Introduction
The use of antimicrobials in hospitals is a subtle practice that requires stewardship. Pharmacokinetics and pharmacodynamics of antimicrobials are complex processes that demand understanding of safety and efficacy standards by the experts who can adhere to the stewardship guidelines.
Misuse of the antimicrobials can lead to drug toxicity in patients, encourage the emergence of multidrug resistant microbes, and increase health care system costs. The emergence of multidrug resistant microbes due to inappropriate use of antimicrobials has not only increased prevalence of microbial diseases but has also resulted into diminishing effectiveness of antimicrobials.
The health care system is grappling with the challenges of treating and preventing the emergence of resistant microbes using few effective antimicrobials since many have encountered resistance. Tamma and Cosgrove assert that, “the implementation of a monitoring and intervention system is vital to optimize the effectiveness of currently available antimicrobial agents and preserve our ability to use them in the future” (2009, p.245).
In this view, hospitals have designed diverse stewardship programs that supervise and check the use of antimicrobials. To find out the effectiveness of the stewardship programs in hospitals, random interviews were conducted on the number of medical professionals concerning the available antimicrobial stewardship programs and their effectiveness.
Since proper implementation of the antimicrobial stewardship is imperative in the control of emerging multidrug resistant microbes and reduction of medical costs, assessment of available and effectiveness of programs gives an insight. However, the big question remains; how can the hospitals implement antimicrobial stewardship programs effectively.
Antimicrobial Stewardship
Emerging multidrug resistant microbes and increasing costs in health care system threaten capacity of fighting microbial diseases. The multidrug resistant microbes emerged due to poor stewardship in the use of antimicrobials. Moreover, there is an impending crisis in the treatment and control of microbial diseases because development of antimicrobial has slowed down while at the same time the available antimicrobials are diminishing due to the resistance (Rapp, 2010, p.4).
This crisis poses a great challenge to the health care system. To find out the nature and the effectiveness of antimicrobial stewardship programs in hospitals, a series of random interviews were conducted to determine their effectiveness. Medical professionals answered several questions dealing with the availability of antimicrobial experts such as physicians, microbiologists, epidemiologists, pathologists, and pharmacists.
The research interviews also looked at strategies of administration, laboratory procedures, therapeutic committees, and the availability of pertinent information. To assess the effectiveness of the antimicrobial stewardship, the research also observed and interviewed medical professionals concerning clinical guidelines, prescription strategies of antimicrobials, review of prescription, post-prescription assessment, and application of technology.
Results
The interviews carried out and the observations made showed that in the hospitals, not all antimicrobial experts were available. The available antimicrobial experts were physicians, pathologists, and pharmacists, while epidemiologists and microbiologists were not available. The interviews further revealed that overwhelming cases of microbial diseases at times overstretch the available antimicrobial experts.
On the strategies of administration, the research studies showed that there were some laxities concerning implementation of the responsive measures that ensure antimicrobial stewardship.
There were also very weak laboratory procedures that are involved in the assessment of the therapeutic outcomes while the therapeutic committee had no measures for supervising the safety and efficaciousness of the antimicrobials. The pertinent information regarding antimicrobial stewardship was not readily available and accessible thus prescription strategies were poorly implemented.
Discussion
The availability of all necessary antimicrobial experts determines the effectiveness of the antimicrobial stewardship programs that aim at reducing the emergence of multidrug resistant microbes and costs of managing microbial diseases. Since the hospital lacked some of the crucial antimicrobial experts, implementation of antimicrobial stewardship programs would not be effective.
Epidemiologists and microbiologists are critical antimicrobial experts who work collectively in assessing therapeutic outcomes in order to establish the emergence of multidrug resistant microbes. Their research data is very essential in designing antimicrobial stewardship programs.
Concerning administration, Roberts and Weinstein argue that, “commitment to implementation of antimicrobial stewardship programs must come from upper levels of hospital administration that are willing to invest resources in program development; otherwise funding for initiating and sustaining a stewardship program may be inadequate” (2009, p.10).
Weak administration or lack of administrative will severely affect implementation of the antimicrobial stewardship programs. Poor laboratory procedures and lack of pertinent information discourage implementation of the antimicrobial stewardship programs because robust data will not be available to aid in monitoring and designing of real time programs that are consistent with the trends of microbial diseases.
Conclusion
The emergence of multidrug resistant microbes due to the misuse of antimicrobials has prompted health care system to root for the implementation of antimicrobial stewardship programs. Studies conducted in a hospital revealed that there is poor implementation of the antimicrobial stewardship programs thus encouraging the emergence of multidrug resistant microbes and increasing health costs in the management of the microbial diseases.
For effective implementation of the antimicrobial stewardship programs, hospitals should ensure that they acquire all critical antimicrobial experts, have proper administrative mechanisms, comprehensive laboratory procedures, stringent prescription measures, and availability of pertinent information. Optimal utilization of these resources in hospitals will boost the implementation and the effectiveness of antimicrobial stewardship programs.
References
Rapp, R. (2010). Practice Guidelines for Implementing Antimicrobial Stewardship. Journal of American Society for Health-System Pharmacists, 41(6), 1-20.
Roberts, R., & Weinstein, A. (2009). Hospital and Societal Costs of Antimicrobial Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship. Virginia College Virtual Library, 1-17.
Tamma, D., & Cosgrove, E. (2009). Antimicrobial Stewardship. Infectious Disease Clinics of North America, 25(1), 245-260.