As 2016 is over, it is time to reflect on the work that we did not complete last year - and resolve to do better in 2017.
Some of the most frightening and heartbreaking stories in healthcare in 2016 – like Reuters’ eye-opening investigative report on the rise of superbugs – were the direct result of rampant and pervasive infections in hospitals, long term care facilities, and even schools and locker rooms. Last year’s mandate from the World Health Organization to limit the use of antibiotics and use of antiseptics that contribute to the escalation of drug resistant superbugs should be at the top of every healthcare organization’s and practicing medical professional’s list of resolutions in the New Year. The time has come for us to redefine what the standards are for how to best combat this urgent public health threat.
For the last 5 decades, the traditional approach in medicine has been much like a nuclear bomb - kill everything. Take out all bacteria - good, bad and inconsequential. The ‘destroy everything’ approach has unfortunately caught up to us, and we as a nation are now paying the price. Patients are completely unable to fight infections and we’re also faced with the inability to contain antibiotic-resistant superbugs. Instead of throwing more money into caustic technologies that cause harm to individual patients and entire healthcare communities- we need to be more strategic, selective and innovative in how we prevent the spread of disease.
Everyone intuitively understands that the best type of radiation for fighting cancer would specifically target and kill only harmful cells and leave the healthy cells intact. A similarly “smart” approach for targeting only the bacteria that are harmful for destruction but preserving the others is precisely what is needed to win the infection wars without the burgeoning collateral damage of vulnerable patients, fragile communities, or anyone else.
Sometimes the answer to science’s most seemingly complicated issues are simple and right in front of us. Instead of cooking up expensive and untested solutions in a lab or scouring the globe for obscure ingredients to create yet another antibiotic, how about activating and strengthening the best biological weapons that we have for fighting infection - the skin, which is the body’s largest organ.
Our methodology provides an environment where the patient’s own microbial defenses are strengthened and effectively manage multidrug-resistant organisms (MDROs). This back to basics approach is far from trivial- on any given day, one in 25 hospital patients develops at least one hospital-acquired infection (HAI). This ongoing issue has resulted in a staggering 99,000 deaths and $20 billion in healthcare costs annually.
It is high time that the professional healthcare community has an honest conversation with the general public about the indiscriminate use or misdiagnosed use of antibiotics. The misuse of antibiotics is easy to understand. It means that a drug is selected without a 100% assurance that it will actually cover the specific bacteria that is causing the infection. Think of the thousands of nursing home patients that present with a low-grade fever and rigors. The medical response is almost always automatic- a broad-spectrum antibiotic is prescribed without any lab evidence that these bugs are present in that patient. It is not out of carelessness, but rather a function of how expensive it is to culture each patient and accurately diagnose their specific infection. While the knee jerk reaction may seem prudent at the time, when the patient develops another infection that would respond to the antibiotic- they may have likely already have a resistance to it that renders it ineffective. The take away is that we need to recognize that we are an urgent care society, and we need to slow down and take the time to find the right answers and reserve medicine for proper use.
Part 2 of the long overdue dialogue from the professional healthcare community needs to be about how optimal hygienic protocols is the most powerful weapon in our arsenal to stop infections from entering a patient, stops the transmission of infection in facilities. Preventative measures can keep patients from entering the ICU and becoming another sad statistic. The old adage of an apple a day to keep the doctor away still applies: the best safeguard to prevent infections is appropriate everyday practices that focus on prevention.
The front lines of prevention are precisely where the real focus of combat should be. But, soap and water are not effective enough and hand hygiene policies vary among institutions and caregivers. The stakes could not be higher—rampant UTIs, CAUTI’s in hospitals and long-term care facilities and resistance of CHG and povidone-Iodine further put hospitals in a Catch 22. The Journal of Hospital Infection Control advocates for antiseptic regulation.
The good news for anyone concerned about preventing and reducing the spread of infections is that technologies that bring the battle to the skin (bionome therapies) are in use at over 250 hospitals with multi-state trials demonstrating UTI reduction incidences by 69%, along with other very promising meta analysis confirming efficacy.
Antibiotics have saved many lives over the past 50 years and have made the world a healthier place. They have a strong place in the battle to treat infected patients. The world does need new stronger and smarter drugs- asap. However the environment for antibiotic research is very much over regulated and it makes it very expensive and difficult for new drugs to come to fruition. The FDA needs to remove friction for approval and find ways to fast track promising new drugs. But as a society, we also need to wean ourselves away from the over reliance on medications that we don’t really need, that don’t treat the problem at hand, and collectively make us more at risk and vulnerable to infection.
The American healthcare community is the most innovative in the world, and we need to take the leadership position of reimagining how to fight infection, establish clear standard practices and protocols for prevention, and clearly communicate this on the world health stage. Please resolve to make 2017 the year that the planet decided to focus on prevention and optimal hygiene to prevent infections and contain the antibiotic resistance crisis.
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