Antibiotics save lives, but at a cost? The medications once considered ‘wonder’ drugs for being able to effectively fight infections, may now be causing them.Hospital-acquired infections are not a new problem. Infections like C. Difficile and antibiotic resistant bacteria present ongoing challenges for hospitalized patients and are directly related to antimicrobial use. Ensuring appropriate and judicious use of antimicrobials is an important tool to fight hospital-acquired infection like C. Difficile. “C. Difficile is a real problem in hospitals today,” Dr. Jeff Powis, Director, Antimicrobial Stewardship Program and Infection Control Officer at TEGH. “It thrives in environments where antibiotic use is high and is difficult to kill with traditional environmental cleaners. What’s interesting about C. Difficile is that for the most part you don’t get it unless you take antibiotics. That means judicious use of antibiotics is key to controlling the spread of this infection in hospitals” During a three-month pilot project in Spring 2010 in the Intensive Care Unit (ICU), a team at Toronto East General Hospital (TEGH) took on the challenge of exploring solutions to prevent hospital-acquired infections and produced encouraging results. The hospital was selected as a pilot site by the Canadian Positive Deviance (PD) Project, an innovative model for inducing institutional change that engages a wide array of hospital staff to come up with solutions to reduce hospital-acquired infections. With PD, the assumption is that front-line staff working directly with patients in the unit are aware of the long-standing issues and are the most likely to have ideas for solving them. Through PD, TEGH helped identify that a reduction in antimicrobial use would be an important strategy to reduce C. Difficile. Known as Antimicrobial Stewardship, the project was developed with a goal to improve the appropriate use of antibiotics by choosing ‘the right drug for the right bug at the right time.’ “Research shows that up to 30 to 50 per cent of antibiotics used in hospitals can be improved upon,” says Powis. “If we don’t start using antimicrobials responsibly, we will have ongoing problems with hospital-acquired C. Difficile and may end up with bacteria so resistant to antibiotics they are essentially untreatable.” C. Difficile is a potentially life threatening infection that affects the colon and can be challenging to treat due to strong antibiotic resistance. “As bacteria get more resistant to antibiotics they become more difficult to treat leading to poor outcomes for patients and high costs to the health-care system,” says Valerie Leung, Pharmacist and PD team member. During the pilot, an antimicrobial stewardship pharmacist and physician reviewed the charts of patients receiving antibiotics and discussed recommendations with the ICU care team to optimize antibiotic utilization. The project’s achievements include a 38.9 per cent reduction in antimicrobial use, a 47 per cent reduction in antimicrobial costs and zero cases of C. Difficile in the ICU during the pilot; where typically they would have seen approximately two cases. “The inclusion of front-line staff in the development of the program was integral to its rapid introduction and successful implementation,” says Powis. TEGH is the first community-based hospital in the Greater Toronto Area and possibly Ontario, to successfully implement a stewardship program on this scale. “I think what we have done is amazing,” says Powis. We have been able to work with the ICU team to optimize antibiotic use. Not only did we save money we improved patient care. “I appreciate this opportunity to be a part of something that is trendsetting and can have an impact on patients. The ability to have front line staff engaged is ideal; more ideas are heard.” says Nicole Gagne, PD core team member. Antimicrobial Stewardship is expanding to other patient-care areas, giving TEGH the potential to dramatically reduce hospital-acquired infections, creating a safer care environment for all.