The Most Trusted Professionals in the U.S.: How Nurses Can Impact Antimicrobial Stewardship Programs

By the bioMérieux Connection Editors

As antimicrobial resistance (AMR) has become a growing global health threat, stewardship initiatives to preserve antibiotic efficacy have become increasingly crucial. As of 2019, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. This is an increase from 2 million and 23,000, respectively, reported in 2013. Antimicrobial stewardship programs (ASPs) have been proven to improve individual patient outcomes and reduce the overall burden of AMR.

Amid the COVID-19 pandemic, ASPs may be more important now than ever before. Many resistant infections are healthcare-associated infections (HAIs), affecting patients who are receiving treatment for other conditions. AMR poses a significant additional threat to COVID-19 patients, especially as healthcare systems become overburdened.

Nurses are in a Position to Make a Difference in ASPs

In the past, the development of antimicrobial stewardship efforts mainly focused on prescribers and pharmacists. Today, as the threat of AMR increases, there is growing recognition of the need for efforts to also focus on other stakeholders in antibiotic use—particularly nurses. Nurses have widespread involvement in practices that directly relate to antimicrobial use. Additionally, the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs call for a multidisciplinary approach to improving antibiotic use, and both the CDC and The Joint Commission specifically highlight the need to engage nurses as part of the multidisciplinary effort.

Nurses are in a strong position to take part in and promote stewardship. Nurses perform a central role, closest to the patient and their family, at the hub of communication among all stakeholders in antibiotic use. The American public also overwhelmingly views nursing as the most trusted profession. This opens the door for nurses to be educators, advocates, and ambassadors for widespread change to develop greater awareness of antibiotic resistance and more prudent antibiotic use in our society.

Nurse-Driven Stewardship Practices & Engagement

In July 2016, the CDC and the American Nurses Association (ANA) hosted a conference in which nurses from around the U.S. discussed strategies to promote nurse-driven AMS and to identify specific nurse-driven stewardship activities. The workgroup ultimately provided suggestions on how nurses can fully participate and engage in ASPs, to demonstrate the value of nursing within the programs. These suggestions included a list of the roles that nurses can and should play in working to improve antibiotic use, the education and training requirements to perform those roles, and ways to become engaged at the national and hospital level.

One method by which nurse-driven AMS may be accomplished is through implementing short extensions to nurses’ current roles. A 2018 study that explored the nurse’s role in antibiotic stewardship determined five practices nurses can do to take part in ASPs. Three were perceived most favorably by the clinical nurses, nurse managers and infection preventionists that participated. Specifically, questioning the necessity of urine cultures, ensuring proper culturing techniques, and encouraging the prompt transition from intravenous to oral (IV to PO) antibiotics were found to be relevant practices that didn’t challenge traditional nursing responsibilities.

Because of nurses’ widespread involvement in practices that directly relate to antibiotic use, there is a belief that an absent partnership between ASPs and nurses limits the success of the programs. So, the question is not whether to involve nurses in ASPs, but how. Front-line ASPs should allow nurses to participate and fully engage and, according to the CDC and ANA, their overall measurement approach should evaluate nursing impact on antimicrobial use. In this way, nurses can make a difference when it comes to the success of ASPs and the fight against AMR.


Opinions expressed in this article are not necessarily those of bioMerieux, Inc.

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