The Centers for Disease Control and Prevention has launched a version of its "Get Smart About Antibiotics" campaign in an effort to get hospital-based physicians to be more diligent about not prescribing their inpatients with unnecessary antibiotics to avoid resistant strains.
"This is an educational message we're presenting for physicians to help them understand, what are the real indications to treat a patient who has a sore throat with antibiotics. What are the signs and symptoms of an infection with a bacteria versus a virus," says Arjun Srinivasan, MD, the CDC's Associate Director for Healthcare Associated Infection Prevention Programs, Division of Healthcare Quality Promotion.
"There's been a perception that some clinicians might not be as familiar with the indications."
Fliers and other material distributed to hospital physicians carry the message: "Healthcare providers—the power to prevent antibiotic resistance is in your hands." It adds that the increase in bacteria that are resistant to common antibiotics results in increased risk of hospitalization, length of stay, hospital costs, transfer to the intensive care unit and increased mortality.
"Hospital administrators and payers can help," reads another part of the campaign. "We must enhance efforts to get healthcare administrators to recognize the importance of antibiotic stewardship and provide resources to do it," and "make appropriate antibiotic use a quality improvement and patient safety priority."
The previous three-year Get Smart campaign had targeted patients, to educate them not to demand antibiotics from their physicians unless they have a bacterial infection, and had targeted community physicians. This is the first time the campaign has approached acute care hospital providers.
For physicians, Srinivasan says, there are three simple fixes to make the system work better to prevent inappropriate antibiotic prescribing. They are:
- Make sure that whenever you write an order for an antibiotic, include not just the name of the drug and the dose, but the duration and the indication. "Rather than having an order that says 'Penicillin, 500 mg,' we'd like it to say 'Penicillin, 500 mg for five days for pneumonia,' " Srinivasan says.
"It's not that much more information, but it's important." That's because patients care responsibility often is passed from one hospital or intensivist to another, "and sometimes patients are continued on antibiotics longer than necessary."
"This allows them to say, Oh wait a minute, this patient doesn't have pneumonia, they actually have heart failure, but Dr. Williams put them on antibiotics for pneumonia because that's what we thought the patient had two days ago. Let's stop it now."
2. Whenever you're prescribing an antibiotic, to make sure you get appropriate microbiology cultures order the sample that's necessary before the antibiotics are given. "That way when you get the results back, you can see either that no bacteria grew from the culture, or the patient's bacteria is resistant, and the type of antibiotic needs to be changed. Or, you may find out that the patient is on a broad spectrum antibiotic when a much narrower one would work."
3. Adopt "time out" procedures similar to those used in surgical settings.
"It's the same idea. After a day or two, we want clinicians to take an 'antibiotic time out' to assess, very quickly, is the patient on the right antibiotic, the right dose, for the right duration given the symptoms and the results from the culture."
Srinivasan says the CDC has targeted its campaign for hospitalists, internists, intensivists and pediatricians---"anyone who provides inpatient care" who prescribes antibiotics.
But it's also targeting hospital CEOS and administrators with the message that resistance is expensive, resulting in $35 billion in societal costs, $20 billion in excess healthcare costs, and 8 million additional hospital days each year.
"Inpatient antibiotic stewardship programs have consistently demonstrated annual savings of $200,000 to $400,000," reads one part of the campaign.
The agency also is working with the Institute for Healthcare Improvement to eliminate institutional barriers that prevent rapid culture results from getting in front of the physician to stop inappropriate antibiotic use as soon as possible. One strategy is to ask all hospitals to develop a unified system for approaching antibiotic delivery, something Srinivasan calls "stewardship."
That in essence means making a special effort to understand what causes any delays in the process. "Is it in ordering the sample, or collecting the sample, or transporting the sample from the unit to the lab, or is there a delay in the lab? There's a lot of steps involved and the more steps, the more opportunities there are for the system not to work smoothly."