One year ago, with the most widespread Ebola epidemic in history, there was a ‘wake up moment’ for Hygiene and Infection Control in hospitals around the world. Health care practitioners stopped and took a look at the importance of hygiene and infection control. It highlighted our preparedness in dealing with outbreaks. It made us realize that with effective hygiene measures you can fight even the most difficult and complicated infections. And it was because of hygiene and infection control, the epidemic was eventually contained.
One year later, the Hygiene and Infection Control department (HIC) of the St. Maarten Medical Center (SMMC) is using International Infection Prevention Week (IIPW) October 18- 24 to raise awareness to Infection Prevention among staff, patients and visitors.
The focus? Antibiotic resistance.
Since the 1940s, antimicrobial agents have been used to greatly reduce illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective (CDC, 2015). With the misuse of antibiotics, antibiotic resistance is becoming a global issue for which all hospitals have to be alert.
Dr. Maarten Visschers, internist-infectiologist at SMMC advocates with the HIC department, “spread the word not the germs.” In doing so, he explains antibiotic resistance and recommends actions that everyone and health care providers can take to reduce the spread of antibiotics resistance.
What is Antibiotic Resistance?
Antibiotic resistance is the inability to use certain antibiotics to treat infections caused by particular bacteria.
How do we become resistant to antibiotics?
Everyone carries bacteria in and on our bodies, even when we are healthy. These are called resident bacteria. When we misuse or overuse an antibiotic, the resident bacteria are attacked. Some survive and adapt to the new antibiotic environment. They make antibiotic resistant genes and pass those genes on to bacteria that make them resistant, and ultimately make us sick.
What is the prevalence Highly Resistant Micro-Organisms (HRMO) on the island?
We do not have sufficient data of the prevalence of ARO in the Dutch Caribbean; within the hospital or in the community. Progress is being made in that aspect, however it is known that St. Maarten does have a higher prevalence of HRMO compared to the Netherlands, in ratio. This makes it challenging to apply Dutch protocols to dealing with these infections.
One reason why HRMO is increasingly prevalent is that “quite often we fly patients abroad and although they receive good care there, these countries usually have a high prevalence of HRMO and many times patients bring these bacteria back to our hospital,” Dr. Visschers.
What does the hospital do to prevent the spread of HRMO?
Dr. Visschers continues, “We want to prevent other vulnerable patients from acquiring HRMO.” The SMMC uses stringent surveillance measures; screening patients who were hospitalized abroad two months prior to their admittance at SMMC. There are other stringent measures, in line with Dutch protocols which are very strict compared to the US and Latin America.
But first, in applying protocols to address HRMO, it is important to learn whether the patient is colonized and infected?
What is the difference between colonization and infection and how is it addressed differently?
“People carry billions of bacteria on their skin and in their bowels which will not lead to disease; this is called colonization. These good bacteria help with digesting food and protect the body against infections. Even if bacteria mutate and become resistant most healthy people never become sick of them. In people with weakened immune systems however, especially after antibiotic use, there can be overgrowth of one bacteria and this imbalance cause sickness; this is called infection. This infection has to be treated by antibiotics; colonization only has to be treated when this bacteria likely causes a problem for the person colonized or the people around him.
Methicillin-resistant Staphylococcus aureus MRSA is one example of the common skin bacteria S. aureus which is carried by 30% of all people but became resistant to a whole group of antibiotics and therefore causes a threat for people with weakened immune systems. It’s not easy to eliminate a MRSA infection, as you have to give antibiotics which are sometimes less effective and have more side effects than the standard antibiotics.
As in other hospitals around the world we do notice an increasing prevalence of HRMO colonization of patients in the SMMC and that’s a worrying trend. We still apply these strict protocols which are sometimes bothersome to the patient and their families but we do so to reduce the spread of these multiresistant micro-organisms to other at-risk people. ”
What can we do?
“Stringent hand hygiene is one of the paramount pillars of infection control,” says Glenda Severin, Infection Control Practitioner. Health care professionals know that they have a responsibility to exercise good hand hygiene. Employees are each other’s advocate, by encouraging each other to practice good hygiene and teaching the patient and family about good hygiene practices.
Quite commonly, family members think that it is okay to sit on the patient bed. This is not safe. The patient is vulnerable to bacteria that are all around us. Avoiding this practice also protects the visitor from possible spread of infections.
At each room entrance there is a hand sanitizer that visitors are also encouraged to use when entering and leaving the room; to reduce risk of spreading to the patient and from the patient when leaving.
Such things are important to keep in mind. Patients too can be advocates in ‘spreading the word, not the germs’. They should not be afraid to ask their nurse, doctor or family member to practice hand hygiene before touching them.
“Close contact is always at risk to get colonized with the bacteria but fortunately the chance that they become sick is low if they are healthy. For our hospital population of vulnerable patients we have to take strict measures but when the patient goes home the family does not need such strict measures if they are not sick or have a weakened immune system. We rather use slightly too strict protocols than slightly too loose protocols. Dr. Visschers explains. In our hospital, we do inform the colonized patient and family of good hygiene measures that should be practiced at home.
Dr. Visschers continues, “Patients should also not abuse or misuse antibiotics. Do not persist in asking for antibiotics when your doctor doesn’t see an indication to prescribe them to you. Do not use other people’s antibiotics and when you do get antibiotics, you should use all of the recommended and finish the whole course.” Globally, doctors too are advised to administer antibiotics wisely and based on evidence.
As we live in a global economy, Hygiene and Infection Control should be everyone’s business. Germs have no borders but we can create barriers to protect our health and reduce risks to antibiotic resistance.