Hospital survey highlights challenges for infection control, antibiotic stewardship programs

Doctors consulting with nurses

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A survey of healthcare facilities in the United States and seven other countries found that infection prevention and control (IPC) and antibiotic stewardship program (ASP) interventions requiring staff, time, and specialized training were implemented less frequently in 2021, researchers reported today in Infection Control and Hospital Epidemiology.

The Society for Healthcare Epidemiology of America Research Network (SRN) survey was completed by 50 of 91 healthcare facilities that collaborate on research studies related to antibiotic stewardship and healthcare epidemiology. Previous surveys were conducted in 2013 and 2018 to evaluate IPC and ASP interventions among SRN-affiliated facilities. The facilities participating in the 2021 survey were from 21 US states, with one facility each in Canada, Mexico, Spain, South Korea, India, Egypt, and the United Arab Emirates.

Surveillance, stewardship down

The survey found that surveillance for multidrug-resistant organisms was performed by most facilities in all three survey periods, with surveillance for methicillin-resistant Staphylococcus aureus (MRSA) the most common (86%) in the 2021 survey, followed by carbapenem-resistant Enterobacterales (78%). Twenty-six facilities (52%) reported surveillance for Candida auris, which was not included in the previous surveys.

But compared with the 2018 survey, the proportion of facilities conducting surveillance for healthcare-associated infections (HAIs) declined slightly, with fewer facilities reporting surveillance for central-line bloodstream infections (96% vs 100%), catheter-associated urinary tract infections (90% vs 95%), hospital-onset Clostridioides difficile infection (86% vs 89% in 2018), and ventilator-associated pneumonia (74% vs 81%). Trends in public reporting of HAIs was variable.

Overall, the 2021 SRN survey results have emphasized the challenges facing IPC programs and ASPs, underscoring the lack of trained personnel and time to complete key activities.

Among ASP interventions, pre-authorization or formulary restriction was used by a greater proportion of facilities in 2021 compared with 2018 (93% vs 80%), but prospective audit and feedback was used in fewer facilities (74% vs 93%). Staff education, pharmacy-driven interventions, and monitoring antibiotic days of therapy were also less frequent.

The greatest challenges cited for IPC programs were lack of trained personnel or staffing constraints (42%), insufficient time devoted to frontline staff (42%), and insufficient information technology or data support (40%). For ASPs, insufficient information technology (40%), insufficient financial support (36%), and insufficient time to perform work responsibilities (36%) were the biggest challenges.

Possible impact of COVID-19

The authors note that while the survey didn't specifically ask about the impact of the COVID-19 pandemic, the findings likely reflect pandemic-related demands on hospital staff. They say the pandemic highlighted the need to bolster resilience in systems by investing more in technology and data support and embedding automated solutions that can be relied on during staffing crises.

"Overall, the 2021 SRN survey results have emphasized the challenges facing IPC programs and ASPs, underscoring the lack of trained personnel and time to complete key activities," they wrote. "Regulatory bodies may consider revising HAI and stewardship metrics to capture meaningful data that rely less on personnel time, and hospitals should invest in automated data collection, analysis, and reporting to liberate person-power to frontline activities."

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