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What is an antibiotic?
According to Centers for Disease Control and Prevention (CDC) (2017), Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria in both humans and animals. Antibiotics fight these infections either by killing the bacteria or making it difficult for the bacteria to grow and multiply. Antibiotics do not have any effect on viruses.
(Centers for Disease Control and Prevention [CDC], 2017)

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What is the problem?
- Antibiotic Resistance.
CDC (2017) states, Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. Antibiotic resistance occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply, causing more harm. (CDC, 2017)

Who is affected?
Antibiotic Resistance can affect anyone, of any age, in any county.
(Word Health Organization [WHO], 2018)

How?
Simply using antibiotics creates resistance.  These drugs should only be used to manage infections. (CDC, 2018a)

Where?
Like stated previously, according to WHO, it can affect anyone in any country.
Also according to CDC (2018b),  Antibiotic resistant can happen anywhere. Data show that most happen in the general community; however, most deaths related to antibiotic resistance happen in inpatient healthcare settings, such as hospitals and nursing homes. (CDC, 2018b)

When?
After being exposed to antibiotics, sometimes one of the bacteria can survive because it found a way to resist the antibiotic. If even one bacterium becomes resistant to antibiotics, it can then multiply and replace all the bacteria that were killed off.

(CDC, 2017)

Why?
According to CDC, Overuse and misuse of antibiotics can promote the development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria (bacteria that antibiotics can still attack) are killed, but resistant bacteria are left to grow and multiply. This is how repeated use of antibiotics can increase the number of drug-resistant bacteria.
(CDC, 2017)

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Direct Adverse Outcomes Related to Resistance

Clinical: Treatment Failure or Death.

Economic: Cost of care or length of stay.

The Impact of Resistance on Healthcare Systems

Rise to additional infections.

It is estimated that between 38.7% and 50.9% of pathogens causing surgical site infections and 26.8% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA.

Expense

Hospitals spend, on average, and additional US $10,000 to 40,000 to treat a patient infected by an MDR organism.

Antibiotic resistance influences the total disease management costs by increasing ICU and hosptal stays and more than half of extra healthcare expenditure caused by multidrug-resistant organisms is to cover additional nursing and medical care.

Interrupted hospital actiivity

Total closure of an affected ward or unit is one of the most expensive control measures that may be required to contain a nosocomial outbreak.

Microbiology and staff costs associated with the implementation of infection control measures (screening & contact isolation)

Limited treatment options

(Friedman, Temkin, & Carmeli, 2016).

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As healthcare workers at the forefront of patient care, we need to support the idea of antimicrobial stewardship. This includes:

Avoid requesting antibiotic for treatment of viral or fungal infections in our own personal and family care.

Use the right antibiotic by the right route for the shortest appropriate time in our personal and professional lives.

Refrain from disposing of unused antibiotics into the environment.

Use hand hygiene and other infection control practices at all times to decrease the risk of spread of antibiotic-resitant bacteria.

(Faoagali, 2018)

Is this improving or worsening the issue?
- Unfortunately this has not really improve the issue due to the increase use of antibiotic in boteconomic and clinical setting.

Attached is a form that shows that Sentara Healthcare supports and participates in Antimicrobial Stewardship:

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Antibiotic Stewardship Playbook

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ANALYSIS: Importance of Nurse's involvement. 

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ANALYSIS: Importance of Nurse's involvement. 

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"When nurses speak, change can indeed occur; patients, doctors, nurse practitioners, physician assistants, and others can be influenced positively when a nurse is able to make a strong case for a particular course of action. Nurses who understand the risks of pan-resistant bacteria can act as powerful change agents, educators, and advocates."
(Carlson, 2017)

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Be Antibiotics Aware (formerly Get Smart about Antibiotics) is a national effort to help fight antibiotic resistance and improve antibiotic prescribing and use. 

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Be Antibiotics Aware (formerly Get Smart about Antibiotics) is a national effort to help fight antibiotic resistance and improve antibiotic prescribing and use. 

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"Antibiotics save lives but any time antibiotics are used, they can cause side effects and lead to antibiotic resistance. At least 80 million antibiotic prescriptions each year are unnecessary, which makes improving antibiotic prescribing and use a national priority."
(CDC, 2018)

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Challenges:
It is certainly a challenge for nurses to deal with this issue because the public has high expectations for nurses to be ethical, honest, and the educated professionals the society can depend on.  (Carlson, 2017)

Even though as nurses and the rest of healthcare professionals we do provide education to our patients and public about this issue.  Knowledge deficit is still remaining as both a challenge and barrier in helping fight the continued rise of antibiotic resistance in our nation.

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Two Curricular Concepts:
1. Isolation Precautions

Deaths related to C. difficile increased 400% between 2000 and 2007, in part because of a stronger strain.

Most infections are connected to receiving medical care.

Hand sanitizer does not kill C.difficile, and hand washing may not be sufficient.

(CDC, 2018b)

As CDC states how much of a threat C.difficile infection is, the importance of implementing Isolation precaution is critical. Isolation precaution is not put in place just to protect the healthcare workers and patients but also families & visitors.

2. Patient Education
- Emphasize on taking the full course of antibiotics despite feeling better.
- Explain that antibiotics is not needed for cold/flu symptoms.
- Wearing the appropriate personal protective equipment (PPE) will ensure safety of everyone, especially the patient, who is at higher risk for inquiring infections, possibly resistant infections.
- Know why you are taking the medication.

Leadership Role...
These two curricular concepts that I learned during the 2 1/2 years of education at SCOHS has prepared me to take a leadership role once I transition to professional practice in the following ways:
- To be a nurse is to be a role model to your patients, families, visitors and your healthcare team. We can help set the standards for those around us, because whether we like to admit it or not teaching patients/families/visitors are not always enough. When they see how strictly we follow our facilities guidelines and protocols for each and everyone's safety, the impact will be much stronger.

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1. Educate, Educate, Educate!!!
- Educating our patients and our community is our main priority. We really have to make the public understand that antibiotics does not work for anything else other than bacterial infections.

According to a study, excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance.
(Alsan, Morden, Gottlieb, Zhou, & Skinner, 2015)

Additional important patient education:

Tell your healthcare professional you are concerned about antibiotic resistance.

Ask your healthcare professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics.

Take the prescribed antibiotic exactly as your healthcare professional tells you.

Discard any leftover medication

Ask your healthcare professional about vaccines recommended for you and your family to prevent infections that may require an antibiotic.

Never skip doses.

Never take an antibiotic for a viral infection like a cold or the flu.

Never pressure your healthcare professional to prescribe an antibiotic.

Never save antibiotics for the next time you get sick.

Never take antibiotics prescribed for someone else.

(CDC, 2018)

2.  Nurses Must Educate Themselves too
- It is crucial for nurses to be completely educated about antibiotic-resistant bacteria. Lack of full understanding and proper planning for prevention negates our interventions.
(Carlson, 2017)

Reviewing and understanding your facility’s infection prevention and control standards, policies, and procedures

Ensuring that cultures are ordered prior to antibiotics being prescribed

3.  Get involved. Take Action.

Joining the Infection Control committee at your facility

Becoming involved in your hospital’s Antibiotic Stewardship Program (ASP)

Seeking increased education on the prevention of antibiotic resistance

Encouraging your facility to become involved in regional or statewide efforts to curb antibiotic resistance

Actively educating patients regarding the dangers of antibiotic resistance and the overprescribing of antibiotics

(Carlson, 2017)