Infection prevention must be the cornerstone of our approach to tackling antimicrobial resistance, says Pat Cattini, president of the Infection Prevention Society, who looks at the reasons why effective infection prevention is a crucial part of the fight against AMR
The threat of antimicrobial resistance (AMR) is widely publicised. As highlighted by a report from the Health and Social Care Committee, AMR could result in the death of 10 million people per year by 2050 if we don’t take action. The second year of Public Health England’s national 'Keep Antibiotics Working' campaign is also well underway. But are we taking action on this major public health threat where it’s needed most?
Awareness campaigns to educate the public and health professionals on the correct administration of antibiotics are an important way to help the over prescription and incorrect use of antibiotics. But first and foremost, we must prioritise effective infection prevention. Every infection results in an increased demand for antibiotics, and failure to control antibiotic use provides opportunities for resistance to emerge. With further lapses in infection prevention, these resistant organisms will continue to spread and thrive in our healthcare environments, posing a significant threat to our ability to deliver modern healthcare including surgery, transplants and cancer care.
We are unlikely to find a solution by looking to the development of new antimicrobials. There have been no new classes of antimicrobials for decades, and those which are brought to market through re-engineering of old antibiotics are expensive and often redundant within a short time. Big pharmaceutical companies generally do not see a good return on the massive investments needed to produce antimicrobials and are more likely to focus on producing drugs which appeal to a wider, more long-term market.
This situation is unlikely to change within the next five years - the lifetime of the government’s new AMR strategy. It is therefore vital to focus on looking after the effectiveness of existing antimicrobials by reducing their use. Infection prevention is key, because every infection prevented means we don’t have to administer antibiotics. Infection prevention must be the foundation of preserving antimicrobial treatment and controlling resistance.
A vital element of the infection prevention armamentarium is the use of vaccination to prevent disease circulating within our communities. Encouraging vaccination is particularly important given recent figures showing that take-up of MMR vaccine has fallen for the fourth year in a row, while measles outbreaks are increasing in the UK and across Europe. Vaccination is probably a victim of its own success: with a lack of visibility of many conditions within the general public over recent decades, people have forgotten the very real risks that they pose and may not appreciate how devastating conditions like measles can be.
Simple and inexpensive practices such as hand hygiene can significantly reduce rates of infections in health and care settings, reducing the need for antibiotics to be used. However, there is more to infection prevention and control. It is vital that we build and maintain the right environment to deliver care, that we ensure the procurement of clinical devices and equipment which best enhance patient safety, and that we ensure a clean environment and clinical equipment. The robust education of staff and patients is also crucial.
The role our the health workforce
Although infection prevention is one of the most simple and effective ways to tackle the root of AMR, the last few years has seen reduced investment in the infection prevention and control workforce, resulting in a loss of experience and leadership. For example, a survey of the Infection Prevention Society’s members carried out last year showed that almost a third (30 per cent) have seen a reduction in the IPC services where they work. This is particularly true in primary and community care settings, where community infection control services have been significantly depleted. Some services are dependent on a single IPC professional.
We must ensure that healthcare workers on the front line are well armed to tackle the challenges. This means investing in the development of a specialist infection prevention workforce across the health and social care sector. Healthcare providers need to have access to competent infection prevention teams – and infection prevention behaviours must become ingrained.
Infection prevention and control is a constantly changing field, with healthcare professionals required to deal with various new and emerging threats. Infection prevention staff need to have access to best practice guidance and be assured that they have robust governance on infection prevention. To help ensure this, the Infection Prevention Society has developed a set of professional competencies that provide healthcare leaders with assurance of the professional development of their infection prevention staff. They allow infection prevention professionals to assess their skills and knowledge, further their understanding and identify development needs.
Every time we prevent an infection we go some way to reducing the use of antibiotics. Ensuring well-equipped, well-resourced and well-educated infection prevention teams will help deliver effective infection prevention and must be the cornerstone of our approach to tackling AMR. Effective infection prevention also limits illnesses and saves lives. It saves on length of stay in hospital and costly consumables. Successful infection prevention is a win-win for patients, staff and healthcare providers.