The Health Information and Quality Authority (HIQA) are conducting a national quality assurance review across all public acute hospitals in relation to antimicrobial stewardship. The announcement from China that a newly discovered gene has made infectious Gram-negative bacteria resistant to the last line of currently available antibiotics has brought into sharp focus the importance of vigilance when it comes to the proper usage of antimicrobials.

HIQA’s Inspector Manager of Healthcare Regulation, Sean Egan said; “Antimicrobial resistance poses a huge current and future challenge for health services globally. The ongoing discovery of new antibiotics has failed to keep pace with the emergence of antibiotic resistance. While there are a number of global initiatives underway to try to address this mismatch, in the short term it is unlikely that new antibiotics aimed at treating Gram-negative infection in particular will become available. Consequently, as a society we need to ensure that all possible measures are in place to preserve the utility of antibiotics that remain effective in treating such infection.”

“Antimicrobial stewardship helps to combat resistance by ensuring the effectiveness of antimicrobial agents is preserved for as long as possible through careful and expert usage. All public acute hospitals are expected to have effective antimicrobial stewardship programmes in place. In short, these programmes intend to ensure that every patient receives the right antimicrobial therapy, at the right dose, route and duration, for the right infection type at the right time.”

Since June of this year, HIQA’s hospital inspection programme, in line with monitoring compliance against the National Standards for the Prevention and Control of Healthcare Associated Infections, has focused specifically on antimicrobial stewardship. This national assurance review intends to recognise and share learning where good practice exists, and identify potential scope for improvement where possible, in the interest of improving high performance in all public acute hospitals. HIQA’s guidelines outline the necessary governance structures, essential staffing requirements and recommended interventions required to implement antimicrobial stewardship effectively.

Sean Egan continued; “In a time of ever increasing global travel, the risk of the spread of resistant bacteria is heightened. It is critically important that all hospitals have appropriate defences in place to both mitigate the risk of transmission of multidrug resistant bacteria, and prevent their emergence through optimal usage of antimicrobials.”

The full document, Guide to the Health Information and Quality Authority’s review of antimicrobial stewardship in public acute hospitals, can be found here.

Ends.

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA
01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Notes to the Editor: 

• Antimicrobial resistance poses a significant threat to modern healthcare. Advanced treatments such as complex surgery, cancer chemotherapy and organ transplantation rely on antibiotics to protect patients throughout treatment.
• The majority of antibiotic prescribing in Ireland occurs in the community healthcare setting, largely in the treatment of respiratory infection. However, approximately one in three patients in hospital at any given time will be progressing through a course of antibiotics to either treat or prevent infection. HIQA’s current assurance review is focused on hospitalised patients as these patients are most vulnerable to multidrug resistant infection. However, prudent antibiotic usage in all settings, both in human and vetinary usage, is necessary to protect against the emergence of resistance.
• The threat of antibiotic resistance is recognised as a key strategic risk by the Irish Government, and is listed as such on the countries current risk register which is maintained by the Department of An Taoiseach.
• Antimicrobial stewardship refers to a set of coordinated strategies which aim to improve the quality of use of antimicrobial medications, with the goal of enhancing patient health outcomes, reducing adverse effects, reducing the emergence of resistance, and reducing healthcare costs. In short, these programmes intend to ensure that every patient receives the right antimicrobial therapy, at the right dose, route and duration, for the right infection type at the right time. In addition, it also intends to ensure that should be continually reviewed, refined and discontinued where the patient’s condition allows.
• Good practice in relation to antimicrobial stewardship in the hospital setting requires an effective multidisciplinary approach involving but not limited to; Hospital Managers and Clinical Leaders, Doctors, Clinical Pharmacists, Pharmacy Technicians, Nurses, Surveillance Scientists, laboratory and other staff. The benefits include better patient outcomes, reduced antimicrobial resistance, reduced adverse drug reactions and reduced treatment costs.
• Gram-negative bacterial species which commonly cause infection include E. coli and Klebsiella pneumoniae. These species are the most common cause of urinary tract infection. In hospitalised patients Gram-negative bacteria may also commonly cause bloodstream infection, pneumonia and abdominal infection following surgery. Gram-negative bacteria are commonly implicated in cases of sepsis and septic shock.
• In order to effectively protect patients against the risk of antimicrobial resistance, antimicrobial stewardship activities must be accompanied by optimal infection prevention control practice (including good hand hygiene and environmental hygiene).