| | NOVEMBER 20239UTLOOKHealthcare Tech It is time to double down on prioritizing practices and interventions to improve patient outcomes and to slow the spread of MDROsRe-Focus on PreventionGetting `Back to the Basics' has never been more important. Hardwired prevention strategies incorporating hand hygiene, cleaning and disinfection, vaccinations, and standard precautions are impactful in reducing the risk of HAIs and improving outcomes. However, on the tail end of the pandemic peak, many organizations are identifying opportunities to reengage the team in these basic but necessary principles. Hand hygiene programs such as the World Health Organization's (WHO) 5 Moments for Hand Hygiene or CDC's Clean Hands Count offer simple educational products for patients and healthcare workers. Personal protective equipment (PPE) is no longer in critical supply and should be used as single use only with standard and transmission-based precautions as guidance. Respiratory hygiene and cough etiquette are still of very high importance as COVID and other respiratory illnesses such as influenza and respiratory syncytial virus (RSV) continue to circulate; ensuring facilities have simple, posted reminders and easily available masks and tissues can go a long way in improving compliance. Lastly, care should be taken to clean and disinfect patient equipment and the environment to aid in reducing the transmission of infectious organisms. Infection prevention education for patients and the community should be cognizant of health equity and hygiene poverty or lack of availability or access to products to clean oneself or their environment. Scrutinize Culture Collection TechniquesPoor culture collection techniques continue to be of concern, potentially exposing patients to unnecessary antibiotics and increased length of stay. It is important to practice diagnostic stewardship and obtain cultures only on patients that require them and based on the signs and symptoms displayed and source potential. 'Pan culturing' practices should be avoided. For blood cultures, stewardship includes hand hygiene, proper skin antisepsis, blood culture bottle disinfection, proper fill volume of culture bottles, collection before antibiotic administration, and venipuncture collection versus collection via central venous or peripheral catheters. Diversion devices have become commercially available to decrease contamination potential, as well. Urine cultures are of further concern due to contamination risk and the prevalence of asymptomatic bacteriuria (ASB) that is common in women, the elderly, and certain comorbid populations and tends to lead to unnecessary use of antibiotics to treat this benign condition. Additional principles of urine culture stewardship include proper cleansing of the perineum prior to collection and, for patients with indwelling catheters, changing of the catheter prior to collection unless contraindicated to avoid culturing of biofilm. Examine Antibiotic Use and NecessityHealthcare facilities are responsible for tracking, monitoring, and reporting antibiotic use. Prescribers, nurses, pharmacists, and patients should receive education about antibiotics and antibiotic resistance but cannot be used alone as a strategy. Regular distribution of facility antibiotic use and resistance summaries should occur along with prescriber-specific details and comparisons to promote accountability. Additionally, patient and staff education is essential to improve antibiotic prescribing practices and usage and is most effective when tailored to the individual. Maintaining a strong partnership and engagement with pharmacists can identify and improve prescribing practices. Key actions incorporating audit and feedback, preauthorization, facility-specific treatment guidelines, and utilization of common treatment interventions for lower respiratory tract infections, urinary tract infections, and skin and soft tissue infections improve antibiotic prescribing and usage. ConclusionIt is time to double down on prioritizing practices and interventions to improve patient outcomes and slow the spread of MDROs. The advances made in antibiotic use, antimicrobial resistance, and HAI prevention before the pandemic are recoverable, and small changes can greatly impact overall infection prevention and safety. HT
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