Health Care-Associated Infection Prevention and Control: Pharmacists' Role in Meeting National Patient Safety Goal 7

Abstract

Health care-associated infections and antimicrobial resistance are continually increasing, with fewer drugs available for effective treatment. Potential benefits of infection control and antimicrobial stewardship programs include improvements in antibiotic use and conversion from intravenous (IV) to oral antibiotics and reductions in resistance and infection rates and length of hospital stay. NorthShore University HealthSystem in Evanston, Illinois, was the first large hospital system in North America that adopted universal inpatient surveillance for methicillin-resistant Staphylococcus aureus (MRSA). Results showed that nasal MRSA was a powerful predictor of MRSA disease and antibiotic resistance in other organisms. MRSA infections occurring up to 30 days posthospitalization decreased by approximately 70%. At the Hospital of Saint Raphael, a community teaching hospital in New Haven, Connecticut, an antimicrobial stewardship pilot program focused on automatic conversation from IV to oral antimicrobials and appropriate antimicrobial use. The percentage of patients receiving oral fluconazole increased from 63% to 77%; the percentage of those receiving oral linezolid increased from 54% to 71%. Total antibiotic use decreased by 6%. Based on the 60-day trial, potential cost savings were estimated as $874,000 annually, less the cost of a pharmacist's salary and benefits. Infection control and antimicrobial stewardship programs offer pharmacists new opportunities for helping improve patient safety and quality of care. Pharmacy-medical staff partnership, combined with support from microbiology, infection control, information technology, and hospital administration, is key to a successful program.