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Experts Partner to Address Resistant Bacteria Through Antibiotic Stewardship, Environmental Hygiene: A Q&A with Stuart Levy and Rosie Lyles
By Karin Lillis
Infection Control Today magazine asked Stuart Levy, MD, president of the Alliance for the Prudent Use of Antibiotics (APUA), and Rosie Lyles, MD, MHA, MSc, head of clinical affairs for Clorox Healthcare, to share their perspectives on how healthcare should address resistant bacteria.
Q: Do you think that microorganisms are becoming less susceptible to surface disinfectants over time?
Levy: They’re getting more resistant, and this has been demonstrated in numerous studies. The chief antibacterial culprit is triclosan. In many meetings I’ve been asked, “Why is there so much antibacterial resistance out there?” That’s a probing question. Maybe it’s because of all of these antibacterial home cleaners that contain triclosan. While they may not be used steadily, it may be a sufficient cause to resistance in bacteria, and that can cause cross- resistance to antibiotics. It’s difficult to tie together the use of these antibacterial products in the home and resistance to antibiotics—but we’re engaging in research to answer that question and how it translates to a solvable problem.
Lyles: No. The likelihood of bacteria developing resistance to surface disinfectants is low due to the rapid kill times of surface disinfectants, such as bleach. Manual surface disinfection is essential for removing soils and killing pathogens on surfaces and surface disinfectants approved by the Environmental Protection Agency (EPA) are equally effective against antibiotic- resistant and nonresistant bacteria.
Q: What challenges do you think hospitals face when it comes to keeping MDROs under control?
Levy: Hospitals are really a reflection of the homes and the communities—in the homes where antibacterial soaps and cleansers are in use. If we can rectify the answer to the question, how does antimicrobial resistance in the home translate to the same issue in healthcare institutions, perhaps we can curtail resistance in hospitals. I’m not sure we have the answer yet, but I feel confident that this partnership with Clorox can help us ask—and answer—these kinds of questions.
Lyles: Before the era of multidrug-resistant organisms (MDROs), if you knew the bug, you knew the drug to use to treat it. MDROs are now considered a “global threat,” which has put added pressure on healthcare facilities to keep their patients free of infections and show progress on reducing hospital readmissions to comply with government healthcare reform policies. However, these types of infections can be prevented if improved infection control practices and antibiotic stewardship efforts are adopted. The main challenge for facilities is educating their staff on how to implement better protocols to achieve compliance. Even the best prevention protocols can’t stop the spread of infection if they are not followed or implemented correctly.
Q: What are some of the ways this partnership will help healthcare facilities address antibiotic resistance?
Levy: We can prevent the healthcare community from being at fault if we can eliminate the overuse of antibacterial cleaners in the community. The link between antimicrobial resistance in the home and multidrug-resistant organisms is not yet clear, but I think this partnership will help us find the answer. I suspect there is a link. The question is, how much does the use of antibacterial products influence multidrug-resistant organisms, and what role they place in the emergence of MDROs.
Lyles: Clorox Healthcare and the Alliance for the Prudent Use of Antibiotics (APUA) will be working together in the coming months to develop educational resources, such as a webinar, to help increase awareness of the issue of antibiotic resistance and to help prevent the spread of infections in healthcare facilities. APUA and Clorox Healthcare believe that education for healthcare professionals can help improve infection prevention practices to kill antibiotic-resistant organisms before infections can spread, better protecting patients, staff and communities. Improving antimicrobial prescribing practices in conjunction with other infection prevention strategies (i.e., adequate environmental cleaning) has been effective in reducing Clostridium difficile infection (C. difficile); which is a common infection from misuse or overuse of antibiotics.