By placing an emphasis on early screening as well as new innovations in remote monitoring supported by predictive algorithms to detect infections earlier, health systems can minimize risk to other patients in the hospital.
By Peter Ziese, PhD, MD
For years, the U.S. has feared the arrival of superbugs, otherwise known as strains of bacteria that have become resistant to antibiotics. We’ve previously seen superbugs in other countries, and in May 2016, researchers found the first person in the U.S. carrying bacteria resistant to antibiotics of last resort—a frightening development that could mean the end of the efficacy of antibiotics.
Drug-resistant bacteria affect more than 2 million people in the U.S. every year and kill at least 23,000, according to the Centers for Disease Control and Prevention (CDC). And if those numbers aren’t sobering enough, a 2013 project commissioned by the British government released estimates of the near-future global toll of antibiotic resistance: an expected 10 million deaths per year (O’Neill, 2016).
The presence of superbugs is undoubtedly deeply concerning, but there are steps that health systems can take to better understand the precautions required to minimize the impact. Health systems need to reevaluate their current treatment approaches, and now that superbugs are officially in the U.S., there are certain key strategies hospitals can use to best equip themselves in the fight.
Antibiotics can’t be the first line of defense
Too frequently, antibiotics are administered in cases where other treatment options are available—this is a key contributing factor to our current situation of antibiotic-resistant germs. There’s been a need to shift away from trigger-happy antibiotic prescription for years, but that need is essential now that the threat of superbugs is real. In 2014, 266.1 million courses of antibiotics were dispensed to outpatients in U.S. community pharmacies, which works out to more than five prescriptions written each year for every six people in the country (Hicks et al., 2015). At least 30% of these prescriptions were unnecessary—in other words, no antibiotic was needed at all (Fleming-Dutra et al., 2016).
There is no reason to shoot sparrows with a cannon, which is exactly what physicians are doing when they prescribe antibiotics as a first choice to treat something that does not require them. Not only should antibiotics only be used as a last resort when all other treatment methods have failed, but they need to be highly efficient, and physicians need to emphasize that patients must see the treatment through. If a physician prescribes antibiotics for a week, but a patient only uses them for three days, there is a risk that the germs will survive and ultimately become resistant to antibiotics.
An emphasis on early identification and isolation
According to the World Health Organization (WHO), antibiotic resistance is accelerated not only by the overuse of antibiotics, but also by poor infection prevention and control (World Health Organization, 2016). As superbugs continue to be an issue, it will become increasingly important that infected patients are identified and isolated early. This will help limit the spread of superbugs among hospital patients, who are the most vulnerable to the bugs in the first place. Hospital-acquired infections are still a huge concern for health systems, and the rise of superbugs exacerbates it. By placing an emphasis on early screening as well as new innovations in remote monitoring supported by predictive algorithms to detect infections earlier, health systems can minimize risk to other patients in the hospital.
Advances in DNA sequencing will provide genomic information to care givers identifying the germs quickly. Even more importantly this technology will help targeted treatment by providing insights into the resistance to specific antibiotics.
Patient care has expanded beyond the hospital and into the home, and in the case of a patient that has been infected with a superbug, these advanced monitoring solutions are pivotal. Remote surveillance technology and video options can monitor patients in isolation while keeping hospital staff and the patient population out of harm’s way.
Maintaining good hygiene is more important than ever
According to the Centers for Disease Control (CDC), hospital-acquired infections affect one in 25 hospitalized patients on any given day. Hygiene among clinicians should always be a priority in the context of limiting hospital-acquired infections, but it’s even more vital when dealing with antibiotic-resistant bacteria.
In fact, recent research from Duke University found that the scrubs of ICU nurses often pick up disease-causing germs, including those resistant to antibiotics. Researchers set out to learn more about the spread of bacteria leading to hospital-acquired infections by focusing on the triangle of transmission in the hospital: patient, environment, and nurse. They took cultures twice a day from the nurses’ scrubs, patients, and the patients’ rooms and found 22 transmissions of the same strain of bacteria. Of those transmissions, 27% were from patient to nurse, 27% were from room to nurse, and 45% were from patient to room (Infectious Diseases Society of America, 2016).
In the era of superbugs, good hygiene will help prevent the spread of germs between patients, which ultimately can help contain the issue.
Uncharted territory requires new ways of thinking
The rise of superbugs brings a new wave of challenges. While dealing with superbugs may be uncharted territory for many health systems in the U.S., by executing these three strategies—using antibiotics as a last line of defense, identifying and isolating infected patients early, and maintaining good hygiene—we can help minimize the impact of superbugs. The trick, however, is to implement these strategies across the board. Superbugs are no small issue, and to successfully battle against them, health systems nationwide need to commit to putting these strategies in motion.
Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M. Jr. … Hicks, L. A. (2016). Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA, 315(17), 1864–1873.
Hicks, L. A., Bartoces, M. G., Roberts, R. M., Suda, K. J., Hunkler, R. J., Taylor, T. H., & Schrag, S. J. (2015). U.S. outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis, 60(9), 1308–1316.
Infectious Diseases Society of America (2016, October 27). Nurses’ scrubs often contaminated with bad bugs. Eureka Alert! Retrieved from https://www.eurekalert.org/pub_releases/2016-10/idso-nso102516.php
O’Neill, J. (2016). Tackling Drug Resistant Infections Globally: Final Report and Recommendations: The Review on Antimicrobial Resistance. Retrieved from https://amr-review.org/.
World Health Organization (2016, October). Antibiotic resistance fact sheet. Retrieved from http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/
Peter Ziese, PhD, MD started his clinical career 1990 at the University Hospital of Tuebingen in Germany where he specialized in anesthesiology, with interest in pediatric and cardio-thoracic cases. He further specialized in intensive care and emergency medicine. Dr. Ziese joined Philips in 2001, working in international management and heading up first the marketing organization for patient monitoring and later on the sales and marketing center for Patient Monitoring and Critical Care Systems for Europe, Middle East and Africa. Since 2005, he has been leading international sales and service organizations in different parts of Europe, Middle East and Africa with responsibilities for various Business Groups within Philips. He is responsible for global sales and marketing for Patient Care and Monitoring Solutions at Philips.