Antimicrobial Stewardship and Infection Control Programs

How many U.S. patients contract a healthcare-associated infection (HAI) daily?

About 1 in 31 hospitalized patients

Annual U.S. impact of HAIs?

>700,000 infections, ~75,000 deaths, ~$30 billion in excess costs.

What is the CDC’s NHSN?

The National Healthcare Safety Network — tracks HAIs and resistance benchmarks

Why is infection control critical for hospitals?

Accreditation depends on it (e.g., The Joint Commission standards)

What are standard precautions?

Infection prevention measures used for all patient care

Most important standard precaution?

hand hygiene

Who demonstrated the importance of handwashing in 1847?

Ignaz Semmelweis

Key components of standard precautions?

Hand hygiene, PPE, respiratory hygiene, safe injection practices, equipment disinfection, sharps safety

What are the three types of transmission-based precautions?

Contact, droplet, airborne

When are contact precautions used?

For infections spread by direct or indirect contact

PPE required for contact precautions?

Gown and gloves upon room entry

Key room considerations for contact precautions?

Single room if possible; dedicate equipment; enhanced cleaning

How are droplet pathogens transmitted?

Respiratory droplets from coughing, sneezing, talking

Source control for droplet precautions?

mask the patient

PPE for droplet precautions?

mask upon room entry

What room type is required for airborne precautions?

Airborne Infection Isolation Room (AIIR) with negative pressure

PPE for airborne precautions?

Fit-tested NIOSH-approved N95 (or higher respirator)

Primary risk factor for CAUTI? (catheter associated UTI)

Prolonged urinary catheter use

What percent of hospitalized patients receive urinary catheters?

15–25%

Key pharmacist roles in CAUTI prevention?

Antibiotic stewardship & urine culture stewardship (avoid culturing asymptomatic patients)

What is a central line?

A catheter placed in a large vein (neck, chest, groin)

Key prevention measure once a central line is placed?

Remove as soon as no longer needed

Pharmacist role in CLABSI prevention?

Advocate for removal; educate patients; stewardship

What is an SSI?

Infection occurring at or near surgical incision

Pharmacist’s primary role in SSI prevention?

Ensure appropriate surgical prophylaxis antibiotics

Why do ventilators increase infection risk?

Bypass natural airway defenses

Pharmacist’s main role in VAE prevention?

Antimicrobial stewardship

What is MRSA?

Methicillin-resistant Staphylococcus aureus

Annual burden of MRSA in U.S.?

>70,000 severe infections; ~9,000 deaths

Recommended precaution for MRSA?

Contact precautions (CDC recommendation)

What commonly causes C. diff infection?

Antibiotic exposure

Why is alcohol-based sanitizer ineffective against C. diff?

It does not kill spores

Preferred hand hygiene for C. diff?

soap and water

How long should contact precautions continue for C. diff?

At least 48 hours after diarrhea resolves

Why are carbapenem-resistant organisms concerning?

Limited treatment options; high mortality (up to 50%)

What is antimicrobial stewardship?

Coordinated interventions to optimize antibiotic use (drug, dose, duration, route)

Stewardship programs are required by which accrediting body?

The Joint Commission and CMS

two primary stewardship strategies?

Prospective audit & feedback; formulary restriction with pre-authorization

Most effective stewardship strategy?

Prospective audit with intervention and feedback

What is an antibiogram?

A yearly summary of pathogen susceptibility patterns within an institution

Core pharmacist responsibilities in infection control?

Standard precautions, stewardship, sterile compounding, policy enforcement

Why is stewardship one of the pharmacist’s biggest impacts?

Antibiotic misuse directly drives resistance and infections like C. diff