Infection Preventionists Marginalized in Antimicrobial Stewardship Programs

It’s a small study and certainly more studies will be needed (and possibly demanded), but investigators with the University of South Florida College of Public Health set out to determine how well infection preventionists (IPs) are used in antimicrobial stewardship programs (ASPs). They also sought out to take a look at what other members of ASPs think about IPs. The answer to both questions was “not much.” 

In what investigators are calling the first evaluation of what multidisciplinary hospital-based peer groups think about the role of IPs in ASPs, the research team seemed to question whether IPs will be part of the programs in the future.

“The optimal engagement of IPs in ASPs is being challenged by varying expectations among ASP clinician peer groups,” according to the study published in the American Journal of Infection Control. “Additionally, the absence of a role definition for IPs in ASPs is likely hindering IPs from contributing in consistent, meaningful ways.”

But back to the mixed method study’s limitations. The survey sample size was 28 people spread out over 10 states. Participants included 8 IPs, 6 ID physicians, 10 pharmacists, and 4 hospital executives. Eighty-six percent of participants held a master’s or doctoral degree.

Telephone interviews were conducted between November 1, 2016, and December 12, 2016. Two IP leaders and 2 (non-IP) ASP leaders validated the survey instruments prior to use and establish content validity through Cronbach’s alpha using analysis of variance factor without replication within Microsoft Excel; a value of 0.468. 

The investigators measured facility demographics and ASP characteristics, how the IP’s role was characterized, what barriers there may be to optimal IP engagement, how ASP success is measured, and participant demographics. 

First, though, came the context. Investigators cited data from the US Centers for Disease Control and Prevention (CDC) to remind readers that “antimicrobial resistance is one of the greatest public health challenges of our time.” ASPs have helped decrease antimicrobial resistance and are crucial for patient safety, but the role of the IP in ASPs is not well defined. 

The survey found that IPs spend either no time (12%) or up to 5 hours a week (63%) on ASP work, while 25% reported less then 5 hours a week participation. In addition, 42% said that IPs don’t have enough knowledge about ASPs. 

“When asked whether political/social tensions hindered IP involvement, 38% indicated yes and were mostly physicians (21%),” the study stated. “The most common barriers cited were antimicrobial stewardship as a lower priority (58%), time constraints (54%), IP staffing levels (46%), and communication difficulties (46%). Interestingly, several participants cited that antimicrobial stewardship is not part of the IP role (33%) and some (21%) suggested no barriers exist.” 

Again, more data is needed as the investigators said that their results suggest “that IPs are currently contributing to ASPs in some undefined ways. Clarifying the role and responsibilities of IPs in ASPs would help to define and recognize specific contributions.”