Page 184 - policy and procedure infection control

Policies and Procedures on Infection Control

12.5 Antimicrobial management program/strategies
Success of antimicrobial restriction in hospitals varies on the basis of the genesis of the
antimicrobial resistance program. Workshop on Antimicrobial Resistance in Hospitals:
Strategies to Improve Antimicrobial Use and Prevent Nosocomial Transmission of
Antimicrobial-Resistant Microorganisms in 1994 under CDC have identify five strategic
goals to optimize antimicrobial use (Goldman et al, 1996) :
• Optimizing antimicrobial prophylaxis for operative procedures

• Optimizing choice and duration of empiric therapy
• Improving antimicrobial prescribing by educational and administrative means
• Monitoring and providing feedback regarding antibiotic resistance
• Defining and implementing local guideline (National Antibiotic Guideline as reference)
Paterson, 2006 have recommended implementation of a program using a front-end approach
and back end approach through discussion with and endorsements from the clinical
departments that will be affected (e.g., the ICU, surgical department, emergency department,
and outpatient clinics, as well as other affiliated hospitals).
1. Use of front end approach
• Pre-approval before administration of restricted agents
• Use of special antimicrobial request forms
• Antimicrobial cycling
2. Use of back end approach
• Post-prescription review/Automatic stop order
A back-end approach to antimicrobial management permits empirical use of broad-
spectrum antimicrobial agents, followed by post-prescription review and, then,
by streamlining (de-escalation) or discontinuing antimicrobial therapy on day 2 or
3, if this decision is supported by culture and susceptibility testing results and
by the patient’s clinical response.
3. However, it should be noted that reacting to resistance against individual antibiotics
by instituting antibiotic restriction may lead to increased use of alternate antibiotics,
which, in turn, leads to increased resistance to other antibiotic classes.
4. Feedback mechanism
There are many possible intervention could be proposed to reduce inappropriate or
excessive antimicrobial use but deciding which one is the most effective measures
in any particular setting can be difficult. It is best that each individual hospitals
institute their own programs to improve antimicrobial prescribing practice and to do
comparison before and after each programs is initiated. These programs can be
conducted as quality improvement activities as a continuous process.

12.6 Antimicrobial policy
Addressing the problem of antimicrobial resistance requires both infection control and regulation
of antimicrobial use; addressing either alone is insufficient. Therefore, collaboration with Infectious
Disease physicians, clinical microbiologist and infection control nurses is necessary to
developed strategies to developed antimicrobial policy to improved antimicrobial control.

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