Reducing Antibiotic Misuse In Wound Care: Impact On Antibiotic Stewardship
Rummana S. Aslam
Spaulding Rehabilitation Hospital Cape Cod, East Sandwich, MA, USA
Despite increase in awareness of antibiotic stewardship there is still misuse of systemic antibiotics for wound care. At the core of the problem is lack of evidence-based education in wound medicine, wound infection and biofilms.
We created an interdisciplinary wound care team including physician leadership, nursing leadership, physical therapists, occupational therapists, nutritionist, and director of quality and safety. The wound care team together with the hospital infection control committee implemented a multi-dimensional strategic plan for reducing the misuse of systemic antibiotics as part of treatment of wounds. Our hospital setting is acute inpatient rehabilitation hospital where approximately 12-20 percent of inpatients have wounds. Our daily census is 40 to 43 patients. Our strategy included ongoing series of wound lectures for all providers on basics of wound care, effective wound dressing techniques, wound bed preparation, wound infection, biofilms, and chronic wound inflammation. We implemented weekly interdisciplinary wound care teaching rounds which involves teaching of wound team members, bedside nurses, as well as the patient and patient caregiver. We designed and implemented hands on training in wound care including debridement techniques and application of effective compression. Wound team meets regularly to look at trends and troubleshoot and foresee challenges.
We have practically eliminated the use of systemic antibiotics for wound care by education on evidence-based guidelines for wound care
Providing evidence-based wound education to providers to help them differentiate signs of wound inflammation vs infection, understand wound microbe interaction, biofilms, and acquire skills to decrease wound bio burden, we can significantly reduce misuse of systemic antibiotics. This is a significant positive contribution to institutional antibiotic stewardship. This is a pilot trial in one out of four rehab hospitals in a network and we plan to implement this protocol across the network.
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