'Careful Observation' Can Improve Infection Prevention in Healthcare Settings

Robin Jump, MD, PhD, assistant professor in the Department of Medicine at the Case Western Reserve University, discusses how 'careful observation' can be used to decrease the number of unnecessary antibiotic prescriptions in the healthcare setting.

Interview Transcript (slightly modified for readability)

“So another missed opportunity for doing better infection prevention with [Clostridium difficile] C. difficile, relates to antibiotic use [by] the public. The public has a perception that antibiotics will make them feel better, which is not always the case. The public will often demand or request antibiotics for a viral infection and that won’t make them feel better physically, but it often makes [them] feel better psychologically, because now [they’ve] been given something by the doctor that makes us feel better. Having [an antibiotic] prescribed by the physician, there’s some weight to that, [which] we can’t [psychologically feel] when we [take medications] that come over the counter from the drugstore somehow.

I think we have to help educate the public about the differences between viruses and bacteria. We have to, all of us, not just patients, but all of us in healthcare as well, become more willing to delay starting an antibiotic [regimen] and engage in what some people have called 'watchful waiting'. I like to call [it] 'careful observation,' [because] when we say 'watchful waiting' it sounds like we’re not doing anything and that’s not the case, we actually are carefully observing people, and this is especially true for people who are in long-term care and post-acute care facilities.

Often it’s not clear if an older adult truly has an infection so if we can wait 6 hours, 12 hours, 24 hours [or] 48 hours before starting an antibiotic, and offer them more hydration, review their medicines, make sure they’ve gotten a good night’s sleep, talk to them and see what else might be going on, [then] there might not be a need for an antibiotic. That spares them the exposure to a potentially harmful medication, which is fantastic.”