Advanced Microbial Stewardship

Define Antimicrobial stewardship (AMS)?

an organisational or healthcare system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.

Why have course lengths been reduced?

trying to preserve some of the natural flora

What most effective AMS activity?

Infection prevention is the best way to stop AMR

What are some of your unknown infection prevention tools?

Diabetics → wound care, keeping blood sugar under control, risk of UTI
Elderly pressure ulcer → mobilisation, incontinence
Catheter → right one?

Training

Respiratory → chest infections → good cough clearance, sat upright (especially when eating and drinking)

What is 2nd care abx protocol?

Start smart → focus

What is the aim of guidance?

over 90% likely organisms
Reduce use overtly broad spectrum abx
Reduce potential harm
Often do not follow hospital

How can guidance compliance barrier be overcome?

Access, agree with specialist teams, audit

How can guidance allergies barrier be overcome?

Allergy recording, investigation, challenge, immunology

How can guidance resistance barrier be overcome?

Reduce inappropriate use, improve narrow spectrum use, improve shirt course , IPC

How can guidance diagnostics barrier be overcome?

Diagnostics tools (FEVERPAIN), culture quality, PoC testing

How can the microbiology poor sample quality barrier be overcome?

Education on sample quality

How can the microbiology Not taken/taken after abx barrier be overcome?

Pathways encourage timely culturing

How can the microbiology incorrect work up barrier be overcome?

Automated, compulsory details

How can the microbiology accessibility barrier be overcome?

Education, IT, push data, specialist follo2 up