WAAW Blog: The importance of infection prevention and control in tackling AMR – reflections from an NHS England Antimicrobial Stewardship Regional Lead
Dr Naomi Fleming
NHS England Antimicrobial Stewardship Regional Lead
The importance of infection prevention and control in tackling AMR – reflections from an NHS England Antimicrobial Stewardship regional lead
Antimicrobial resistance is a natural evolutionary phenomenon. When micro-organisms are exposed to an antimicrobial, the more susceptible ones die off, leaving behind those that are resistant. They can then pass on their resistance to the next generation. As we share our micro-organisms with each other through touch, inhalation, etc and with the growth of global trade and travel, resistant micro-organisms can spread promptly to any part of the world (WHO, 2017).
As a result of antimicrobial resistance (AMR), standard treatments become ineffective and infections have more opportunity to spread to others. The O’Neill (2016a) report estimated that by 2050, 10 million lives a year and a cumulative $100 trillion of economic output will be at risk due to the rise of drug-resistant infections if we do not find proactive solutions to slow down drug resistance.
I am the antimicrobial stewardship (AMS) lead for the East of England, antimicrobial stewardship programmes to reduce inappropriate prescribing of antimicrobials are an important way to tackle AMR, however, reducing the need for antimicrobial therapy by reducing infected patients is also key to driving down AMR acquisition. The less people get infected, the less they need to use medicines such as antibiotics, and the less drug resistance arises (O’Neill, 2016a). It is imperative that IPC and AMS teams work closely together to prevent and manage infections and prevent AMR. The first comprehensive analysis of global impact of AMR across 204 countries and territories estimated resistance itself caused 1.27 million deaths in 2019 – more deaths than HIV/AIDS or malaria – and that antimicrobial-resistant infections played a role in 4.95 million deaths. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis – The Lancet (2022) If all drug-resistant infections were replaced by no infection, eg were prevented with IPC, 4·95 million deaths could have been prevented in 2019, whereas if all drug-resistant infections were replaced by drug-susceptible infections, 1·27 million deaths could have been prevented.
Poor infection prevention and control can increase the spread of drug-resistant infections (WHO, 2017). Poor IPC practices will speed up the pace at which new drug-resistant infections emerge. A failure to control infections in care settings provides greater opportunities for resistance to occur and resistant micro-organisms to spread, while high incidence of infection results in increased demand for antibiotics – a catalyst to rising drug resistance (O’Neill, 2016b).
Interventions that reduce the opportunities for infections to spread therefore have significant potential not just to lower the burden of mortality and morbidity associated with infections, but also to limit opportunities for drug-resistant strains to emerge. The simplest way that all of us can help counter the spread of infections is by proper hand washing (O’Neill, 2016a).
Vaccines are important to prevent infections, particularly in vulnerable groups lowering the demand for antimicrobial treatments, reducing use of antimicrobials and therefore slowing the rise of drug resistance. This is true for vaccines that prevent bacterial infections and it is also true for vaccines that prevent viral infections, such as flu, which should not be treated with antibiotics but often is. (O’Neill, 2016c).
Correct use of personal protective equipment, safe use and disposal of sharps, correct waste disposal, appropriate use and management of long-term urinary catheters, correct procedures during enteral feeding and the management and prompt removal of unnecessary vascular access devices can also prevent unnecessary infection. National Institute for Health and Care Excellence. Healthcare-associated infections: prevention and control in primary and community care. 2012. https://www.nice.org.uk/guidance/cg139
IPC is key to reducing demand for antimicrobial use and therefore reducing the acquisition of AMR. IPC in community settings is as important as IPC in an acute setting. Hand washing is the simplest way to prevent infection spread and vaccinations are a fundamental intervention to prevent infection in the susceptible host.