Antibiotic Resistance: Hospitals' Growing Concern

Antibiotic resistance is a significant threat to global health, reducing treatment options and delaying effective treatment for those who are sick. It occurs when bacteria, viruses, fungi, and parasites change over time and are no longer responsive to antimicrobial medicines, rendering common antibiotics ineffective against widespread bacterial infections. This resistance can spread within and between healthcare facilities, such as hospitals, through various pathways, including person-to-person contact, medical equipment, and environmental surfaces. In hospitals, patients often have weakened defenses against infections, making them more susceptible to antibiotic-resistant bacteria. Inadequate infection control measures, such as poor hand hygiene and non-sterile equipment, further contribute to the spread of resistance within these settings. The misuse and overuse of antibiotics accelerate the development of antibiotic resistance, emphasizing the importance of careful prescribing practices and appropriate infection prevention and control strategies in hospitals to curb the spread.

Overuse and misuse of antibiotics

The overuse of antibiotics accelerates the process of antibiotic resistance. Taking antibiotics when they are not necessary, or when viruses cause the infection, contributes to this issue. About 90% of all antibiotic prescriptions are issued by general practitioners, with respiratory tract infections being the leading reason for prescribing. However, antibiotics are often ineffective against viruses, and their overuse can lead to antibiotic resistance in bacteria.

Misuse of antibiotics provides an opportunity for bacteria to multiply and mutate. For example, forgetting doses, discontinuing treatment prematurely, or using another person's medication can lead to bacteria reproducing and changing, resulting in antibiotic resistance. Additionally, spontaneous resistance can occur when the genetic makeup (DNA) of bacteria mutates, rendering the antibiotic unable to recognize and target the bacterium effectively.

To combat the global health problem of antibiotic resistance, it is crucial to take antibiotics only when prescribed by a healthcare provider and to complete the entire course of medication as directed. This helps prevent the spread of antibiotic-resistant bacteria within hospitals and the community.

Furthermore, the inappropriate use of antibiotics in healthcare settings, such as hospitals, contributes to the spread of antibiotic resistance. When patients are prescribed antibiotics unnecessarily, or when infection control practices are inadequate, antibiotic-resistant bacteria can spread to other patients, healthcare workers, or the community. This is especially concerning in inpatient healthcare facilities, where resistant germs can be shed through fecal waste and survive in plumbing systems, potentially affecting wastewater treatment processes.

Poor infection control

Lack of Standard Precautions and Infection Control Procedures

Infection control procedures, such as standard precautions, are essential in hospitals to prevent the spread of antibiotic-resistant bacteria. Standard precautions refer to basic infection prevention practices that should be followed regardless of a patient's infection status. This includes practices such as hand hygiene, the use of personal protective equipment (PPE), and proper waste management. When these precautions are not consistently implemented, the risk of transmitting antibiotic-resistant organisms increases.

Inadequate Hand Hygiene

Hand hygiene is a fundamental aspect of infection control. Healthcare workers, patients, and visitors must all practice proper handwashing techniques, scrubbing their hands with soap and water for at least 20 seconds. Failing to do so allows bacteria, including antibiotic-resistant strains, to spread from person to person, surfaces, and medical equipment.

Improper Use and Overuse of Antibiotics

The inappropriate use and overuse of antibiotics contribute to the development of antibiotic resistance. Prescribing antibiotics when they are not necessary or using the wrong type of antibiotic for a particular infection can accelerate the emergence of resistant bacteria. Healthcare workers should exercise careful prescribing practices and test samples before administering antibiotics to ensure their appropriate use.

Insufficient Cleaning and Sterilization

Maintaining clean and sterile hospital environments is crucial to preventing the spread of antibiotic-resistant bacteria. This includes regularly cleaning and disinfecting surfaces, equipment, and facilities, such as bed rails and bed linen, that may come into contact with patients or healthcare workers. Inadequate cleaning practices allow bacteria to persist and spread, increasing the risk of infection.

Lack of Isolation Precautions

In some cases, patients infected with antibiotic-resistant bacteria may require additional precautions, such as isolation or the use of a dedicated toilet or single room with ensuite facilities. These measures aim to prevent the spread of bacteria to other patients or staff. When these precautions are not implemented or properly followed, the risk of transmission within the hospital setting increases.

Inadequate Waste Management

Improper management of human waste, particularly in healthcare settings, can contribute to the spread of antibiotic-resistant bacteria. Fecal waste can contain antimicrobial-resistant germs, which can survive in plumbing systems and wastewater treatment plants. Inpatient healthcare facilities must have adequate waste management systems in place to prevent the spread of these germs within the facility and into the community.

Lack of sanitation and hygiene

Inadequate sanitation and hygiene services in hospitals contribute to the spread of AMR and increase the risk of healthcare-associated infections (HAIs). HAIs are serious infections that patients can acquire during their medical treatment within healthcare facilities. According to the Centers for Disease Control and Prevention (CDC), antimicrobial-resistant germs can spread within and between healthcare facilities, causing deadly infections.

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) reported in 2022 that half of the healthcare facilities worldwide lack basic hygiene services. This includes the absence of water and soap or alcohol-based hand rub at points of care and toilets. The report emphasized the critical need for safe water, clean toilets, and proper waste management in hospitals. Inadequate sanitation and hygiene practices can lead to contaminated hands and environments, which play a significant role in the transmission of pathogens and the spread of AMR.

