Smarter, cleaner approach needed to fight superbugs
Lindsay Grayson July 14, 2012
IF AN alien from outer space were to assess what humans have done with antibiotics, they would surely consider us a rather stupid species. Since the first key antibiotic, penicillin, was invented in the early 1940s we have misused and wasted these precious compounds to the point that they are often no longer effective.
Each year in Australia, an increasing number of patients die due to infections which are untreatable with all currently available antibiotics. The reason is multi-drug resistance (MDR).
There are many reasons for the current MDR situation. They include the misuse of antibiotics in humans, the ridiculous use of antibiotics in farming to assist in “growth promotion” or to prevent disease due to overcrowding related to intensive farming practices, and even the recent use of antibiotic sprays in some Asian countries for fruit and vegetables.
Additionally, the abandonment of antibiotic research by the pharmaceutical industry in favour of more profitable “lifestyle” drugs such as Viagra and anti-cholesterol medications has meant there are few new agents to fill the gap. Unfortunately, the reasons almost don’t matter any more because MDR is now almost unstoppable if we continue with our present attitudes. We need to assume MDR is certain to spread in our community and affect our health system.
More below
To have any chance of control, we must return to the basic approaches that were employed before antibiotics were available. In my view there are five key steps to controlling MDR superbugs.
First, hygiene must be improved, especially the use of new alcohol-based hand-rubs. These have dramatically reduced the risk of ”golden staph” infections in Australian hospitals, since this bug is primarily transmitted on healthcare workers’ hands and on shared hospital equipment. Studies in Victoria have shown a greater than 50 per cent reduction in the risk of acquiring MDR golden staph in hospitals after only two years of the program. Although the program costs only $2.50 per patient admission to maintain, long-term funding remains insecure.
Also, not all Australian medical schools include the use of alcohol-based hand-rub in their curriculums and medical staff lag behind other healthcare worker groups in their rates of hand hygiene compliance.
Improved hospital cleaning should be another priority. Over the past 25 years in Australia there has been a steady decline in the importance placed on hospital cleaning, with cleaning staff now one of the lowest paid and often least educated groups. But recent initiatives at the Austin Hospital, including a skilled cleaner training program, a “new” bleach-based cleaning agent and an infection control committee, resulted in marked reductions in the level of contamination by superbugs.
More below
It would shock most patients to know that Australia has no standard approach to inserting and managing invasive devices. Among the multitude of hospital protocols, few require the use of sterile gloves or formal training (simply “watch one, do one, teach one” is enough). Yet devices such as intravenous drips frequently become infected and are the main cause of hospital-associated bloodstream infections. A single set of standards for all hospitals is needed if we are to reduce the spread and frequency of serious MDR infections.
Other than golden staph, most key superbugs live in the gut and are spread in faeces. Put simply, this means hospital architects should aim for “one bum per toilet” when designing Australian hospitals. Thus, hospital design that prioritises having a large number of single rooms, each with an en suite bathroom, minimises the risk of cross-transmission of superbugs.
Finally, better antibiotic stewardship is needed. In Australia, our consumption of antibiotics is among the highest in the developed world – ironically, mostly for viral infections that do not respond to them. Thus, a greater emphasis is required on rapid diagnostic tests to establish whether a bacterial infection is indeed present before an antibiotic is supplied. We should emulate the Scandinavian countries, where antibiotics are highly regulated and GPs are rewarded for investigating the patient before prescribing.
The art of good prescribing is to use the most effective narrow-spectrum antibiotic, in the correct dose for the correct duration, to maximise the effect against the pathogen and minimise disruption to a patient’s routine “good” bacteria, which help form a natural defence against superbugs.
Unless we return to the basics of managing infections we are headed for a difficult time.
Professor M. Lindsay Grayson is director of infectious diseases and microbiology with Austin Health, University of Melbourne.
Discussion
No comments for “Fighting Superbugs”