Tackling Antimicrobial Resistance Through RN Involvement

The US Centers for Disease Control and Prevention (CDC) reports that every year more than 2 million Americans acquire antibiotic-resistant infections, leading to at least 23,000 related deaths. This growing threat is fueled by antibiotic use in multiple industries from agriculture to health care. One of the most challenging aspects of tackling antimicrobial resistance in health care is driving change within providers’ practice, and a resource that is often forgotten is that of the registered nurse (RN).

In the face of increasing regulatory focus on antimicrobial stewardship (AS), many are looking to ways of enhancing compliance and innovation within their medical facilities. While physicians and pharmacists play a vital role, a new article in the American Journal of Infection Control serves as a reminder of the critical role of RNs.

Pointing to the 2017 joint paper from the American Nurses Association and the CDC, the authors emphasize the role of RNs in hospital antimicrobial resistance practices, but also that of the infection preventionist in providing education to RNs. While RNs play a critical role in patient care, their role in AS needs further development. Therefore, it is important to get a baseline of their knowledge and attitudes towards antimicrobial stewardship, and that’s just where the authors began. To assess the current state of knowledge and attitudes, the investigators of this study surveyed 2000 RNs at 3 hospitals within an integrated healthcare system in Utah.

Within the survey, there were 15 questions focusing on overall knowledge, delivery of antimicrobials, knowledge and attitudes about antimicrobial use, knowledge and attitudes about antimicrobial resistance, and resources and education and about antimicrobials. Within each category, there were several questions — for those on knowledge and attitude about antimicrobial resistance, there were questions asking the nurses to rank their agreement with 9 statements on a Likert-type scale, such as “antimicrobial resistance is a significant problem nationally” and “inappropriate use of antimicrobials causes resistance”. The participants also answered 8 demographic questions in the survey.

The investigators received 343 completed survey responses but excluded 27 that were from RNs who had primary roles that were not at the bedside. According to the investigators, 89% of the respondents were women, with 64% reporting a baccalaureate degree or higher. Further, 52% of the staff RNs were not at all familiar with the term “antimicrobial stewardship” while 27% reported hearing the term but not knowing what it meant.

The authors note “There was no statistical difference in familiarity, overall AS knowledge, and importance of having an AS program by location, education level, or ethnicity (P > .05). There was also no relationship between AS knowledge, age, and years of experience (r = 0.10 and 0.067; P > .05). There was a positive relationship between the familiarity of AS (r = 0.568; P = .000), and importance of having an AS program (r = 0.519; P = .000) with overall knowledge of AS.” When asked about delivery antimicrobials, 87% of respondents reported that they know the reason their patients received the antimicrobial but 15-25% reported questioning why they were being given it.

Regarding antimicrobial resistance, the highest scores in terms of agreement were that “inappropriate use of antimicrobials causes resistance” while the lowest scores in terms of agreement were that “appropriate use of antimicrobials can cause resistance”. The authors found that RNs with a baccalaureate degree or higher agreed more strongly that “prescribing broad-spectrum antimicrobials when equally effective narrower spectrum antimicrobials are available increases resistance”. In regard to resources, respondents found all the options helpful but a majority stated that evaluating antimicrobials after 48 hours of therapy would be a helpful intervention and that there should be pharmacist involvement in AS efforts.

Overall, this study sheds light on not only the enthusiasm RNs have to become engaged in antimicrobial stewardship programs, but that there is a gap in knowledge regarding both the efforts and their potential role in these programs. These findings suggest there is a critical need to focus on education for RNs, especially by infection prevention programs, to help drive change. Nurses have a vital role in patient safety and while traditional efforts might focus on prescribers and pharmacists, this survey and the corresponding analyses suggest we need to invest more in providing education on antimicrobial resistance and stewardship.