•
Hands must be decontaminated with alcohol hand rub directly before and after any episode of direct contact with the patient, and following any contact with the patient’s equipment and environment in accordance with the 5 Moments of Hand Hygiene (See Chapter 12).•
Gloves and aprons must be changed in between each task or episode of patient care performed for the patient, and following any contact with the patient’s equipment (see Chapter 13).138
•
Neutropenic patients must have their own dedicated patient equipment (e.g. dynamap, blood pressure cuff, tourniquet and commode).•
As previously stated, neutropenic patients must not be placed in beds next to patients who are known to be colonised or infected or who have open wounds (including leg ulcers). Addi- tionally, they must not be exposed to staff or visitors who may have infections (e.g. coughs, colds or cold sores).•
Sepsis is the leading cause of death in intensive care units.•
Eighteen million people worldwide die from sepsis each year.•
Septic shock, a complication caused by bacterial toxins, is characterised by hypotension which does not respond to fluid resuscitation.•
The early identification of sepsis and implementation of aggressive treatment are keys to patient survival.•
Neutropenic sepsis is a recognised complication of treatment for cancer and is an acute medical emergency; its management is a clinical priority in the United Kingdom.•
Following chemotherapy or radiotherapy, patients are susceptible to overwhelming opportunistic infections which may be acquired endogenously.•
In patients admitted with neutropenic sepsis, ‘door to needle time’ is of paramount importance (blood culture to be taken and IV antibiotics to be commenced within one hour of admission).•
Neutropenic patients admitted to a general surgical or medical ward do not necessarily have to be admitted to a single room but must not be exposed to colonised or infected patients or to staff or visitors who may have infections.Chapter summary: key points
Further resources are available for this book, including interactive multiple choice questions. Visit the companion website at:
www.wiley.com/go/fundamentalsofinfectionprevention
139
References
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Daniels R. (2011). Surviving the first hours in sepsis: getting the basics right (an intensivist’s approach). Journal of Antimicrobial Chemotherapy. 66 (2): 11–23.
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National Institute for Clinical Excellence (NICE) (2012). Draft Clinical Guideline. Neutropenic Sepsis:
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Slade E., Tamber P.S., Vincent J.L. (2003). The Surviving Sepsis Campaign: raising awareness to reduce mortality. Critical Care. 7 (1): 1–2.
Vincent J.L. (2002). Sepsis definition. Lancet Infectious Diseases. 2: 135.
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Contents
Fundamentals of Infection Prevention and Control: Theory and Practice, Second Edition. Debbie Weston.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. Companion Website: www.wiley.com/go/fundamentalsofinfectionprevention
Antibiotics and the problem of resistance
10
Part A 141
The discovery of penicillin 141
How antibiotics work 143
Antimicrobial resistance 145
Factors leading to the emergence of resistance and problems within the
healthcare setting 146
Antimicrobial stewardship 148
Part B 150
Specific antibiotic-resistant organisms 150 Clinical practice points: the infection
control management of patients colonised or infected with an ESBL or
carbapenem-resistant organism 155 Chapter summary: key points 156
References 157
141
Introduction
Very few new antimicrobial agents have been developed since the late 1980s and early 1990s, and with the continued rise of multidrug resistance, particularly amongst Gram-negative bacteria, antimicrobial resistance has been acknowledged to be a major public health threat and a global concern since the late 1990s (Department of Health [DH], 2002). Key documents published in the United Kingdom over the last decade by the House of Lords Select Committee on Science and Technology (1998) and the DH (1998) have emphasised the need for the ongoing monitoring and surveillance of antimicrobial resistance, and identified the prudent use of antibiotics as an area requiring intensified control measures. In 2013, the Chief Medical Officer (CM0), principal medical advisor to the UK government, announced that antimicrobial resistance should be placed on the National Security Risk Register, and carry the same level of ‘political interest’ as MRSA and C. difficile.
This chapter is in two parts. Part A describes the history of antibiotics and the development of resistance. It goes on to explain how antibiotics work, the problems of antibiotic resistance and the importance of antimicrobial stewardship. Part B looks at the problems associated with resist- ant Gram-negative rods, and the major public health threat posed by carbapenem resistance.
Note: Extensive information on national and global campaigns regarding antibiotic-prescribing policy and antibiotic resistance, including bulletins, reports and guidelines, can be found on the following websites: hpa.org.uk, www.dh.gov, www.cdc.gov, www.who.int, scot.nhs.uk, and www.wales.nhs.uk.
After reading this chapter, the reader will be able to: