Infection Control Teams

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Infection Control Teams Antibiotic Pharmacists
the Team Approach

• Clare Colligan Antibiotic Pharmacist
• Sybil Solomon Nurse Consultant Infection Control

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Overview of the role of Nurse Consultant
Infection Prevention and Control

• Multi faceted
• To provide leadership and supervision to
  infection control service delivery area wide on
  prevention and control of infection including
  independent contractors to ensure compliance with
  national initiatives, guidance and standards
  working with a range of staff cross the board
  i.e. strategically and operationally
• Responsibilities in a wide ranging portfolio
  which reflects the HAI Task Force Action Plan and
  local Infection Control Programme based on
  clinical/expert practice, education and training,
  professional leadership and consultancy, research
  to improve the quality of patient care through
  audit and evaluation of practice and working in
  collaboration with clinical teams
• Other involvements member of SIGN review team
  for antibiotic prophylaxis guideline, member of
  SAPG, co-author for NES module colonisation v.
  infection

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Antimicrobial Stewardship what that means for
the Infection Control Team? (1)

• The action of prescribing an antibiotic is the
  end point of a process in making a decision to
  treat based on clinical findings e.g. signs and
  symptoms, patient examination, microbiological
  sampling supported by documented evidence. Its
  the elements of the decision making process that
  infection control teams can be proactive with.

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Antimicrobial Stewardship what that means for
the Infection Control Team? (2)

• Based on a small study in 6 primary care of
  elderly wards (111 prescriptions for 90 patients)
  to investigate compliance with antibiotic
  prescribing guidelines for the three commonest
  infections i.e. UTI, RTI, S/STI, the following
  were identified
• Incidence of antibiotic prescribing 43
• Prevalence of antibiotic prescribing 17
• Patient examination 40
• Annotation of SS 65
• Microbiological samples obtained 35 of which 59
  positive distinction between colonisation and
  infection not made
• Clinical indication for therapy recorded in
  patient notes 85
• Where therapy met guidelines administration often
  exceeded it.

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Antimicrobial Stewardship what that means for
the Infection Control Team? (3)

• Its in the context of these findings that the
  infection control team can lead
• Antimicrobial prescribing -
• Raise awareness of implications to the patient
  and professional accountability
• Ensure that SS, patient examination and
  microbiological sampling are undertaken and
  recorded if it isnt recorded then it didnt
  happen
• Provide education on the difference between
  colonisation and infection
• Ensure accurate giving of information - consider
  utilisation of SBAR methodology to standardise
• Surveillance
• Share data collected for CDAD, SABs etc.

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Antimicrobial Stewardship What that means for
the Antibiotic Pharmacist

• Antibiotic guidelines
• Limit misuse of antibiotics
• Indication
• Correct drug, route, dose
• Monitoring
• Consumption data
• Audit

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How the Antibiotic Pharmacist and the Infection
Control Team started to work together!

• Review of structure and membership of AMG
• ScotMARAP action plan
• Links to surveillance results e.g. CDAD and SABs
• Results of NCIC dissertation study shared with AP
  and AMG
• Proposal to meet the requirements of ScotMARAP
  (2008), NHS Forth Valley Antimicrobial Management
  Group Action Plan, CEL 11 (2009) A Revised
  Framework for National Surveillance of HAI and
  HEAT target for CDAD, national study (ESAC) of
  antimicrobial prescribing (2009).

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Working together primary care (1)

• ESAC audit
• NCIC and PC Antibiotic Pharmacist to work with
  physicians and GPs to develop awareness around
  common infections and develop awareness of CDAD
  in primary care
• Joint study day for Charge Nurses on CDAD and
  antimicrobial management and infection control
  measures to minimise cross infection
• NCIC and PC Antibiotic Pharmacist to work with
  nursing staff around ensuring appropriateness of
  antibiotic prescribing based on algorithms
  produced for commonest infections

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ALGORITHM FOR PRESCRIBING ANTIBIOTICS IN URINARY
TRACT INFECTIONS IN THE ELDERLY (adapted from
Loeb et al, 2001)
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Working together - primary Care (2)

• CREATE sessions for GPs infection control /
  antibiotic prescribing
• CDAD
• Cause
• Management
• Antibiotic prescribing
• Enhanced service

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Working together acute care(1)

• Sharing information
• Infection control surveillance data collected by
  surveillance nurse for CDAD, SABs
• Infection control routine surveillance of all
  positive microbiological results
• Antibiotic Pharmacist input to data collection
  forms for CDAD
• Using infection control surveillance data the
  Antibiotic Pharmacist can identify which
  antibiotics patients are prescribed in relation
  to CDAD and SABs reports sent regularly
• Antibiotic Pharmacist surveillance data on
  antibiotic use can assist the infection control
  team in identifying prescribing issues from an
  antibiotic utilisation report if there is a
  perceived problem identified through routine ward
  visits, increased numbers of cases etc.

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Acute Care
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Working together (3)

• CDAD Policy and ICP
• Review of CDAD cases multi disciplinary
  including clinician, ICT, microbiologist,
  Antibiotic Pharmacist

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Working Together - MRSA/ MSSA SABs

• Appropriate antibiotic use
• Peripheral venous catheter care bundles
• Timely IV to oral switch
• Reduce venflon associated infections
• MRSA eradication pharmacists review kardexes

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The Future (1)

• Utilise all the data that is collated
• Reduce duplication
• Enhance the monitoring already in place
• Infection control surveillance data collected by
  SSI officer for SSI
• C section, abdo hysterectomy, hips, knees,
  long bones) SSI surgical antibiotic
  prophylaxis
• SPSP surgical prophylaxis data

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The Future (2)

• MDT events
• Spread the message prevent infection, reduce
  antimicrobial use
• Develop decision support models for common
  infections and implement in LTC facilities

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