The National Institutes of Health’s (NIH) Clinical Center was open about the history of last year’s outbreak of Klebsiella pneumoniae, an antibiotic-resistant bacteria, despite their best efforts to prevent and contain it. That openness brought healthcare acquired infections (HAIs) and the issues of antibiotic use and development into the national media.
NPR’s Diane Rehm show on Tuesday, August 28th did a good job of summarizing the issues:
- Increasing use of antibiotics creates more antibiotic-resistant bacteria, like the one that caused the NIH outbreak.
- Widespread use of antibiotics in animals, to promote growth, exacerbates the resistance to antibiotics in organisms.
- Some doctors start treatment with a more broad-based antibiotic than the situation requires.
- And the relatively short term in which people need to take antibiotics makes it less attractive or profitable for pharmaceutical companies to develop the new antibiotics we need to keep up with adaptive resistant bacteria.
One of the show’s guests made a comment that could be construed to mean that human error and the inevitability of people shortcutting the protocols are what prevent us from stopping the spread of a rampant infection. Dr. Michael Bell of the Centers for Disease Control said, “we can stamp out these infections very, very effectively. Once you detect, you protect. The problem is that people cheat. It’s very, very tempting, when you’re very busy and trying to do a lot of things for a lot of patients, to cuddle to a corner, to slip into a room without putting on a gown, slip back out. And when that happens, that opens a pathway for the organism to be carried to yet another patient.” Unfortunately, the NIH case disproves that idea.
That outbreak took place at one of the most advanced and specialized hospitals in the country. The hospital took all the right precautions of isolation, education, hygiene, and environmental service protocols, and even had personnel to monitor compliance to those procedures. And yet new cases of infection arose weekly. Clearly, handwashing and those other protocols are essential to controlling infection. However, by themselves, they’re not sufficient to the task.
Healthcare-acquired infections are a complex problem that will require ongoing and multi-faceted effort: careful antibiotic stewardship, hygiene and environmental service protocols, hard and soft surface management, ventilation and education—of medical personnel, patients, and the public—must work in concert to prevent and control infections.