COVID-19 Pandemic Presents Opportunities for Formal Integration of Antimicrobial Stewardship & Infection Prevention Programs

By the bioMérieux Connection Editors

A 2018 paper jointly published by three leading infectious disease organizations (APIC, SHEA, and SIDP) stated that infection prevention and control and antibiotic stewardship programs are inextricably linked.

“The vital work of infection prevention and control and antibiotic stewardship programs cannot be performed independently. They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infection and ensuring that effective antibiotic therapy is available for future generations,” said Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC, lead author of the paper.

This sentiment wasn’t new in 2018—the paper was an update to a 2012 paper that also called for collaborative partnerships between infection prevention and stewardship teams. Complete integration of or a partnership between the two disciplines makes sense. Both programs share a common goal (keeping patients safe and improving patient outcomes) and have similar technological infrastructures, data, and metrics. 

Real-world data supports collaboration between the teams—a 2017 study found that antimicrobial stewardship programs were more effective when implemented alongside infection prevention and control measures. Furthermore, similar data has shown that the addition of stewardship interventions can enhance results of robust infection prevention measures, particularly when addressing an outbreak. The outbreak this data was in reference to was an epidemic of clostridium difficile-associated disease in the mid-2000s, however, the more recent and widespread COVID-19 pandemic presents numerous opportunities for healthcare systems to formally integrate infection prevention and stewardship programs.

The Implications of the Pandemic on Infection Prevention and Stewardship Programs

Due to a CMS rule implemented in 2019, virtually all hospitals are required to have an antibiotic stewardship program, so their presence across the country is becoming ubiquitous. Even though these programs often include physicians and pharmacists with specialized infectious disease training, historically, stewardship programs have not been involved in disaster planning or pandemic response efforts, while infection prevention personnel are normally included. However, antimicrobial stewardship teams are uniquely positioned to aid in pandemic response planning and relief efforts.

Antimicrobial stewardship programs have an advantage in pandemic response efforts, as they are likely to have pre-existing infection prevention experience, they are likely to be involved in response efforts early, and they will already have access to key stakeholders within the organization. Additionally, stewardship teams can play a crucial role in monitoring antibiotic use to help prevent the emergence of drug resistance throughout the pandemic. While COVID-19 dominates healthcare conversations across the world, it is important to not lose sight of antimicrobial resistance, which will persist through and may potentially be exacerbated by the pandemic.

“We recommend that hospital epidemiology programs strongly consider integrating their ASP colleagues into disaster preparedness plans as well as identify a more formal role for stewards in their operations beyond the current COVID-19 outbreak,” stated infectious disease experts in an article published online by Cambridge University Press in early March.

The number of hospitalized COVID-19 patients overwhelmed health systems in many parts of the world, and the U.S. still struggles with escalating cases. Integrated stewardship and infection prevention programs can play a critical, much-needed role in US healthcare systems’ continued response to the pandemic, particularly in the management of antibiotics and development of treatment guidelines. Now is the time to establish partnerships between antimicrobial stewardship and infection prevention programs that can aid in the fight against COVID-19 and continue to protect patients and public health in a post-pandemic world.


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

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