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Lab technologist Derek Chau tests the sensitivity of various antibiotics in the microbiology lab at Sunnybrook Health Sciences Centre in Toronto, Ontario Thursday, November 28, 2013. (Kevin Van Paassen/The Globe and Mail)

Lab technologist Derek Chau tests the sensitivity of various antibiotics in the microbiology lab at Sunnybrook Health Sciences Centre in Toronto, Ontario Thursday, November 28, 2013.

(Kevin Van Paassen/The Globe and Mail)

The Hospital

Q&A: How do hospitals deal with superbugs? Add to ...

This is part of The Globe’s months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from staff.

Antibiotic resistance and the rising threat of superbugs are major challenges facing hospitals across the country. The overuse of antibiotics has allowed many types of bacteria to become resistant, meaning they don’t respond to traditional medicines. These resistant organisms, often called “superbugs”, can spread easily in hospitals, where many patients have weakened immune systems and are particularly vulnerable to infection. It’s estimated that 8,000 to 12,000 patients die from hospital-acquired infections each year.

As part of our series on the challenges facing the health-care system, The Globe and Mail recently spoke with Sandra Walker, pharmacy lead for infectious diseases and antimicrobial stewardship at Sunnybrook Health Sciences Centre about how the hospital is dealing with these problems.

We want to hear about health care in your community: What works, what doesn’t, and what you think we should do about it. Share your experiences – and ideas for change. Follow @Globe_Health, tweet with #thehospital or email thehospital@globeandmail.com to join the conversation.

Kevin Van Paassen

What is the antimicrobial stewardship program?

Antibiotics can be life-saving when they’re needed, but unfortunately, in addition to the good things that antibiotics do, there are unwanted consequences of using antibiotics as well.
Stewardship is, first of all, a recognition that we are all here to provide optimal care for the patients… We work very closely with our physician colleagues that are the primary caregivers for that patient to identify whether this patient truly needs an antibiotic… What stewardship is always trying to do is prevent the use of antibiotics when they are not necessary because of those unwanted consequences.
Reduce the risk of a patient getting an antibiotic they don’t need and subsequently potentially having these problems that occur as a result of having an antibiotic.
Kevin Van Paassen

Is this a new problem? Why are we hearing so much about superbugs?

I really don’t think it’s a new problem… Unfortunately, we are running out of antibiotics we can use…because antibiotics were overused in the past. We know that through appropriate antibiotic use, plus having good infection control practices in an institution, we can reduce the prevalence of… quote unquote superbugs.
We need to optimize what we have because we don’t have much else [in terms of new antibiotics] in the pipeline. By overusing things inappropriately when we don’t need them, we’re not going to have anything available to us when we do need them… We’re trying to at least minimize an increase in resistance and hopefully with antimicrobial stewardship we can decrease resistance over time.
kevin Van Paassen

Is that a realistic goal? Have we made any gains?

It’s a very difficult outcome to assess properly and I think it takes time, but we have seen some moves forward to indicate that we’re doing good things with antimicrobial stewardship. With our program that was implemented in intensive care units in 2009, we evaluated the impact of our program, we saw about a 30 per cent reduction it the incidence of Clostridium difficile in our ICU where our program was active.
Kevin Van Paassen

What are the big challenges that remain?

Our program is fairly well entrenched in our hospital at this time. It’s a part of the nature of our institution because we were implemented in 2009. However, one of the more general challenges that institutions face when they’re going to implement a stewardship program is acceptance of the program. When planning an antimicrobial stewardship program, recognizing that program acceptance may be a challenge and therefore, working with the main stakeholders of the intervention could ensure a smoother implementation of an antimicrobial stewardship program.

This interview has been condensed and edited.

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