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Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

PURPOSE: The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementa...

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Autores principales: Lemmen, S. W., Lewalter, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182449/
https://www.ncbi.nlm.nih.gov/pubmed/29796739
http://dx.doi.org/10.1007/s15010-018-1137-1
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author Lemmen, S. W.
Lewalter, K.
author_facet Lemmen, S. W.
Lewalter, K.
author_sort Lemmen, S. W.
collection PubMed
description PURPOSE: The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today. METHODS: A review of the literature. RESULTS: The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures. CONCLUSIONS: In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.
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spelling pubmed-61824492018-10-22 Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication Lemmen, S. W. Lewalter, K. Infection Review PURPOSE: The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today. METHODS: A review of the literature. RESULTS: The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures. CONCLUSIONS: In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs. Springer Berlin Heidelberg 2018-05-23 2018 /pmc/articles/PMC6182449/ /pubmed/29796739 http://dx.doi.org/10.1007/s15010-018-1137-1 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Lemmen, S. W.
Lewalter, K.
Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title_full Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title_fullStr Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title_full_unstemmed Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title_short Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
title_sort antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182449/
https://www.ncbi.nlm.nih.gov/pubmed/29796739
http://dx.doi.org/10.1007/s15010-018-1137-1
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