Commentary: C-suites should see antibiotic stewardship and infection control as one issue

The time has come for two important, but distinct, healthcare conversations to converge in hospital C-suites across America: combating healthcare-associated infections and promoting antibiotic stewardship.

Improving patient and safety outcomes is every healthcare professional's goal. But thanks to value-based payment strategies, infection control now is front and center on hospitals' clinical dashboards as they work to limit their exposure to Medicare penalties for healthcare-acquired conditions.

Meanwhile, the corps of allied professionals that hospitals have deployed to prevent infections have joined with others across the sector in another important national conversation: the need for better antibiotic stewardship because of the danger posed by antimicrobial resistance.

These conversations should no longer take place in silos. Antimicrobial resistance is a serious concern because organisms that build multidrug resistance are a leading cause of a significant number of healthcare-associated infections. They are also difficult to treat because there are fewer and, in some cases, no antibiotics that will cure the infection. In a 2013 report, the Centers for Disease Control and Prevention estimated that approximately 2 million people a year become infected with bacteria that have become resistant to antibiotics, and of those, at least 23,000 die.

In addition to the human cost, hospitals face an economic cost as result of a disproportionally high number of HAIs. For example, in fiscal 2017 769 hospitals lost 1%, or approximately $430 million, of their Medicare payments for being low performers on hospital-acquired conditions.

As a result of the 2015 White House National Action Plan for Combating Antibiotic-Resistant Bacteria and other regulatory changes, fiscal 2017 was also the first year that the spread of antibiotic-resistant bacteria, in the form of methicillin-resistant Staphylococcus aureus and Clostridium difficile infections, was included in the assessment. Thus, the problem of antimicrobial resistance is directly tied to HAIs, which in turn affect patient outcomes and hospital reimbursements.

In a new and timely position paper published jointly, the Association for Professionals in Infection Control and Epidemiology, the Society for Healthcare Epidemiology of America and the Society of Infectious Disease Pharmacists conclude that infection prevention and control and antimicrobial stewardship programs are intrinsically linked. As allied professionals, we believe that a well-functioning prevention and control program is central to a successful antibiotic program and should be recognized as such throughout the sector, but especially in hospitals.

The goals of both programs are the same; keep patients safe and improve outcomes, regardless of where care is delivered. However, the programs are not always in sync, and that's a problem. For example, to change practices and protocols it is important that clinicians and doctors rely on evidence-based infection-prevention and -control interventions, such as robust hand-hygiene interventions to prevent infections in the first place, reducing the demand for antibiotics. In addition, given that these programs are two sides of the same coin, planning, executing and measuring their success simultaneously is a more efficient use of resources and reduces the likelihood of redundant patient safety initiatives.

Health system leaders must take the lead to maximize the effectiveness of these programs by aligning them and funding them adequately. Prioritizing these efforts fulfills dual purposes. Harnessing their synergy by creating and sustaining infrastructure will spread best practices widely across the patient-care continuum. It is also smart business. Adequately staffing these programs will lead to better patient outcomes and fewer hospital-acquired infections, avoiding Medicare penalties.

As our healthcare system continues its transition to a value-based system, infection prevention and antimicrobial stewardship are going to be at the forefront. Healthcare leaders need to recognize that these goals cannot be achieved independently.

Katrina Crist is CEO of the Association for Professionals in Infection Control and Epidemiology. Eve Humphreys is executive director of the Society for Healthcare Epidemiology of America.