End of Antibiotics — National Security Threat
On May 26, 2016, the Centers for Disease Control and Prevention (CDC) announced a U.S. resident was infected with a bacterial “resistant to antibiotics of last resort”. The presence of colistin resistant E. coli (CRE) bacteria is a near apocalyptic moment for public health officials and provides confirmation antibiotic stewardship must be a national health priority. We have reached the point that if CRE continues to spread there are simply no antibiotic options for treating some of our sickest patients.
Hospital infection control practices have been increasing over the past several years in an attempt to reduce hospital acquired infections and ensure that they are not contributing to the problem of antibiotic resistant infections among their patients. However, now is the time for the emergency response community to ensure they are doing their part to prevent infection and adopt organization wide behaviors that promote the limited use, and need, for antibiotics.
Responder safety should always be the first priority during training evolutions or while operating on the emergency incident. For the law officer, fire fighter, or EMS provider, remaining healthy and decreasing the need for antibiotics is important to their well-being and that of their patients.
Think about your emergency response work and the risk of infection:
1. Work Safely –
· Wearing your personal protective equipment can reduce the chances of lacerations and other wounds along with protection from exposure to nasty patient-based emissions. Crew leaders should monitor personnel for compliance with existing department infection control policy and monitor the situation for unsafe conditions.
· Hand washing, as soon as it is available, is a must when the response is complete. In addition, the use of antibiotic hand sanitizers or similar products should be available if washing is not immediately available. The goal is to limit the transfer of germs from patient to provider, provider to equipment, and provider to next patient.
· Ensure equipment surfaces are cleaned after each and maintain a clean station or apparatus environment.
2. Treat Safely –
· Use good sterile technique when completing invasive procedure such as tracheal intubation or intravenous line insertion. Paramedics are familiar with the infection control risk associated with these procedures and should avoid taking any shortcuts when they are deployed in the field. Remember, Do No Harm.
· Avoid cross contamination of equipment in your patient care response kits by wrapping items that may come in contact with germs and organizing gear to limit exposure.
· Purchase single use items such as laryngoscope blades and oral airways. These items will reduce the time required for cleaning and reduce the potential for cross contamination.
3. Live Safely –
· Any potential injury or illness can result in your need for antibiotics. By keeping yourself healthy through good safety and hygiene practices at both work and at home you can reduce the dependency on antibiotics and ensure they work when things occur that are out of your control.
· Keep a clean duty station to ensure that you are not moving germs from the patient into your station, car, or ambulance. Good hygiene in these locations only takes a few movements and is the best practice to reduce the spread of germs to vulnerable patients.
Countermeasures are used to protect communities from and limit the adverse health impacts of CBRN attacks, outbreaks of infectious diseases, and other incidents.
Finally, antibiotics are a key component of our National Health Security Strategy and comprise an element of the Strategic National Stockpile (SNS). Our nation’s health security may rely upon these medically based countermeasures in the event of an unanticipated or nefarious biological event. As the frontline responders, we must ensure that we are practicing non-pharmaceutical interventions (NPI) such as good hand hygiene or covering a cough or sneeze daily to maintain our public and personnel health. The ability to effectively respond to ensure the safety of our communities may be in jeopardy if we fail to address the issues associated with the spread of infection and the over reliance on antibiotics.
These are just a few reminders for pre-hospital healthcare providers and all emergency responders. Many of them are part of your existing policy or practices, but now is the time to ensure that you are compliant. Response personnel can easily be impacted by a failure to maintain a clean and healthy work environment and we can no longer rely on antibiotics to knock out the bugs we get at work or home. Our work is dangerous enough and although our patient care is completed outside of the controlled hospital environment, we are no less responsible for prevention the spread of infection and the protection of our nation.
