Antibiotic Stewardship.pptx

This ppt is useful for B.Sc.(N). Sem.-3 students. This content is prepared according syllabus of INC 3rd Semester students of B.Sc.(N).

1. Unit - 7 Antibiotic Stewardship By, Ahmed Sodha M.Sc.(N). – M.S.N.

2. INTRODUCTION Anti-biotic:- A Drug Used To Treat Infections Caused By Bacteria And Other Microorganisms. Stewardship:- Supervising, Or Managing Of Something. Or The Careful And Responsible Management Of Something. Antibiotic Stewardship:- It Is The Effort To Measure And Improve How Antibiotics Are Prescribed By Clinicians And Used By Patients.

3. ANTIBIOTIC STEWARDSHIP PROGRAM (ASP) Antibiotic Stewardship Program Is A Coordinated Program That Promotes The Appropriate Use Of Antibiotics, Improves Patient Outcomes, Reduces Microbial Resistance, And Decreases The Spread Of Infections Caused By Multidrug-Resistant Organisms. Definition:- The Antibiotic Stewardship Is A Collective Set Of Methodologies Used In Order To Enhance The Appropriate Antibiotic Use & Reduce The Deleterious Effects Of Antibiotic Use And Also Includes The Awareness Of The Related Aspects Like Antibiotic Resistance, Toxicity & Economic Burden.

4. Purposes Of Antibiotic Stewardship Program (ASP ):- The First Aim Of ASP Is The Optimization Of Proper Use Of Antibiotics In Order To Ensure Better Clinical Implications & Reduction Of Harmful Effects. The Second Aim Is To Make The Antibiotic Usage Cost-effective. The Third Aim Is To Maintain It’s Quality In Patient Care. The Fourth Aim Is To Reduction Of Any Collateral Damage In Case Of Multidrug Resistant Microbial Infections. The Fifth Aim Is To Prevent The Generation And Spread Of Antimicrobial Resistance (AMR) Or Anti-Biotic Resistance (ABR). [The More Antimicrobials We Use, The Higher The Resistance]

5. The 5 R Approach To Antibiotic Stewardship Program:-

6. The 5 R Approach To Antibiotic Stewardship Program (ASP):- To Foster A Culture Of Continuous Improvement, Experts Have Recommended ‘ The 5 R Approach To ASP’ . 1. Responsibility:- Everyone Who Uses Antimicrobials Acknowledges That Use Can Cause Harm. When We Do Use An Antimicrobial, We Should Take Actions That Reduce The Risk For Future Public’s Health. 2. Reduction:- Whenever We Can, We Need To Look For Ways To Reduce Our Reliance On Antimicrobials

7. 3. Refinement:- When We Use Antimicrobials, We Should Ensure That We Are Using The Right Drug, At The Right Dose, At The Right Time, Treating The Right Bug, For The Correct Length Of Time . 4. Replacement:- Consider Non-antimicrobial Products That Could Be Used To Promote Good Health And Prevent Disease. 5. Review:- We Should Be Critical Of Every An Antimicrobial Was Used And Decide On A Specific Strategy For Making Further Improvements And Reductions In Use.

8. CORE ELEMENTS OF HOSPITAL ANTIBIOTIC STEWARDSHIP PROGRAM (ASP):- 1. Leadership Commitment:- It Includes The Dedication Of Necessary Human, Financial & Information Technology Resources. 2. Accountability:- A Single Leader Must Be Appointed For Noticing The Program Outcomes. 3. Drug Expertise:- A Single Pharmacist Leader Must Be Appointed To Improve Antibiotic Use. 4. Action:- The Recommended Actions Must Be Implemented. Ex. Deciding & Implementing The Antibiotic Timeout During The Second Antibiotic Treatment In A Patient.

9. 5. Tracking:- The Antibiotic Prescription & The Antibiotic Resistance Must Be Tracked, Monitored & Recorded Frequently. 6. Reporting:- Reporting Must Be Done By The Requisite Persons To The Doctors, Nurses Staff Regarding The Antibiotic Usage & Resistance If Any. 7. Education:- The Clinicians Must Be Properly Educated About The Appropriate Prescription & Resistance Of Antibiotics.

