A new report released today by HIQA on how public acute hospitals are protecting patients from the growing threat of antimicrobial resistance has found that while many hospitals have made significant progress to reduce these risks, more needs to be done in hospitals and the community to better protect patients.

While progress has been made in larger hospitals in implementing best practice in managing and using antibiotics, the level of progress identified varied across the country, with some smaller hospitals not having safe and sustainable measures in place to protect patients. In addition, more effective national planning and coordination is required to ensure that the entire health system is as prepared as it can be for what is an increasing and serious challenge for healthcare providers.

Sean Egan, HIQA’s Acting Head of Healthcare Regulation, commented: “Resistance to antimicrobials continues to increase in Ireland and internationally. In some instances, the level of antimicrobial resistance now being detected leaves clinical staff with a very limited choice of medicines that they can use to try to treat people. Ensuring prudent antimicrobial usage, through antimicrobial stewardship, should be a priority across all health services to help to address this problem.’’

‘‘This review examined how well public acute hospitals implement antimicrobial stewardship best practice. We identified that a number of hospitals need urgent support from the national Health Service Executive (HSE) in this area, as they do not have an antimicrobial stewardship programme in place and lack specialized resources. This is a significant patient safety concern and should be reviewed as a matter of urgency by the HSE.”

More broadly, this review explored how the HSE is addressing the wider risks of antimicrobial resistance through antimicrobial stewardship and infection prevention and control. It found that while MRSA and Clostridium difficile rates have fallen in Ireland, the incidence of multi-drug resistance amongst Gram-negative organisms — which can cause a number of different infection types including urinary tract and bloodstream infection, and which may be more difficult to treat — is increasing.

Sean Egan continued: “A number of these Gram-negative bacteria are highly resistant, and are associated with serious infections, up to and including life-threatening sepsis. Unlike MRSA, patients who carry these bacteria cannot be treated to eradicate them from their bodies. Antimicrobial prescribing and infection control practices in hospitals, and equally in community health and social care settings, needs to be of a high standard to fully address this emerging problem.”

“Therefore, the nature of this change requires a different, nationally coordinated response by the HSE and in particular be extended beyond acute hospitals into other non-acute residential and community care settings.”

The national plan to deal with these problems in Ireland has not been updated since 2001 and a new one is urgently needed.

Sean Egan concluded: “This review found much commendable progress by highly committed front-line staff in advancing antimicrobial stewardship, but this has been hampered by the lack of an up-to-date national plan in this area. There are pockets of excellence in some hospitals, yet others lag behind, and progress in non-acute settings such as nursing homes has been very limited. More needs to be done to ensure that good practice in this area becomes the routine norm.”

Ends

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA
01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Notes to the Editor:

Antimicrobial resistance — a major and growing threat

The ability to treat infection with antimicrobial agents represented one of the major technological triumphs of the 20th century. Millions of lives have been saved or improved globally since the discovery of penicillin, and other antimicrobial agents. However, resistance to antimicrobials has begun to outpace the discovery of new antimicrobial medicines, with highly resistant — and indeed untreatable — infection beginning to emerge in some parts of the world. The World Health Organization has declared this to be a ‘major global threat’ to healthcare. A recent report commissioned by the UK government has estimated that if left unchecked, this problem could conservatively account for in excess of 10 million global deaths annually by 2050, more than cancer and diabetes combined.

What is antimicrobial stewardship?

Antimicrobial stewardship programmes aim to ensure that every patient receives the right antimicrobial therapy at the right dose, route and duration, and for the right infection type at the right time. In addition, it also intends to ensure that therapy is continually reviewed, refined and discontinued where the patient’s condition allows.