The impact of poor sanitation and hygiene in hospitals is far-reaching. It not only affects patient safety but also influences care-seeking behavior and patient satisfaction. Studies have shown that patients, especially women, are more likely to opt for home births or alternative healthcare options when faced with unsanitary and unhygienic conditions in hospitals. This can lead to increased risks during childbirth and a lack of access to essential medical care.

Furthermore, inadequate sanitation and hygiene can result in gastrointestinal and opportunistic infections, posing risks to both patients and healthcare providers. The presence of antimicrobial-resistant germs in human waste, particularly in inpatient healthcare facilities, is a significant challenge. These germs can survive in plumbing and wastewater treatment systems, spreading back to individuals and the environment.

Improving sanitation and hygiene practices in hospitals is essential to combating the spread of AMR and reducing the risk of infections. This includes ensuring access to safe water, promoting proper hand hygiene, implementing effective waste management practices, and maintaining clean and sanitary environments. By addressing these issues, hospitals can provide safer and more effective care to their patients and contribute to the global effort to prevent the spread of AMR.

Transmission between patients and healthcare workers

Patient-to-Patient Transmission

Antibiotic-resistant bacteria can easily spread from one patient to another within a healthcare facility. This transmission often occurs when patients come into direct or indirect contact with each other or share medical equipment. For example, a patient with an antibiotic-resistant infection may touch a surface, such as a bedrail, and transfer the bacteria to that surface. Another patient or a healthcare worker touching the same surface can then contract the resistant bacteria and potentially develop an infection. This highlights the importance of rigorous hand hygiene and environmental disinfection in hospitals.

Healthcare Worker-to-Patient Transmission

Healthcare workers can inadvertently contribute to the spread of antibiotic resistance by transmitting bacteria between patients. This typically occurs when healthcare workers do not follow proper hand hygiene protocols or fail to use appropriate personal protective equipment (PPE). As they move from patient to patient, healthcare workers can unknowingly carry antibiotic-resistant bacteria on their hands, clothing, or equipment. This transmission can lead to the spread of infections within a healthcare facility. Therefore, strict adherence to infection control measures, including proper handwashing techniques and the use of gloves, masks, and other PPE, is essential for preventing the spread of antibiotic resistance.

Inadequate Infection Control Practices

Inadequate infection control practices in hospitals significantly contribute to the spread of antibiotic resistance. This includes insufficient hand hygiene among both patients and healthcare workers. Proper handwashing with soap and water for at least 20 seconds is crucial before and after interacting with patients, handling medical equipment, and performing clinical procedures. Additionally, the appropriate use of alcohol-based hand sanitizers can be an effective adjunct to hand hygiene practices. Ensuring that healthcare workers and patients adhere to these practices can significantly reduce the transmission of antibiotic-resistant pathogens.

Patient Transfer between Facilities

The transfer of patients between healthcare facilities can also facilitate the spread of antibiotic resistance. When a patient is transferred from one hospital to another or discharged to a long-term care facility, they may unknowingly carry antibiotic-resistant bacteria with them. This transfer can introduce new strains of antibiotic-resistant bacteria into different healthcare settings, contributing to the spread of resistance across multiple facilities. Implementing effective infection control measures during patient transfers, such as proper patient isolation and disinfection protocols, is crucial to mitigating this risk.

Surgical Procedures and Medical Devices

Surgical procedures and the use of medical devices, such as catheters and ventilators, can also contribute to the transmission of antibiotic-resistant bacteria. These procedures and devices provide a direct pathway for bacteria to enter the patient's body, bypassing the body's natural defences. Inadequate sterilization of surgical equipment and improper aseptic techniques during procedures can increase the risk of introducing antibiotic-resistant bacteria into sterile environments, leading to severe infections. Therefore, strict adherence to surgical site infection prevention protocols and proper sterilization techniques is essential to prevent the spread of antibiotic resistance during surgical procedures and in the use of medical devices.

Inadequate cleaning and sterilisation of equipment

Endoscopes are heat-sensitive medical devices used for diagnostic and therapeutic purposes. They must be properly cleaned and subjected to high-level disinfection (HLD) following each use to prevent the spread of healthcare-associated infections (HAIs). HLD is a process that destroys all microorganisms, ensuring the safe use of medical devices. However, there are challenges in ensuring proper cleaning and disinfection of endoscopes due to factors such as the reuse of detergents and manual cleaning methods, which can lead to the formation of endoscopic biofilm.

To address these challenges, hospitals should implement rigorous equipment maintenance routines and routine audits of reprocessing staff. Reprocessing, or the cleaning and disinfection of endoscopes, should be initiated within an hour of use to minimise the opportunity for biofilm formation. While there is currently no single technology or strategy to guarantee patient safety, enforcing evidenced-based practices and providing comprehensive training for staff can help reduce the risk of contamination and the spread of antibiotic-resistant pathogens.

In addition to endoscopes, other types of medical equipment, such as semicritical and noncritical items, require specific cleaning and sterilisation procedures. Semicritical items, which come into contact with mucous membranes or non-intact skin, must undergo high-level disinfection, and staff should be trained in the safe reprocessing of these instruments. Noncritical items, such as blood pressure cuffs and crutches, can be cleaned with detergents, while single-use disposable items can be used to reduce the risk of cross-contamination.

Overall, inadequate cleaning and sterilisation of equipment in hospitals can facilitate the spread of antibiotic resistance by providing a pathway for the transmission of antimicrobial-resistant germs. Proper disinfection and sterilisation methods, along with staff training and adherence to guidelines, are crucial to preventing the spread of healthcare-associated infections and reducing the impact of antibiotic resistance.

Frequently asked questions