10. SIGNIFICANCE / IMPORTANCE OF ANTIBIOTIC STEWARDSHIP PROGRAM (ASP ):- Patient Care:- The Quality Of The Care Of Patient Improves If Antibiotic Stewardship Program (ASP) Is Being Practiced In A Hospital Environment. Safety:- The Safety Of The Patient Enhances Due To The Implementation Of The Antibiotic Stewardship Program (ASP). Treatment Failure Reduction:- The Antibiotic Stewardship Program (ASP) Implementation Reduces The Treatment Anomalies As Less Antibiotic Resistance Is Observed.

11. ANTI-MICROBIAL RESISTANCE

12. What Are Antimicrobials? Antimicrobials – Including Antibiotics, Antivirals, Antifungals And Antiparasitics – Are Medicines Used To Prevent And Treat Infections In Humans, Animals And Plants. What Is Antimicrobial Resistance? Antimicrobial Resistance (AMR) Occurs When Bacteria, Viruses, Fungi And Parasites Change Over Time And No Longer Respond To Medicines Making Infections Harder To Treat And Increasing The Risk Of Disease Spread, Severe Illness And Death.  As A Result Of Drug Resistance, Antibiotics And Other Antimicrobial Medicines Become Ineffective And Infections Become Increasingly Difficult Or Impossible To Treat.

13. Antibiotics Are Becoming Increasingly Ineffective As Drug-resistance Spreads Globally Leading To More Difficult To Treat Infections And Death Hence New Anti-bacterial Are Urgently Needed. However, If People Do Not Change The Way Antibiotics Are Used Now T hose New Antibiotics Become Ineffective. Role Of A Nurse In AMR Reduction:- Can Help Minimize The Inappropriate Use Of Antibiotics. Can Help Practice Appropriate Infection Control Practices. Can Educate Patients & People On The AMR Issues & On How To Prevent Them.

14. Multidrug-Resistant Organisms (MDRO):- Multidrug-resistant Organisms Are Organisms That Are Resistant To Multiple Antibiotics Or Antifungals. MDROs Can Be Difficult To Treat, And Therefore, Can Cause Serious Illness Or Even Death. Common MDRO Include:- Vancomycin-Resistant Enterococci (VRE) Methicillin-Resistant Staphylococcus Aureus (MRSA) Extended-Spectrum Β-Lactamase (ESBLs) Producing Gram-Negative Bacteria Carbapenem Resistant Enterobacteriaceae Or Carbapenem Resistant Pseudomonas. Multidrug-Resistant TB (MDR-TB) is Caused By An Organism That is Resistant To At Least Isoniazid And Rifampin, The Two Most Potent TB Drugs.

15. Methicillin-Resistant Staphylococcus Aureus (MRSA ):- Introduction:- Staphylococcus Aureus  Is A Bacterium That Is Carried On The Skin Or Nasal Lining Of Up To 30 Percent Of Healthy Individuals. In This Setting, The Bacteria Usually Cause No Symptoms. However, When The Skin Is Damaged, Even With A Minor Injury Such As A Scratch Or A Small Cut From Shaving, Staphylococcus Aureus Can Cause A Wide Range Of Problems. These Problems Can Range From A Mild Pimple To Severe Illness, Especially In Young Children, Older Adults, And People With A Weakened Immune System.

16. Where Did Methicillin-Resistant Staphylococcus Aureus (MRSA) Come From? Initially, Most  Staphylococcus Infections Were Sensitive To Penicillin. In The 1950s, Many Infections Became Resistant To Penicillin And Methicillin (A Related Drug Developed To Treat These Germs). Thus, The Term Methicillin-Resistant Staphylococcus Aureus (MRSA) Was Derived. MRSA Must Be Treated With Alternate Antibiotics.

