Prevent, control, and treat
As in all spheres of patient safety, work is being done on preventing, controlling, or mitigating and treating,”, said Marcelo Barbato, intensive care doctor and director of Hospital Maciel’s ICU
In the field of prevention, "a central element is the good use of antibiotics – prescribing them only when strictly necessary, for the number of days necessary and with the greatest possible specificity." At the same time, Dr. Barbato pointed out the importance of trying to reduce the length of time patients spend in ICUs through diagnosis and timely treatment. "The greatest appearance of antimicrobial resistance occurs in patients who spend many days in intensive care units, who undergo many invasive procedures, and who are the most immunosuppressed,” he said.
In the event that resistant bacteria appear, their spread is prevented through isolation, protective equipment, hand washing and tests on unoccupied beds to confirm that whoever occupies them is not at risk of contracting an infection. "We have to be permanently focused on details because we can design many processes but 'the devil is in the details,'" Dr. Barbato explained.
Dr. Barbato, who has a long trajectory in infection control, measures results in terms of controlling infection and uses them to evaluate management. “If there are a lot of outbreaks or the cases spread quickly and take a long time to control, that means there is less awareness.” He added that behavior related to infection varies from place to place. “Each place has its different culture and that is why it is so important to measure the results,” he said. Although health staff is aware of resistant bacteria, the level of awareness is not as developed as with diseases such as COVID-19, to which workers feel exposed on a personal level.
"Handwashing is perhaps the cheapest safe practice, with evidence that has been proven for more than 150 years, and yet, it has been extremely difficult to get people to do it," he lamented, adding that workers often forget when they are about to treat a patient. It is important to strengthen education as well as supervision and control. "Health workers have to regulate behavior," he said.