Pharmacists safeguarding patient health
Most hospital patients come into contact with a pharmacist during their stay. But there is one type of hospital pharmacist working behind the scenes whose role is somewhat mysterious – an Antimicrobial Stewardship Pharmacist.
JCU Pharmacy Alumni and part-time JCU Lecturer, Kerrie Aitken, works at the Townsville University Hospital as an Antimicrobial Stewardship (AMS) advanced pharmacist. She checks that the antibiotics and other antimicrobial drugs used to prevent and treat infections throughout the hospital are administered safely and appropriately.
“We work closely with the hospital ward pharmacists to make sure that whenever antibiotics or other antimicrobials are being prescribed to manage and prevent infections, they are being used for the right reasons and at the right doses, either intravenously or in oral form,” says Kerrie.
“AMS pharmacists also work hand-in-hand with infection prevention and control strategies for antibiotic resistant organisms, which is an increasing risk with real dangers to the patient’s health and to those around them.”
The danger of antibiotic resistance
Antibiotic resistance is increasing globally and is regarded by the World Health Organization (WHO) as one of the greatest threats to human health. According to WHO, close to one million people die every year from bacterial infections that cannot be treated with common antibiotics.
“Because we're not developing new antibiotics as quickly as the resistance is developing, we really need to make sure that we're conserving the antibiotics that we have and are using them appropriately, “says Kerrie.
“The work of an AMS pharmacist is really important, especially considering that Australia is one of the highest users of antibiotics in the developed world. Today we take antibiotics for granted, but it wasn’t all that long ago, before 1941 to be exact, that an infection from even a small cut to the skin could kill.
“Our role is to check that the hospital’s use of antibiotics is appropriate and not increasing the risk of developing antibiotic resistant strains which can then cause havoc with a patient’s recovery and treatment options, including chemotherapy treatment.
"We rely on effective antibiotics to prevent post-operative infections in patients undergoing surgery, and if access to effective antimicrobials were reduced, the risk of post-operative infections could increase significantly.
“It has even been predicted that by 2050, if we don’t act against the growing trends of microbial and antibiotic resistance, then more than 10 million people across the world could die every year because of antibiotic resistant infections, including from HIV and TB infections.”
Infection control and super bugs
Another important aspect to Kerrie’s role is to limit infections in hospitals caused by the dreaded ‘golden staph’ (Staphylococcus Aureus) and its antibiotic resistant ‘super bug’ strain MRSA (Methicillin-Resistant Staphylococcus Aureus).
“A lot of people think of antibiotic or antimicrobial resistance as just affecting an individual who becomes resistant to the antibiotic. But actually, what happens is that the bug or bacteria also has the ability to pass its antibiotic resistance gene to other bacteria. So, there is the added risk that the individual can transfer those resistant genes and resistant bugs to other people around them, including in the hospital setting, and to the community in general.
“This is why it is so important to take antibiotics only when they are needed and to take them as prescribed by a health professional. If antibiotics are used when they’re not needed, or used incorrectly, they can contribute to the development of drug resistant bacteria.”
Australian hospitals setting the standard
In 2011, antimicrobial stewardship was mandated as a National Health Standard by the Australian Commission on Safety and Quality in Health Care and subsequently implemented as part of the Australian hospital accreditation process. As a result, most hospitals around Australia now have dedicated AMS Pharmacist positions, which has made a significant impact on improving appropriate antibiotic use.
“There has been a great increase in the awareness of having to conserve antibiotics,” says Kerrie. “For example, we have increasing restrictions being placed on the use of broad-spectrum antibiotics, with a preference for using antibiotics that are narrower in spectrum but more targeted towards particular bacteria.
“Another success of the AMS Stewardship program in Australia has been the reduced incidence in ‘golden staph’ (Staphylococcus aureus) blood infections in public hospitals and also the reduced incidence of antibiotic resistant strains of the staph bacteria.
“AMS pharmacists are also heavily involved in reporting data to the National Antimicrobial Utilisation Surveillance Program (NAUSP), which is an excellent tool to help hospitals target and monitor their AMS interventions and compare usage against other hospitals.”
“AMS pharmacists work hand-in-hand with infection prevention and control strategies for antibiotic resistant strains, which is an increasing risk with real dangers to the patient’s health and to those around them.”
JCU Lecturer and AMS Pharmacist Kerrie Aitken
Educating and leading change
Kerrie recently completed a Graduate Certificate in Healthcare Leadership to assist with the advocacy and change work that also features in her AMS role.
“A large part of what I do as an AMS pharmacist is to educate and lead change on the use of antibiotics and antimicrobials. I am currently part of the steering committee for the Queensland infection clinician network, which consists of representatives from not only pharmacy, but also medicine, nursing, General Practice and consumers. It covers all infectious diseases and so includes COVID-19 related issues as well.
“I think I have one of those personalities that wants to know how all the pieces of the puzzle fit. I like to understand the ‘why’, rather than just knowing the ‘what’.”