17. How is Methicillin-Resistant Staphylococcus Aureus (MRSA) Spread? You Can Be "Colonized" With MRSA, Meaning That You Carry The Bacteria On Your Skin Or In Your Nose But You Have No Signs Or Symptoms Of The Illness. You Can Become Colonized With MRSA By Touching The Skin Of Another Person Who Is Colonized With MRSA, And By Touching A Contaminated Surface (Such As A Door Handle, Phone e tc.)

18. Treatment Of MRSA:- Treatment Of MRSA Usually Includes A 7- To 10-day Course Of An Antibiotic Such As Trimethoprim- Sulfamethoxazole , Clindamycin, Minocycline, Linezolid, Or Doxycycline. It Is Very Important To Carefully Follow The Instructions For Taking The Antibiotic; This Means Taking It On Time And Finishing The Entire Course Of Treatment, Even If You Feel Better After A Few Days. In The Hospital, If You Are Colonized But Not Infected With MRSA , You May Be Treated With Mupirocin Ointment And Chlorhexidine Soap.

19. Prevention of MRSA & MDRO Infections in A Healthcare Setting 3. Antimicrobial Usage Restrictions 2. Environmental Preventive Measures Cleaning & Disinfection Preventing Understaffing & Reducing Overcrowding of Patients 1. Core Preventive Measures Standard Precautions Contact Precautions Surveillance Decolonization

20. Prevention of MRSA & MDRO Infections in A Healthcare Setting:- The Following Are The Key Preventive Measures Of The MRSA & MDRO Infections Spread In Healthcare Setting: Core Preventive Measures Environmental Preventive Measures Antimicrobial Usage Restrictions

21. Core Preventive Measures:- This includes following preventive measures: Standard Precautions:- It Includes The Very Basic Measures Like The Use Of PPE Like Gloves, Gown, Face Masks, Eye Shield, Etc. That Must Be Used Appropriately In A Healthcare Facility. Hand Hygiene Is Another Very Important Standard Precautions In Order To Decrease The Spread Of The MRSA & MDRO And Must Be Followed & Monitored At All Levels In Healthcare Setting. Keep Hands Clean By Washing Thoroughly With Soap And Water. Hands Should Be Dried With A Single-use Towel Like A Paper Towels. Alcohol-based Hand Sanitizers Are A Good Alternative For Disinfecting Hands If A Sink Is Not Available.

22. The Contact Precautions:- The Contact Precautions Like Wearing Of The Gloves, Gown, Mask etc. Must Be Practiced Strictly While Dealing With The Suspected Or Confirmed Cases Of Colonized Or Infected MRSA/MDRO Cases In Hospital Environment. Avoid Touching Other People's Wounds Or Bandages. Use Of Disinfectant On Surfaces Like Tables, Counters, Doorknobs, Phones, Computer etc.

23. Surveillance:- The Periodic Or Routine Inspection Within A Healthcare Facility Must Be Done At The Following Two Levels: Patient’s Surveillance:- Screening Must Be Done To Detect Carriers Known As The Main Reservoir Especially During Admission To The Hospital & The Incident Cases That Is Who Get MRSA Infection From The Hospital Environment Later. Healthcare Workers Surveillance:- The Healthcare Workers Must Be Screened Especially Those Working In The High-risk Areas Like ICU, Burn Units, Surgical Areas, Dialysis Wards Etc. Decolonization:- Nasal 2% Mupirocin, Chlorhexidine Gel Washing & Systemic Antibiotics Can Be Used For Decolonization Of Healthcare Workers & Colonized Patients With Or Without Symptoms.

24. 2. Environmental Preventive Measures:- This includes following preventive measures: Cleaning & Disinfection:- Enhanced Cleaning & Disinfection Of The Hospital Environment Results In The Reduction & Control Of The MRSA & MDRO Outbreaks. Preventing Understaffing & Reducing Overcrowding of Patients :- The Patient-staff Ratio Must Be Conductive & Maintained In A Healthcare Facility In Order To Make The Infection Prevention Policies More Effective.

25. 3. Antimicrobial Usage Restrictions:- The Over Usage Of Antibiotics Must Be Avoided & Its Overuse Must Be Monitored As Far As Possible By Educating, Updating & Supervising The Patients, Families & The Staff.