (sepsis), and surgical site infections.
  • MRSA spreads through direct contact with infected wounds, healthcare equipment, or contaminated hands of healthcare workers.

B. What are MDROs?

  • Multidrug-Resistant Organisms (MDROs) are bacteria resistant to multiple antibiotics.
  • Common MDROs in healthcare settings include:
    1. Carbapenem-Resistant Enterobacteriaceae (CRE) – Resistant to carbapenems (last-resort antibiotics).
    2. Vancomycin-Resistant Enterococci (VRE) – Resistant to vancomycin, used for severe Gram-positive infections.
    3. Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria – Resistant to beta-lactam antibiotics (penicillins, cephalosporins).
    4. Multidrug-Resistant Pseudomonas aeruginosa – Found in hospital-acquired infections, resistant to multiple antibiotics.
    5. Multidrug-Resistant Acinetobacter baumannii – Causes respiratory, wound, and bloodstream infections in critically ill patients.

Both MRSA and MDROs increase mortality rates, prolong hospital stays, and raise healthcare costs due to limited treatment options.

2. Transmission of MRSA and MDROs in Healthcare Settings

A. Modes of Transmission

  1. Direct Contact with Infected or Colonized Patients
    • Patients with wounds, catheters, or ventilators are at high risk of spreading MRSA/MDROs.
  2. Healthcare Workers’ Hands
    • Contaminated hands of healthcare staff act as primary vectors for transmission.
  3. Contaminated Medical Equipment & Surfaces
    • Ventilators, catheters, bed rails, door handles, and patient monitoring devices can harbor MRSA/MDROs.
  4. Poor Infection Control Practices
    • Inadequate hand hygiene, improper disinfection, and failure to follow isolation precautions contribute to outbreaks.
  5. Overuse and Misuse of Antibiotics
    • Excessive prescribing of broad-spectrum antibiotics promotes resistance.

3. Strategies to Prevent MRSA and MDRO Infections in Healthcare Settings

A. Hand Hygiene and Standard Precautions

  • WHO’s “Five Moments of Hand Hygiene” must be strictly followed:
    1. Before touching a patient.
    2. Before a clean/aseptic procedure.
    3. After body fluid exposure risk.
    4. After touching a patient.
    5. After touching patient surroundings.
  • Use alcohol-based hand sanitizers (minimum 60% alcohol) or soap and water for at least 20 seconds.
  • Healthcare staff should avoid wearing rings, artificial nails, and watches while handling patients.

B. Contact Precautions and Isolation

  • MRSA and MDRO-infected patients should be placed in isolation rooms.
  • Contact precautions include:
    • Wearing gloves and gowns before entering a patient’s room.
    • Removing PPE and performing hand hygiene before exiting the room.
    • Minimizing patient movement within the facility.
    • Using dedicated medical equipment (stethoscopes, blood pressure cuffs) for infected patients.
  • Cohorting: Patients with the same MDRO infection can be grouped in the same room to prevent cross-infection.

C. Environmental Cleaning & Disinfection

  • Routine cleaning of hospital surfaces, equipment, and high-touch areas (bed rails, door handles, IV poles).
  • Use EPA-approved hospital-grade disinfectants effective against MRSA and MDROs.
  • Regular deep-cleaning of ICUs, surgical theaters, and high-risk units.
  • Proper handling of soiled linens, waste disposal, and decontamination of reusable medical devices.

D. Antimicrobial Stewardship Program (ASP)

  • Rational prescribing of antibiotics based on culture and sensitivity testing.
  • Avoiding unnecessary use of broad-spectrum antibiotics (e.g., carbapenems, fluoroquinolones).
  • De-escalation of antibiotic therapy when possible.
  • IV-to-oral conversion when clinically appropriate to reduce antibiotic exposure.
  • Monitoring local antibiograms and resistance patterns to guide empirical therapy.

E. Screening and Surveillance of High-Risk Patients

  • Routine MRSA/MDRO screening for high-risk patients upon hospital admission:
    • Patients with a history of previous MRSA/MDRO infections.
    • ICU patients, dialysis patients, and those on prolonged ventilator support.
    • Residents from long-term care facilities or nursing homes.
  • Active surveillance cultures (ASC) help in early detection and containment of MRSA/MDRO outbreaks.

F. Staff Education and Training

  • Regular infection control training for healthcare workers, cleaning staff, and nurses.
  • Education on proper PPE use, hand hygiene, and antibiotic prescribing practices.
  • Training sessions on recognizing early signs of MDRO infections and outbreak management.

G. Safe Handling of Invasive Devices (Catheters, Ventilators, IV Lines)

  • Use aseptic techniques while inserting catheters, IV lines, and ventilators.
  • Remove unnecessary invasive devices as soon as possible to minimize infection risk.
  • Follow proper disinfection protocols before and after device insertion.

H. Patient and Visitor Education

  • Educating patients and families about MRSA/MDRO risks and infection control practices.
  • Encouraging visitors to follow hygiene protocols, wear protective gear, and limit unnecessary visits.

4. Challenges in Preventing MRSA and MDROs

  • Poor compliance with infection control measures due to lack of awareness or training.
  • Inconsistent hand hygiene practices among healthcare workers.
  • Overuse of antibiotics in hospitals and outpatient settings.
  • Inadequate hospital resources for surveillance, screening, and environmental cleaning.
  • Emergence of new antibiotic-resistant strains requiring more robust treatment options.

Solutions:

  • Regular hospital audits and monitoring of infection prevention practices.
  • Strict implementation of antimicrobial stewardship programs (ASP).
  • Government policies regulating antibiotic use in human and veterinary medicine.
  • Stronger enforcement of hospital infection control guidelines.
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