GERM Commission attacks antibiotic resistance issue

Local effort supports IC, reduces drug resistance

Despite a series of national warnings and guidelines in the 1990s, increasing resistance to antibiotics among an array of pathogens remains one of the major infection control problems for the future. Among the more recent approaches to the problem are grass-roots efforts that seemingly apply the old axiom of the environmental movement — "think globally, act locally."

For example, a consortium of hospitals and big business in New York City has been formed to draw attention to the problem and stem the tide of resistant pathogens. (See Hospital Infection Control, September 1998, pp. 134-135.) Now physicians in the San Diego County Medical Society have formed a commission called the Group to Eradicate Resistant Microorganisms (GERM). Well aware of the national alarms that have sounded on the issue — and the easy availability of antimicrobials across the Mexican border — the Germ Commission is lobbying hospitals to adopt a strategic plan to prevent, detect, and control antibiotic-resistant microbes, explains Ramon Moncada, MD, GERM Com mission chairman and infectious disease specialist at Coronado (CA) Physicians Medical Center. (See box, at right.)

Teams to monitor antimicrobial use

Moncada and colleagues are hopeful the local emphasis will underscore the importance of the recommendations, which are drawn from guidelines by the Centers for Disease Control and Prevention and other concerned groups. While none of the proposals are new, the commission’s involvement underscores the issue’s importance "at the highest level of the hospital hierarchy," he notes. The GERM Commission recommends that hospitals create multidisciplinary teams — including infection control professionals — to monitor and promote the appropriate use of antimicrobials.

"What we are really asking of them is to support the surveillance efforts of infection control practitioners and infectious disease specialists, and the coordination of services between pharmacy and infection control, microbiology, and the physicians," he tells HIC. "We have had great support so far."

In addition to pledging continued support for infection control programs, efforts to educate patients and the public on the problem of antibiotic resistance can be seen as a hospital’s fulfillment of its mission to improve community health, he adds. In essence, patients represent the "demand side" of the equation and must be brought into any real solution of the problem, he notes. (See excerpt of patient education handout, p. 39.)

"The way I’ve approached this when I speak to hospitals is to [emphasize] that they all have in their mission statement that they are going to do something for the community," Moncada says. "This is the perfect opportunity. Here is something you can do for your community: Teach them how to use antibiotics properly — particularly here in San Diego, where we are so close to the border with Mexico, where there is no restriction on antibiotics."

In that regard, some of the education and outreach program is being done in Spanish, particularly at hospitals near the border, he adds. Overall, the program has been well-received by hospital administrators, in part because the economic as well as the social consequences are emphasized. Indeed, business interests in the aforementioned New York program cited the potential economic toll on the city’s hospital industry as one of the prime motivations for involvement.

"When they realize the emergence of resistant bacteria is a real problem — and an expensive problem — they pay attention," Moncada says. "And now hospitals are health systems that deal with large groups of doctors and HMOs. Everybody is intent on the same thing, which is to save money. What better way to save money than by preventing infections?"