The leakage of pharmaceutical pollution into the environment, the overuse of antibiotics in animal husbandry and the inappropriate prescribing of antibiotics in human medicine all lead to one thing: the rise of antimicrobial resistance (AMR).
Nurses are on the frontline of the AMR crisis, caring for an increasing number of patients with multidrug-resistant infections.
However, they have frequently been overlooked and underutilised in combatting AMR. While nurses already play a vital role in infection control and prevention along with therapeutic management of infections, the involvement of nurses in national AMR action plans has been lacking.
In particular, there is considerable potential to increase nurses’ involvement in antimicrobial stewardship and educating patients about responsible antibiotic use. The European Specialist Nurses Organisations (ESNO) aims to tackle this by producing an Information and Communication Guide to educate nurses about the problem of drug resistance and how they can make an even more significant contribution to combatting it.
As outlined in the WHO competency framework for health workers’ education and training on AMR, nurses have important roles in promoting awareness of AMR and appropriate antimicrobial use, encouraging optimal antimicrobial treatment, preventing and controlling infections and both collecting and reporting microbiological samples and test results.
One particular area where the involvement of nurses has been frequently overlooked is antimicrobial stewardship programmes (interventions which aim to minimise the development of AMR through selection of appropriate antimicrobials, optimising dose and duration).
Antimicrobial stewardship teams have primarily included physicians, pharmacists, microbiologists and epidemiologists. However, as antibiotic first responders, central communicators and monitors of patient status, nurses have the potential to be instrumental in these programmes. Nurses have the most consistent presence as patient carer of any healthcare professional hence they have regular opportunities in the multidisciplinary team to ensure optimal prescribing.
Research presented at this year’s annual conference of the Association for Professionals in Infection Control (APIC) demonstrated that nurses need to be empowered to participate in these programmes.
A baseline assessment found that 93.8 percent of nurses incorporated microbiology results during sign-out reporting, but only 50 percent checked susceptibility results of cultures before administering antibiotics. If cultures showed resistance, only 65.1 percent of clinical nurses notified the physician.
"Nurses are on the frontline of the AMR crisis, caring for an increasing number of patients with multidrug-resistant infections"
As recognised in this study, one of the main barriers to nurse participation has been gaps in nurses’ knowledge and education on microbiology, antibiotic use and stewardship. This is something that ESNO is hoping to change.
By developing a ‘Nurses Information and Communication Guide on AMR and Vaccination’ and implementing a Europe-wide awareness campaign, ESNO aims to empower nurses across Europe to become educators and advocates on AMR and responsible antibiotic use.
ESNO is collaborating with a number of European organisations to produce an accessible handbook to ensure nurses are properly equipped to help combat AMR.
The desired results of such education would be: improved collection and quality of microbiology specimens and increased input of susceptibility results into decisions about antimicrobial use, ultimately leading to reduced inappropriate antibiotic use.
Due to nurses’ central role in working closely with patients and their families, nurses can play an important part in educating the general public: they have the opportunity to reduce expectation and demand for antibiotics along with placing greater emphasis on prevention of infection.
"By ensuring antimicrobial management is considered within the remit of nursing expertise, healthcare institutions will be able to take a true multidisciplinary approach to tackling AMR"
One area where nurses can have a real impact is the promotion of vaccinations. Vaccines can prevent infections, lowering the demand for treatment and thereby reducing the use of antimicrobials.
However, scepticism towards vaccines has grown in recent years and, rather worryingly, coverage is decreasing.
This is increasing the reservoirs of various pathogens within society that may subsequently become resistant to antimicrobials.
The UK Review on AMR outlined: “we need more people in the human and animal healthcare settings who are experts in AMR and infectious disease. These include key frontline personnel such as … nurses”.
By ensuring antimicrobial management is considered within the remit of nursing expertise, healthcare institutions will be able to take a true multidisciplinary approach to tackling AMR.
As the single largest group of healthcare providers, the education and empowerment of nurses on AMR is a crucial step in tackling this cross-border public health threat.