August 2024

In this VETgirl online veterinary continuing education blog, Sarah Ambrose-Kuhl, CVT reviews our responsibility as veterinary medical care providers to promote antibiotic stewardship by implementing practices that optimize antimicrobial use and preserve their effectiveness. Read on to see how we can slow the impact of antimicrobial resistance!

By Sarah Ambrose-Kuhl
Manager of Medical Quality, Blue Pearl Veterinary Affairs – Research and Development

Five Strategies to Promote Antimicrobial Stewardship in a Small Animal Practice

The phrase ‘antibiotic resistance’ has recently become more commonplace in both veterinary and human hospitals. We rely on antibiotics daily to treat bacterial infections and improve patient outcomes, but the overuse of antibiotics has led to a perpetual rise in antimicrobial resistance. This resistance threatens the efficacy and long-term availability of antibiotics used to save both human and animal lives. As healthcare providers, it is our responsibility to promote antimicrobial stewardship by implementing practices that optimize antimicrobial use and preserve their effectiveness.

So, what can those of us in small animal medicine do to slow the impact of antimicrobial resistance? Here are five strategies to promote antimicrobial stewardship in a small animal practice.

Education
The foundation of any stewardship program starts with education and awareness. Understanding the impact of our medical decisions on patient outcomes and public health is the drive to spread knowledge to hospital associates and clients. Sharing knowledge shares responsibility, the responsibility to give medications as prescribed, provide preventative measures, and practice proper hygiene and husbandry. These are all measures in which anyone can contribute to antimicrobial stewardship, regardless of their role. In a clinical setting, consider client handouts that explain why a pet may not be a candidate for antibiotics or that detail the potential risks of unnecessary antibiotics. As the veterinary community moves away from routine prophylactic antibiotic prescribing, pet owners may need reassurance that their pets are still receiving top-notch, medically sound care, even if their treatment plans differ from those in the past.

Identifying a champion(s) to drive momentum
Find an enthusiastic individual or group to serve as an advocate for antimicrobial stewardship in your clinic. Individuals who demonstrate a commitment to OneHealth and infection control will naturally encourage hospital-wide strategies to reduce antibiotic use. This champion could be a veterinarian, a technician, or another staff member exhibiting leadership qualities and a genuine interest in promoting antimicrobial stewardship. Through education, collaboration, and empowerment, champions can inspire positive change and foster a culture of responsible antimicrobial use throughout others within the clinic.

Improve infection prevention
We all wash our hands multiple times a day, but have we taken a moment to truly assess the efficacy of our hand-washing technique? Providing handwashing stations or hand sanitizer dispensers in strategic places around our clinics improves hand hygiene compliance and infection prevention. While exam gloves are also a key component of hand hygiene, they can provide a false sense of security when it comes to infection prevention. Despite the barrier gloves provide between our hands and the patient, we often forget that they do not replace the necessity of washing our hands before and after patient interactions. Using personal protective equipment (PPE) when interacting with infectious patients is a no-brainer, but let’s also commit to wearing PPE when performing high-infection risk procedures such as central line placements or inserting urinary catheters. Other everyday infection prevention strategies that are often overlooked include disinfecting clipper blades between patients, selecting the correct disinfectants for the inciting pathogens, and eliminating the use of pre-made chlorohexidine-soaked gauze in sundry jars.

Prescribe antibiotics only when needed
Utilizing evidence-based treatment guidelines is essential for antimicrobial stewardship. Guidelines should be specific to recommended drugs, dosages, duration of treatment, pathogen, and infection location. Recent scientific evidence has shown that several common clinical scenarios may not always warrant antibiotics such as feline idiopathic cystitis, acute colitis in dogs, or routine dental cleanings. Thanks to science, many antibiotic treatment durations have significantly decreased, with many bacterial infections that were previously treated with 10-14 days of an antibiotic now being treated with as little as 3-5 days of therapy.

It is important to remind ourselves and pet owners that antibiotics can have undesirable side effects, including vomiting, nausea, diarrhea, and the growing evidence of their disruption of normal gut flora. In addition to antimicrobial stewardship, these potential side effects are yet another reason to avoid giving antibiotics ‘just in case.’ Encouraging the use of culture and sensitivity testing to tailor treatment decisions can minimize unnecessary antibiotic use, eliminate the risk of side effects, and even provide cost savings to our clients in the long run.

Enhance standard operating procedures
Standard operating procedures (SOPs) are employed to provide clarity and instruction for all hospital associates providing the highest standard of care. Take a moment to ensure that biosecurity SOPs are easily accessible and consistently followed. Regularly review your current SOPs to identify areas of optimization. For example, brands of spray disinfectants change based on availability, so assessing the recommended contact time of new disinfectants can ensure we are eliminating contaminants effectively. By refining our SOPs through an antimicrobial stewardship lens, we can all play a vital role in combatting antimicrobial resistance. What we do in our daily lives, how we protect our patients, and how we create our treatment plans will ensure future access to these vital medications.

Antimicrobial stewardship is a shared responsibility across all roles in veterinary clinics. By implementing these five strategies, clinics can promote prudent antibiotic use, minimize the progression of antimicrobial resistance, and improve patient outcomes. Embracing these strategies will not only benefit individual patients but also contribute to the collective effort of preserving antimicrobial efficacy for future generations. Antimicrobial stewardship is medical excellence.

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Please note the opinions in this blog are the expressed opinion of the author(s)/sponsor, and not directly endorsed by VETgirl.


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